This proposal addresses specific intrapersonal and interpersonal (family-level) factors associated with diet quality among women with previous gestational diabetes mellitus (pGDM). A diagnosis of gestational diabetes mellitus (GDM) is a sentinel health event associated with significant modifiable cardiometabolic (CMR) risk factors and a seven-fold elevated risk for Type 2 diabetes mellitus (T2DM). Though the evidence of risk is well-documented, and studies have demonstrated the effectiveness of lifestyle interventions in the prevention of T2DM among women with pGDM, there are no follow-up or clinical practice guidelines regarding risk counseling or dietary management to mitigate T2DM risk after delivery. Many pGDM women do not meet recommendations for a healthy diet as outlined in the Dietary Guidelines for Americans. Furthermore, many pGDM women do not perceive themselves at elevated risk for T2DM, and most are not engaging in any risk reduction behaviors. Supportive social environments are beneficial in promoting dietary change, and the family environment may be critical in specifically supporting healthy dietary behavior changes. Little is known about the family-level influences with diet quality among at-risk adult populations, and no study has examined this in a population of pGDM women.
The specific aims of this project are;1) Examine the relationship between individual perceived beliefs (threat of T2DM, perceived diet benefits, barriers, and self-efficacy) and diet quality, controlling for age, race/ethnicity, knowledge, education and depressive symptoms in pGDM women;2) Determine the contribution of family-level influences (family functioning and family food interaction) to diet quality in pGDM women. A secondary aim will explore the relationship between diet quality and risk status for CMR (>3 risk factors: elevated waist circumference, hypertension, dyslipidemia, hyperglycemia) and T2DM (Hemoglobin A1C >5.7) 1-3 years post-GDM, controlling for physical activity, prepregnancy BMI, breastfeeding duration and age. Descriptive, correlation, and regression analysis will be conducted to address the specific aims of this study. By examining these multi-level factors, especially family influences that contribute to eating behaviors and diet quality among an at-risk population, this study fills a gap in the understanding of modifiable factors that can improve diet quality. Over 200,000 women per year are affected by GDM and the incidence is growing. Therefore, the need to identify effective interventions to mitigate the progression to T2DM is critical. This translational research project will provide the foundation for identifying important intrapersonal and interpersonal factors that influence diet quality among these at-risk women. Findings will guide the development and testing of interventions to improve diet quality, which will not only serve to benefit the individual woman, but will have the potential for improving diet quality for her at-risk offspring and family. The focus of this proposal is in line with the mission of the National Institute of Nursing Research (NINR) to promote and improve the health of individuals, families, communities and populations.

Public Health Relevance

This study will examine the dietary quality, influencing factors, and the cardiometabolic risk status of women with a history of gestational diabetes mellitus within 1-3 years after their first episode. Because women with previous gestational diabetes mellitus are at high risk for developing Type 2 diabetes mellitus (T2DM) and cardiometabolic risk factors, identifying modifiable individual and family level factors associated with diet quality is essential. Data from this study will guide the development and testing of targeted interventions that can improve diet quality within this at-risk population, which may reduce the progression of T2DM and cardiometabolic disease and improve health for women and their families.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Predoctoral Individual National Research Service Award (F31)
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National Institute of Nursing Research Initial Review Group (NRRC)
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Banks, David
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Emory University
Other Health Professions
Schools of Nursing
United States
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Ferranti, Erin Poe; Narayan, K M Venkat; Reilly, Carolyn M et al. (2014) Dietary self-efficacy predicts AHEI diet quality in women with previous gestational diabetes. Diabetes Educ 40:688-99