{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T13:17:26Z","timestamp":1788182246362,"version":"build-2803163510"},"reference-count":60,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R01HD108194"],"award-info":[{"award-number":["R01HD108194"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pregnancy"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore barriers and facilitators to gestational diabetes mellitus (GDM) self\u2010management\u00a0and\u00a0insulin\u00a0use, aiming to inform future interventions, in a diverse population of pregnant people.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>In this ancillary study of an ongoing randomized controlled trial testing thresholds for\u00a0insulin\u00a0initiation for GDM, participants in the parent trial were recruited from February 2023 to January 2024. Purposive sampling was used to recruit diverse participants with respect to age, race, ethnicity, insurance status, parity, and\u00a0insulin\u00a0use. In\u2010depth semi\u2010structured interviews were conducted after 34 weeks\u2019 gestation. Interview guides addressed topics related to pregnancy with GDM; this analysis focused on experiences with\u00a0insulin and adherence to their treatment plan. Transcripts were analyzed using a reflexive thematic analysis approach to develop themes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 20 participants, 80% had GDM for the first time and 50% required\u00a0insulin\u00a0treatment. Analysis identified key barriers and facilitators to treatment plan adherence. Barriers included: (1) fear of\u00a0insulin\u00a0(\u201cWhen I was first told about it, I threw a tantrum\u2026 I do not like needles, and that's all I could think about.\u201d), (2) the time and cognitive effort to learn self\u2010management, (3) managing emotions related to GDM diagnosis and self\u2010management with insulin, and both (4) jobs and (5) family\/friends unawareness made it difficult to manage GDM as recommended. Facilitators included (1) training from the medical team (\u201conce I saw my\u00a0insulin\u00a0pen, it wasn't that bad.\u201d), (2) support from family\/friends, and (3) concern for the well\u2010being of the fetus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Self\u2010management\u00a0of GDM requires substantial social and institutional support, learning, and adjusting to a new lifestyle in a short period of time. For some, the recommendation to use\u00a0insulin\u00a0caused a strong negative reaction, but hands\u2010on education provided by the medical team helped to alleviate fear and other barriers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pmf2.70232","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T08:33:03Z","timestamp":1768552383000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Barriers and facilitators to insulin management in pregnant people with gestational diabetes mellitus: A qualitative study"],"prefix":"10.1002","volume":"2","author":[{"given":"Idayat","family":"Akinola","sequence":"first","affiliation":[{"name":"Department of Medicine Division of Hematology and Oncology Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn E.","family":"Flynn","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Hematology and Oncology Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6274-0544","authenticated-orcid":false,"given":"Lynn M.","family":"Yee","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Division of Maternal\u2010Fetal Medicine Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5508-5326","authenticated-orcid":false,"given":"Eleanor","family":"Saffian","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Division of Maternal\u2010Fetal Medicine Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaira","family":"Peterson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Division of Maternal\u2010Fetal Medicine Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6568-0201","authenticated-orcid":false,"given":"Anna","family":"Palatnik","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Division of Maternal\u2010Fetal Medicine Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2018.02.023"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms19113342"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.868094"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2021.04.263"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc07\u2010s206"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc08\u20101038"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-159-2-201307160-00661"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa0902430"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.11.039"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1479\u2010828x.2006.00676.x"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.25.10.1862"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2004\u20101808"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2009\u20100305"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jand.2018.03.014"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jada.2006.06.009"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/aog.0000000000002501"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa042973"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc11\u20101687"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu12103050"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1080\/14656566.2018.1509955"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40265\u2010017\u20100807\u20100"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326\u20105377.1998.tb140192.x"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc17\u2010s016"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.cd009275.pub3"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc09\u20100007"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884\u2010020\u20102745\u20101"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1080\/16549716.2022.2087298"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2024.104141"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10995\u2010017\u20102261\u20108"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102393\u201012\u201099"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.2337\/ds19\u20100044"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.2196\/17794"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2023.107237"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1177\/16094069241296206"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.4300\/jgme\u2010d\u201015\u201000414.1"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1177\/1362361318823902"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1080\/2159676X.2019.1628806"},{"key":"e_1_2_9_40_1","volume-title":"The Coding Manual for Qualitative Researchers","author":"Salda\u00f1a J.","year":"2021"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1177\/1525822X980100020301"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcjd.2014.09.005"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000035831"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1590\/s0100\u201072032013000300004"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wombi.2018.03.001"},{"key":"e_1_2_9_46_1","unstructured":"ACOG. 2018.Employment Considerations during Pregnancy and the Postpartum Period. The American College of Obstetrics and Gynecology. (https:\/\/www.acog.org\/clinical\/clinical\u2010guidance\/committee\u2010opinion\/articles\/2018\/04\/employment\u2010considerations\u2010during\u2010pregnancy\u2010and\u2010the\u2010postpartum\u2010period)."},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijcp.12691"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2023.108596"},{"key":"e_1_2_9_49_1","doi-asserted-by":"publisher","DOI":"10.2337\/dci20\u20100023"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.13196"},{"key":"e_1_2_9_51_1","doi-asserted-by":"publisher","DOI":"10.1185\/03007995.2011.621416"},{"key":"e_1_2_9_52_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.13132"},{"key":"e_1_2_9_53_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0217771"},{"key":"e_1_2_9_54_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc25\u2010S009"},{"key":"e_1_2_9_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.srhc.2016.11.003"},{"key":"e_1_2_9_56_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884\u2010018\u20101657\u20109"},{"key":"e_1_2_9_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2012.05.013"},{"key":"e_1_2_9_58_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471\u20106712.2009.00735.x"},{"key":"e_1_2_9_59_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049732304270825"},{"key":"e_1_2_9_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tjog.2019.01.005"},{"key":"e_1_2_9_61_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102393\u201014\u201041"}],"container-title":["Pregnancy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pmf2.70232","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pmf2.70232","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pmf2.70232","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T12:27:01Z","timestamp":1788179221000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/pmf2.70232"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":60,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1002\/pmf2.70232"],"URL":"https:\/\/doi.org\/10.1002\/pmf2.70232","archive":["Portico"],"relation":{},"ISSN":["2997-9684","2997-9684"],"issn-type":[{"value":"2997-9684","type":"print"},{"value":"2997-9684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-07-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70232"}}