Exploring physical activity and mental health during pregnancy in women with diabetes.

Pregnancy is a key life transition in which women's mental health and wellbeing are intrinsically linked to their own physical health and that of their baby. Like many life transitions, pregnancy is associated with significant change, complex decisions and increased stress which can impact coping abilities. This vulnerability and substantial psychological burden experienced by expectant mothers is exacerbated in the presence of chronic health conditions.
Diabetes (pre-existing type 1 or type 2, or emergent gestational diabetes) is the most common chronic condition affecting women during pregnancy. In 2021 diabetes affected over 10% of recorded UK.

pregnancies resulting in live births (~65000). However, the overall impact, although difficult to quantify precisely, is substantially greater due to the 3-4 fold increase in risk of miscarriage, congenital malformations and numerous adverse maternal and neonatal outcomes.
Managing diabetes during pregnancy has a profound impact on maternal anxiety and mental health due to heightened risk of pregnancy complications, the challenges of having to control glucose levels even more tightly to mitigate these risks, and the impact of changes to treatment.1,8-10 Given its prevalence and consequences, diabetes in pregnancy is an important driver of mental health inequality, a priority area for action identified by the WHO, ESRC and MRC. Understanding strategies to reduce the mental health burden of diabetes in pregnancy therefore is a priority.
Regular physical activity (PA) during pregnancy improves cardiovascular health, reduces risk of numerous adverse pregnancy and labor outcomes and improves mood and mental health. As such in 2019 the UK Chief Medical Officers published the first PA guidelines for pregnant women, recommending 150 mins of moderate PA per week.14 During pregnancy PA levels decline among women with uncomplicated pregnancy: as few as 10% will be reach recommended activity levels in trimester 3. For women with diabetes, reaching this level of PA is especially difficult. Limited evidence suggests most are very inactive.
Healthcare professionals (HCPs: midwives, doctors, health visitors, community nurses) are key in supporting women with diabetes during pregnancy. The UK Maternity Review envisions effective support during pregnancy based on individual circumstances. However, at present there is no evidence-based guidance to support PA in women with diabetes during pregnancy due to fundamental gaps in our knowledge. At present no one has examined:

1: How PA patterns change over time during pregnancy, and how these changes may be different in women with different diabetes diagnoses and from different backgrounds. Longitudinal changes in PA during pregnancy may be linked to changes in management of diabetes, mood and mental health outcomes.
2: The interaction between lived experiences of women with diabetes during pregnancy, the psychological determinants of PA and perceptions of its potential to improve mental health and wellbeing, and their views regarding what information and support might be most useful.
3: The experiences of HCPs and other stakeholders of supporting women with diabetes during pregnancy, their perceptions of both PA as a potential therapeutic tool and the resources/strategies/materials which could be most useful.

This interdisciplinary PhD project will combine evidence synthesis, epidemiological and psychological research methods to address fundamental knowledge gaps outlined above, and to inform improved support for the mental health of women with diabetes during pregnancy. This will be achieved through consolidation of existing literature and a novel and ambitious mixed-methods longitudinal study