Predictors of Health-Protective Behavior and Glycemia After Gestational Diabetes, NHANES 2007-2014

Diabetes Educ. 2019 Aug;45(4):408-419. doi: 10.1177/0145721719848447. Epub 2019 May 10.


Purpose: This study examined weight loss behavior and the prevalence of hyperglycemia unawareness (unknown high blood glucose) after gestational diabetes mellitus (GDM), within a nationally, representative sample. This study also examined social-demographic, psychosocial, provider communication, and health care access/utilization factors as predictors of A1C and health-protective behavior after GDM.

Methods: A secondary analysis of 2007-2014 National Health and Nutrition Examination Surveys (NHANES) data was conducted, including 205 women, aged 20 to 44 years, with a history of GDM, whose last live birth was in the past 10 years, excluding pregnant women and those with diabetes. Weighted bivariate, stepwise linear, and binary logistic regression analyses were conducted to examine correlates of A1C, weight change, weight loss attempt and behavior, diabetes screening, and physical activity.

Results: Hyperglycemia unawareness was associated with increased A1C and weight gain in the past year. Personal weight loss goal and perception of overweight increased the odds of weight loss attempt. Depressive symptoms were associated with weight gain over the past year. A third of the sample failed to have their glucose tested in the past 3 years. Two-thirds were never told about their personal risk for diabetes, but provider communication increased the odds of meeting weekly activity recommendations and glucose screening. Hispanic women and non-Hispanic black women were less likely to have had glucose screening than non-Hispanic white women.

Conclusion: Diabetes educators should address gaps in provider communication, while supporting psychosocial needs and reducing disparities to encourage health-protective behavior after GDM. The American Association of Diabetes Educators, 7 Self-Care Behaviors (AADE-7TM) provides an excellent framework for interventions to support health-protective behavior after GDM.

MeSH terms

  • Adult
  • Blood Glucose
  • Depression / complications
  • Depression / epidemiology
  • Diabetes Mellitus, Type 2 / etiology*
  • Diabetes Mellitus, Type 2 / psychology
  • Diabetes, Gestational / psychology*
  • Exercise / psychology
  • Female
  • Glycated Hemoglobin / analysis
  • Health Behavior
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Hyperglycemia / epidemiology
  • Hyperglycemia / etiology*
  • Hyperglycemia / psychology
  • Nutrition Surveys
  • Patient Acceptance of Health Care / psychology
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Postpartum Period / psychology
  • Pregnancy
  • Prevalence
  • Risk Factors
  • United States / epidemiology
  • Weight Loss
  • Young Adult


  • Blood Glucose
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human