Ethnic Differences in Dietary Management of Gestational Diabetes Mellitus: A Mixed Methods Study Comparing Ethnic Chinese Immigrants and Australian Women

Background: Dietary modification is the primary intervention strategy for management of gestational diabetes mellitus (GDM), which usually occurs in the third trimester of pregnancy when women have extra nutritional needs. There is a high migration rate of ethnic Chinese people to Western countries, and those women present a high-risk group for GDM. Little is known about diet, dietary self-management, and nutritional supplementation use among ethnic Chinese migrant women with GDM compared with members of the host population with GDM. Objective: This study aimed to compare the perceptions and experiences of dietary self-management and nutritional needs of ethnic Chinese migrants with those of Australian-born white women with GDM in Australia. Design: A predominantly qualitative mixed methods approach with a quantitative component was used. Data collection involved in-depth, semistructured interviews, and 3-day 24-hour recall diaries collected concurrently. Data analysis and management relied on NVivo (QSR International Pty Ltd), FoodWorks (FoodWorks Professional 2017, Xyris Software), and SPSS (SPSS Inc). Pearson χ² test, independent-samples t test, and Mann-Whitney U test were used to compare nutrient intakes between groups. The Pearson correlation was used to determine the relationship between dietary patterns and nutrient intake. Participants: A total of 44 ethnic Chinese and 39 Australian-born white participants with GDM were recruited from two large Australian maternity services located in tertiary hospitals. Results: Ethnic differences in satisfaction with GDM education influenced GDM self-management. Ethnic Chinese women with GDM perceived dietary advice received from health professionals to be lacking in cultural relevance and detail and responded by restricting their dietary intake and relying on nutritional supplementation. The perceived benefits of specific supplements produced ethnic differences in the patterns of supplement use. Cultural dietary patterns influenced dietary adequacy in pregnancy. Conclusions: This study suggests the need for provision of more concrete, prescriptive, and culturally relevant dietary and supplementation advice for ethnic Chinese women with GDM.