Objective: This study examines risk perceptions, nutrition practices, and physical activity among ever pregnant South Asian American women, and explores differences by history of GDM, a significant risk factor for the development of type 2 diabetes. Methods: The Diabetes Prevention Study (DPS) recruited a convenience sample of South Asian adults living in the metropolitan Washington DC region. Specific eligibility criteria included English proficiency; having at least one child between the ages of 5 and 15; no current diagnosis of type 2 diabetes mellitus (T2DM); and having a family history of T2DM. The present study utilizes a subset of the DPS dataset and includes 109 ever pregnant women, including 58% with a history of GDM. Results: Mean scores for perceptions of risk showed that both worry and personal control are slightly greater than “neutral” with 3.5 out 5. Therefore, women worry about T2DM yet also perceive personal control for their risk. 40.2% of all respondents use ghee (clarified butter) to cook meals and 41.7% re-use cooking oil. 35% of respondents report no physical activity in an average week. Only 39.8% of women meet the recommended guidelines for adults in the US There are no significant differences between women with or without a history of GDM for nutrition practices and physical activity. Conclusions: This study adds to the literature on GDM and missed opportunities for the prevention of future T2DM.Future research ought to explore knowledge levels on T2DM during and after pregnancy, as well as what types of intervenetions would be effective and acceptable to South Asian women.
Gestational diabetes mellitus (GDM) is defined as a “glucose intolerance with the onset or first recognition of pregnancy” [1,2]. According to the American Diabetes Association (ADA), it affects nearly three to eight percent of all pregnant women [
There are approximately 2.7 million South Asians living in the US comprising of individuals with family origins from Afghanistan, Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka [
A cohort study conducted in Canada by the Ontario Ministry of Health followed over one million women aged 20 - 49 years with in-hospital live births. Study results indicated that the ageadjusted prevalence of GDM was 41% higher among Chinese and 145% higher among South Asians compared to their white counterparts [
Studies reveal that many women with a history of GDM do not only lack the knowledge of diabetes, but more so do not fully understand the relationship between how lifestyle behaviors and developing T2DM [19,22]. Further, theoretical health models suggest that risk perception is a critical determinant of health behavior [
In addition to increased postpartum screening, recommendations have been put forth by the ADA and ACOG on lifestyle modifications for women with a history of GDM [3,4]. Modifications in diet, exercise, and weight reduction and/or maintenance have specifically been shown to decrease the progression of T2DM in several populations including Asians [27,28]. Moreover, although Asian-American women have the highest risk for GDM compared with other racial/ethnic groups, GDM risks and rates vary within Asian subgroups quite significantly, and therefore more attention is needed to fully understand specific populations such as South Asian women [
The Diabetes Prevention Study (DPS) recruited a convenience sample of South Asian adults living in the Washington DC metropolitan region. Specific eligibility criteria included English proficiency; having at least one child between the ages of 5 and 15; no current diagnosis of T2DM; and having a family history of T2DM. For purposes of this study, South Asian is defined as individuals from the following countries: Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka. The present study utilizes a subset of the DPS dataset and includes 109 ever pregnant women, including 58% with a history of GDM.
The research team collaborated with eleven South Asian faith-based and cultural organizations in the Washington DC region for recruitment and data collection. Between July 2011 and March 2012, participants were recruited into the study. Consent was obtained prior to survey administration. To ensure privacy and reduce reporting bias, surveys were administered via individual laptop computers. Study participants completed the survey in English and were given a $25 gift card for their efforts in completing the survey. Upon survey completion, the data were stored in an encrypted file only to be read by the survey design software, SNAP surveys (SNAP Surveys Ltd., 2012).
Recruitment at sites yielded a 92% response rate, and the majority of those who declined to participate stated “not enough time” as the primary reason. People of Indian descent represent 54.7% of the South Asian population in the Washington DC region and therefore the majority of organizations (approximately 90%) in the region are tailored to this community. Significant efforts were made to reach out to all non-Indian focused organizations in the region for data collection, however 87% of participants in the study are of Indian origin.
The survey instrument for the present study gathered information on demographic characteristics, risk perceptions, nutrition practices and physical activity, and took approximately 15 - 20 minutes to complete. Survey questions were adapted from the 2009 National Health and Nutrition Examination Survey (NHANES) [
Demographic characteristics include variables on age, marital status, parity, and country of origin. In addition, immigration status was captured by US born, US citizen, and number of years of living in the US For women with a history of GDM, additional questions were asked including: 1) number of pregnancies diagnosed with GDM, 2) type of treatment (insulin or medication versus none), and 3) whether the GDM pregnancy resulted in a c-section.
Perceptions of risk include two scales measuring “worry” and “personal control”. Both scales are based on reliable and validated measures from E.A. Walker’s 2009 Risk Perception survey [
Several questions from the 2009 NHANES [
A series of questions on physical activity to capture type and amount of time were asked. Participants were asked separately about vigorous and moderate activity for at least 30 minutes continuously, as well as number of days per week. Examples of vigorous activity include running, bicycling, swimming, exercise classes, and basketball. Examples of moderate activity include brisk walking, yoga, and badminton. Participants could report engaging in both vigorous and moderate activity, and the amount of days differed for each. The responses were categorized as follows: No physical activity = no vigorous or moderate activity; Low physical activity = vigorous activity less than 5 days per week only or moderate activity less than 5 days per week only; Medium physical activity = vigorous activity less than 5 days and moderate activity 5 or more days per week or vigorous and moderate activity less than 5 days per week; High physical activity = vigorous and moderate activity 5 or more days per week or vigorous activity 5 or more days per week only. Given that both medium and high levels of physical activity meet the recommended guidelines for physical activity in the US, these two categories were collapsed to provide more meaningful interpretation of the data.
Given the sample size for this study (n = 109), much of the analysis is descriptive and focuses on an overall description of the study population, including overall mean scores for risk perceptions and overall percentages for nutrition and physical activity variables. Some of the variable categories were collapsed to increase the usefulness of the information. Bivariate analysis was conducted to examine any significant differences between women with a history of GDM and those without.
The study sample consists of 109 ever pregnant females with 63 (57.8%) having a history of GDM. As shown in
years and the majority of respondents are currently married (96.3%), have two children (51.4%), and their country of origin is India (86.8%). Only 12.8% of participants were born in the US but 67.9% are US citizens with 89.5% having lived in the US for 11 or more years. Of the 57.8% who have ever been diagnosed with GDM, 71.4% were diagnosed with one pregnancy, 49.7% were treated with either insulin or medication; and 42.6% delivered via cesarean. There are no significant differences by GDM history and demographic characteristics.