Background: Gestational diabetes confers a 3-7 fold higher risk of incident diabetes. However, studies show women with GDM underestimate their personal risk, even when they understand GDM is a risk factor for incident T2DM. The study objectives were to identify predictors of T2DM risk perception in women with GDM and to determine if their level of risk perception impacts adoption of evidence-based health behaviors for T2DM prevention.

Methods: Using electronic health records to identify eligible women between 18-50 years old, we surveyed women with a history of GDM who had not progressed to T2DM.

Results: The study sample (n=264) was racially and ethnically diverse; 37% Hispanic, 29% Asian, 27% non-Hispanic white, and 5% black. About one in five (21%) women were unaware that GDM increases the risk of incident T2DM after pregnancy; almost half (48%) believed their personal risk of T2DM was low. In multivariate analyses adjusting for race, ethnicity, education level, time since index GDM pregnancy, and agreement with GDM diagnosis, family history of T2DM (OR 2.1, 95% CI 1.1-4.0) and knowledge of GDM increasing risk of T2DM (OR 4.5, 95% CI 2.1-9.7) were independent predictors of higher risk perception of T2DM. Higher risk perception was associated with both a higher level of interest in taking metformin (unadjusted OR 2.2, 95% CI 1.1-4.1) and a higher level of interest in attending a National Diabetes Prevention Program (unadjusted OR 2.3, 95% CI 1.3-3.9) compared to women with lower risk perception.

Conclusion: Educating women with a history of GDM about their increased risk of T2DM is important; our study underscores the need to identify ways to effectively convey personal risk of T2DM. Family history of T2DM, which is strongly associated with personal risk perception, may be a key area for discussion with women with GDM to positively impact the adoption of T2DM preventive strategies; this may be relevant for all patients with higher risk of progression to T2DM.


A.V. Vu: None. N. Turk: None. O. Duru: None. C. Mangione: None. H. Panchal: None. S.A. Amaya: None. K.C. Norris: None. T. Moin: None.


National Institutes of Health (5R18DK105464)

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