Type 2 Diabetes Risk Perception and Health Behaviors Among Women with History of Gestational Diabetes Mellitus: A Retrospective Analysis.

Background/Objectives: History of gestational diabetes mellitus (GDM) is a strong risk factor in the development of type 2 diabetes (T2D). We sought to examine the association between perceived risk of developing T2D and relevant health behaviors in this population. Methods: We analyzed self-reported survey items and objective electronic health record data of participants in the Gestational diabetes Risk Attenuation for New Diabetes (GRAND) Study, a multisite randomized control trial testing the effectiveness of shared decision-making for women with elevated body mass index (BMI), prediabetes and history of GDM. Data on demographics, health behaviors, and perceived T2D risk were self-reported. We ran four regression models to study the association between women's perceived risk of developing T2D and four key health behaviors: (1) physical activity, (2) consumption of sugar-sweetened beverages, (3) consumption of ultra-processed foods, and (4) consumption of meals prepared outside the home. All models were adjusted for age, race, ethnicity, income, HbA1c, BMI, family history of T2D, and study arm. Results: Our sample included 242 women who on average were 41 years old (±6 years) with BMI of 32.7 (±6.9 kg/m2). Perceived risk of developing T2D was not significantly associated with physical activity, consumption of sugar-sweetened beverages, ultra-processed food consumption, or meals prepared outside of the home. Higher BMI was significantly associated with increased consumption of sugar-sweetened beverages (OR 1.05, 95% CI 1.01-1.10), but not other health behaviors. Conclusions: We found perceived risk of developing T2D was not independently associated with four key health behaviors. Women with GDM are at high risk of developing T2D and may benefit from tailored or more intensive strategies promoting health behavior changes shown to lower T2D risk.