{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T14:14:20Z","timestamp":1788444860355,"version":"build-2803163510"},"reference-count":45,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"unspecified","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000269","name":"Economic and Social Research Council","doi-asserted-by":"publisher","award":["69467"],"award-info":[{"award-number":["69467"]}],"id":[{"id":"10.13039\/501100000269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,5,15]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Pregnancy in women with pre-existing type 1 or type 2 diabetes (T1D, T2D) is associated with increased risk of complications, largely driven by maternal glucose control. Hormonal changes during pregnancy make glucose management more challenging. Physical activity (PA) may improve glucose control and reduce complications; however, little is known about PA patterns in this population and no pregnancy-specific PA guidance exists for women with pre-existing diabetes. Understanding the behaviours and experiences of both pregnant women and the healthcare professionals (HCPs) who support them is needed to inform evidence-based guidance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This mixed-methods study comprises three sub-studies. The first will recruit 175 pregnant women (75 with T1D and 100 with T2D) who will complete three 7-day monitoring periods, one per trimester. PA will be assessed using wrist-worn accelerometers and exercise diaries, dietary intake via remote food photography, and corresponding continuous glucose monitor and diabetes-related well-being data will be collected.<\/jats:p>\n                    <jats:p>The second involves a subsample of ~16 women participating in focus groups to explore experiences of being physically active during pregnancy.<\/jats:p>\n                    <jats:p>The third invites ~100 HCPs involved in diabetes in pregnancy care to complete an online survey, ~10 HCPS will take part in an optional interview about their experiences of providing PA guidance.<\/jats:p>\n                    <jats:p>The primary outcome is the change in PA across pregnancy. Secondary outcomes include associations between PA, glucose metrics, diet and diabetes-related well-being, and qualitative themes relating to experiences of women and HCP. Quantitative data will be analysed using multilevel modelling and regression analysis, and qualitative data using reflexive thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval was granted by the East Midlands Nottingham 1 Research Ethics Committee (25\/EM\/0190) and University of Exeter Public Health and Sport Sciences ethics committee. Findings will be disseminated through peer-reviewed publications and conference presentations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-118879","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T11:10:49Z","timestamp":1781089849000},"page":"e118879","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["A mixed-methods longitudinal observational study exploring physical activity during pregnancy in women with pre-existing diabetes, support needs and associations with diabetes management: a study protocol"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-0806-5671","authenticated-orcid":false,"given":"Holly Mei","family":"Jones","sequence":"first","affiliation":[{"name":"Public Health and Sport Sciences, University of Exeter, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Andrews","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Taunton and Somerset Hospital, Taunton, UK"},{"name":"NIHR Exeter, Biomedical Research Centre, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma J","family":"Cockcroft","sequence":"additional","affiliation":[{"name":"Health and Community Sciences, University of Exeter, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isy F","family":"Douek","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Taunton and Somerset Hospital, Taunton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard M","family":"Pulsford","sequence":"additional","affiliation":[{"name":"Public Health and Sport Sciences, University of Exeter, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"2026090306265071000_16.6.e118879.1","doi-asserted-by":"crossref","unstructured":"Atkinson L , Psychological TM . Social and Behavioural Changes During Pregnancy: Implications for Physical Activity and Exercise. Exercise and Physical Activity During Pregnancy and Postpartum 2022;21\u201345. doi:10.1007\/978-3-031-06137-0_2","DOI":"10.1007\/978-3-031-06137-0_2"},{"key":"2026090306265071000_16.6.e118879.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61276-9"},{"key":"2026090306265071000_16.6.e118879.3","doi-asserted-by":"crossref","DOI":"10.3389\/fphar.2014.00065","article-title":"Physiologic and pharmacokinetic changes in pregnancy","volume":"5","author":"Costantine","year":"2014","journal-title":"Front Pharmacol"},{"key":"2026090306265071000_16.6.e118879.4","unstructured":"Diabetes profile: statistical commentary, March 2025. Available: https:\/\/www.gov.uk\/government\/statistics\/diabetes-profile-update-march-2025\/diabetes-profile-statistical-commentary-march-2025 [Accessed 23 Oct 2025]."},{"key":"2026090306265071000_16.6.e118879.5","unstructured":"National pregnancy in diabetes audit 2021 and 2022. England and Wales, 2021. Available: https:\/\/digital.nhs.uk\/data-and-information\/publications\/statistical\/national-pregnancy-in-diabetes-audit\/2022"},{"key":"2026090306265071000_16.6.e118879.6","unstructured":"National pregnancy in diabetes audit dashboard 2024. 2025. Available: https:\/\/digital.nhs.uk\/data-and-information\/publications\/statistical\/national-pregnancy-in-diabetes-audit\/2024 [Accessed 2 Feb 2026]."},{"key":"2026090306265071000_16.6.e118879.7","doi-asserted-by":"crossref","first-page":"2029","DOI":"10.1111\/jog.16091","article-title":"Association between diabetes mellitus and miscarriage, recurrent miscarriage: A meta-study","volume":"50","author":"Miao","year":"2024","journal-title":"J Obstet Gynaecol Res"},{"key":"2026090306265071000_16.6.e118879.8","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1111\/dme.13579","article-title":"Pregnancy in Diabetes: challenges and opportunities for improving pregnancy outcomes","volume":"35","author":"Murphy","year":"2018","journal-title":"Diabet Med"},{"key":"2026090306265071000_16.6.e118879.9","doi-asserted-by":"crossref","unstructured":"Macintosh MCM , Fleming KM , Bailey JA , et al . Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study. 2006;333:177. doi:10.1136\/bmj.38856.692986.AE","DOI":"10.1136\/bmj.38856.692986.AE"},{"key":"2026090306265071000_16.6.e118879.10","doi-asserted-by":"publisher","DOI":"10.2337\/dc09-1118"},{"key":"2026090306265071000_16.6.e118879.11","unstructured":"NCC-wch diabetes in pregnancy. NICE guideline NG3; 2015."},{"key":"2026090306265071000_16.6.e118879.12","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1111\/ajo.12446","article-title":"Effect of pregnancy on insulin requirements differs between type 1 and type 2 diabetes: A cohort study of 222 pregnancies","volume":"56","author":"Padmanabhan","year":"2016","journal-title":"Aust N Z J Obstet Gynaecol"},{"key":"2026090306265071000_16.6.e118879.13","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-009-1633-z"},{"key":"2026090306265071000_16.6.e118879.14","doi-asserted-by":"publisher","DOI":"10.1186\/1758-5996-4-41"},{"key":"2026090306265071000_16.6.e118879.15","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph13080836","article-title":"Well-Being and Diabetes Management in Early Pregnant Women with Type 1 Diabetes Mellitus","volume":"13","author":"Linden","year":"2016","journal-title":"Int J Environ Res Public Health"},{"key":"2026090306265071000_16.6.e118879.16","doi-asserted-by":"publisher","DOI":"10.2337\/ds18-0035"},{"key":"2026090306265071000_16.6.e118879.17","doi-asserted-by":"crossref","first-page":"39","DOI":"10.3109\/01674820009075607","article-title":"Pregnancy and diabetes - a hermeneutic phenomenological study of women\u2019s experiences","volume":"21","author":"Berg","year":"2000","journal-title":"Journal of Psychosomatic Obstetrics & Gynecology"},{"key":"2026090306265071000_16.6.e118879.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsams.2022.03.008"},{"key":"2026090306265071000_16.6.e118879.19","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-011-2403-2"},{"key":"2026090306265071000_16.6.e118879.20","doi-asserted-by":"crossref","DOI":"10.3389\/fendo.2020.00486","article-title":"The Impact of Physical Activity on Glycemic Variability Assessed by Continuous Glucose Monitoring in Patients With Type 2 Diabetes Mellitus: A Systematic Review","volume":"11","author":"Bennetsen","year":"2020","journal-title":"Front Endocrinol (Lausanne)"},{"key":"2026090306265071000_16.6.e118879.21","doi-asserted-by":"publisher","DOI":"10.1111\/dme.12438"},{"key":"2026090306265071000_16.6.e118879.22","doi-asserted-by":"crossref","DOI":"10.5888\/pcd17.190366","article-title":"Physical Activity Before and During Pregnancy, Colorado Pregnancy Risk Assessment Monitoring System, 2012-2015","volume":"17","author":"Ussery","year":"2020","journal-title":"Prev Chronic Dis"},{"key":"2026090306265071000_16.6.e118879.23","doi-asserted-by":"crossref","first-page":"2420","DOI":"10.1007\/s00125-024-06259-5","article-title":"Dietary patterns during pregnancy and maternal and birth outcomes in women with type 1 diabetes: the Environmental Determinants of Islet Autoimmunity (ENDIA) study","volume":"67","author":"Thomson","year":"2024","journal-title":"Diabetologia"},{"key":"2026090306265071000_16.6.e118879.24","doi-asserted-by":"crossref","first-page":"182","DOI":"10.2337\/ds22-0046","article-title":"Trends and Self-Management Predictors of Glycemic Control During Pregnancy in Women With Preexisting Type 1 or Type 2 Diabetes: A Cohort Study","volume":"36","author":"Sushko","year":"2023","journal-title":"Diabetes Spectr"},{"key":"2026090306265071000_16.6.e118879.25","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1007\/s00592-019-01459-7","article-title":"Physical activity, sedentary behavior and development of preeclampsia in women with preexisting diabetes","volume":"57","author":"Do","year":"2020","journal-title":"Acta Diabetol"},{"key":"2026090306265071000_16.6.e118879.26","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e3182a0595f"},{"key":"2026090306265071000_16.6.e118879.27","doi-asserted-by":"publisher","DOI":"10.2337\/dc12-1567"},{"key":"2026090306265071000_16.6.e118879.28","doi-asserted-by":"crossref","DOI":"10.2196\/18915","article-title":"Feasibility and Acceptability of a Counseling- and mHealth-Based Physical Activity Intervention for Pregnant Women With Diabetes: The Fit for Two Pilot Study","volume":"8","author":"Larsen","year":"2020","journal-title":"JMIR Mhealth Uhealth"},{"key":"2026090306265071000_16.6.e118879.29","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1111\/jog.14164","article-title":"Quantitative analysis of exercise among pregnant women with impaired glucose tolerance using pedometer data: An observational study","volume":"46","author":"Ueno","year":"2020","journal-title":"J Obstet Gynaecol Res"},{"key":"2026090306265071000_16.6.e118879.30","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-015-0360-1","article-title":"Socio-cultural influences on the behaviour of South Asian women with diabetes in pregnancy: qualitative study using a multi-level theoretical approach","volume":"13","author":"Greenhalgh","year":"2015","journal-title":"BMC Med"},{"key":"2026090306265071000_16.6.e118879.31","doi-asserted-by":"publisher","DOI":"10.1089\/jwh.2010.2676"},{"key":"2026090306265071000_16.6.e118879.32","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.pmedr.2018.04.012","article-title":"Physical activity and sedentary behavior during pregnancy and postpartum, measured using hip and wrist-worn accelerometers","volume":"10","author":"Hesketh","year":"2018","journal-title":"Prev Med Rep"},{"key":"2026090306265071000_16.6.e118879.33","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-015-0479-2","article-title":"Change in level of physical activity during pregnancy in obese women: findings from the UPBEAT pilot trial","volume":"15","author":"Hayes","year":"2015","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026090306265071000_16.6.e118879.34","doi-asserted-by":"publisher","DOI":"10.3758\/BRM.41.4.1149"},{"key":"2026090306265071000_16.6.e118879.35","doi-asserted-by":"crossref","DOI":"10.1186\/s12874-018-0594-7","article-title":"Characterising and justifying sample size sufficiency in interview-based studies: systematic analysis of qualitative health research over a 15-year period","volume":"18","author":"Vasileiou","year":"2018","journal-title":"BMC Med Res Methodol"},{"key":"2026090306265071000_16.6.e118879.36","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2018.07.001"},{"key":"2026090306265071000_16.6.e118879.37","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39335.541782.AD"},{"key":"2026090306265071000_16.6.e118879.38","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"2026090306265071000_16.6.e118879.39","doi-asserted-by":"publisher","DOI":"10.1123\/JMPB.2018-0063"},{"key":"2026090306265071000_16.6.e118879.40","doi-asserted-by":"publisher","DOI":"10.1017\/S0007114508027438"},{"key":"2026090306265071000_16.6.e118879.41","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1177\/19322968241274322","article-title":"A User-Friendly Web Tool for Custom Analysis of Continuous Glucose Monitoring Data","volume":"18","author":"Russon","year":"2024","journal-title":"J Diabetes Sci Technol"},{"key":"2026090306265071000_16.6.e118879.42","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.18.6.754"},{"key":"2026090306265071000_16.6.e118879.43","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1007\/s42532-025-00227-y","article-title":"SeCOM-B: an integrated model for understanding human behaviour change in wicked socio-ecological problems","volume":"7","author":"Nguyen-Trung","year":"2025","journal-title":"Socio Ecol Pract Res"},{"key":"2026090306265071000_16.6.e118879.44","doi-asserted-by":"crossref","DOI":"10.1038\/s43856-025-01159-0","article-title":"DietAI24 as a framework for comprehensive nutrition estimation using multimodal large language models","volume":"5","author":"Yan","year":"2025","journal-title":"Commun Med (Lond)"},{"key":"2026090306265071000_16.6.e118879.45","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-118879","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T13:28:12Z","timestamp":1788442092000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-118879"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":45,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,10]]},"published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1136\/bmjopen-2026-118879"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-118879","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]}}}