INTRODUCTION:

Gestational Diabetes Mellitus (GDM) is a glucose intolerance disorder diagnosed during pregnancy, usually between 24–28 weeks of gestation¹. Although blood sugar levels often normalize after delivery, women with GDM remain at increased risk of developing Type 2 Diabetes Mellitus (T2DM), with up to 60% converting within a decade^2,3.

Intrauterine exposure to hyperglycemia also predisposes offspring to obesity and impaired glucose tolerance (8). Despite this evidence, postpartum glucose screening is suboptimal, with less than 25% of mothers undergoing recommended follow-up^4–6.

Global findings suggest that nearly 10% of women convert to T2DM immediately after childbirth, with cumulative risk reaching 70% over a decade⁷. Psychological barriers, lack of awareness, and low self-efficacy contribute to poor adoption of preventive behaviors^9,10.

This study aimed to evaluate perceived susceptibility and preventive self-efficacy among postnatal mothers with a history of GDM in Kerala, providing evidence for designing effective postpartum interventions^15,16,20.

METHODOLOGY:

A cross-sectional analytical design was employed to assess perceived susceptibility and preventive self-efficacy regarding Type 2 Diabetes Mellitus (T2DM) among mothers with a history of Gestational Diabetes Mellitus (GDM). The study was conducted in the postnatal wards of a tertiary care hospital in Kerala.

Sample and Sampling:

A total of 160 postnatal mothers with GDM in their most recent pregnancy were recruited through consecutive sampling based on inclusion and exclusion criteria.

· Inclusion criteria: Mothers diagnosed with GDM in the current pregnancy who were willing to participate.

· Exclusion criteria: Mothers unable to comprehend Malayalam.

Sample Size:

The sample size was calculated based on previous prevalence estimates of perceived risk (53%) and self-efficacy (63%), yielding a required sample of 160.

Tools and Instruments:

1. Socio-demographic and clinical proforma – collected background data such as age, education, occupation, income, BMI, family history, and treatment type.

2. Modified Risk Perception Survey for Developing Diabetes (RPS-DD): Adapted and validated for local use, Cronbach’s alpha = 0.70. Scores: ≤57 = poor, 58–75 = average, >75 = good susceptibility.

3. Self-Rated Abilities for Health Practices (SRAHP) Scale: 28 items measuring preventive self-efficacy in health-promoting behaviors. Scores: <37 = poor, 38–75 = moderate, 76–112 = good self-efficacy.

Validity and Reliability:

Content validity was ensured by expert review. A pilot study with 16 participants confirmed feasibility.

Ethical Considerations:

Ethical clearance was obtained from the Institutional Human Ethics Committee. Written informed consent was collected.

Data Collection Procedure:

Data were collected using interviews and self-administered questionnaires over a 6-week period. At the end of data collection, participants received an educational leaflet on T2DM prevention.

Data Analysis:

Data were analyzed using SPSS software:

· Descriptive statistics for socio-demographic and clinical variables.

· Chi-square test to examine associations.

· Pearson’s correlation coefficient to determine the relationship between perceived susceptibility and self-efficacy.

RESULTS:

Section A: Socio-demographic characteristics:

Table 1. Socio-demographic characteristics of mothers with a history of Gestational Diabetes (n=160)

Variables	Frequency	Percentage
Age in years
20–24	69	43.1%
25–29	76	47.5%
>30	15	9.4%
Religion
Hindu	43	26.9%
Muslim	54	33.8%
Christian	63	39.4%
Place of Residence
Panchayath	98	61.3%
Municipality	35	21.9%
Corporation	27	16.9%
Type of family
Nuclear family	116	72.5%
Joint family	42	26.3%
Extended nuclear family	2	1.3%
Education
Upper primary education	2	1.3%
High school	25	15.6%
Higher Secondary	62	38.8%
Degree	63	39.4%
Post Graduation	8	5.0%
Occupation
Government Employee	2	1.3%
Private Sector	34	21.3%
Self-Employee	8	5.0%
Manual Labour	1	0.6%
Unemployed	115	71.9%
Economic status
APL	54	33.8%
BPL	106	66.3%

Table 1 shows that the majority of postnatal mothers were aged 25–29 years (47.5%), with Christians forming the largest religious group (39.4%). Most lived in panchayat areas (61.3%) and nuclear families (72.5%). A significant proportion were graduates (39.4%), the majority were unemployed (71.9%), and two-thirds belonged to the Below Poverty Line category (66.3%).

Section B : Clinical Characteristics:

Table 2. Clinical characteristics of mothers with a history of GDM

(n=160)

Variables	Frequency	Percentage
Comorbidities
Hyperlipidaemia	3	1.9%
Hypertension	8	5.0%
Thyroid disorders	60	37.5%
Nil	89	55.6%
Gestational Age at Diagnosis of GDM
First trimester	41	25.6%
Second trimester	117	73.1%
Third trimester	2	1.3%
Treatment
Oral hypoglycaemic drug	77	48.1%
Insulin	83	51.9%
Gestational Age at Delivery
Preterm	35	21.9%
Term	125	78.1%
Mode of Delivery
Normal delivery	99	61.9%
Caesarean delivery	61	38.1%
BMI Category
Underweight	4	2.5%
Normal weight	65	40.6%
Overweight	63	39.4%
Obese	28	17.5%
Miscarriage
Yes	36	22.5%
No	124	77.5%
PCOD History
Yes	24	15.0%
No	122	76.3%
I don't know	14	8.8%
Birth Weight
Low birth weight	33	20.6%
Normal birth weight	127	79.4%
First Degree Relative with Diabetes
Yes	100	62.5%
No	60	37.5%

Table 2 indicates that more than half of the mothers had no comorbidities (55.6%). Most were diagnosed with GDM in the second trimester (73.1%), and a slightly larger share required insulin therapy (51.9%). Term deliveries were common (78.1%), mostly normal vaginal births (61.9%). Normal BMI was most frequent (40.6%), and nearly two-thirds (62.5%) had a first-degree relative with diabetes.

Section C: Perceived susceptibility toward T2DM:

Table 3. Perceived susceptibility toward T2DM among mothers after GDM (n=160)

Perceived Risk Level	f	%
Good	13	8.1%
Average	91	56.9%
Poor	56	35.0%

Table 3 demonstrates that 56.9% of the mothers had an average level of perceived susceptibility toward T2DM, while 35% had poor susceptibility and only 8.1% showed good susceptibility.

Section D: Preventive Self-efficacy toward Type 2 DM:

Table 4. Preventive self-efficacy regarding T2DM among mothers after GDM (n=160)

Self-efficacy	f	%
Poor	33	20.6 %
Moderate	69	43.1 %
Good	58	36.3 %

Table 4 reveals that 43.1% of participants exhibited moderate self-efficacy in preventing T2DM, 36.3% showed good self-efficacy, and 20.6% reported poor self-efficacy.

Section E; Mean scores of susceptibility and Self-efficacy

Table 5. Mean and SD of perceived susceptibility and preventive self-efficacy scores (n=160)

Variable	N	Mean	Standard Deviation (SD)
Perceived Risk Score	160	60.9	11.7
Self-Efficacy Score	160	65.5	23.0

Table 5 presents the mean perceived susceptibility score (60.9±11.7) and the mean preventive self-efficacy score (65.5±23.0), indicating moderate levels for both, with greater variability in self-efficacy.

Table 7 highlights that perceived susceptibility was significantly associated with educational level, occupation, socioeconomic status, BMI, treatment type, and family history of diabetes (p<0.01)

Section F; Association with socio-demographic and clinical variables

Table 7. Association between perceived susceptibility and socio-personal/clinical variables (n=160)

Variables	Category	Poor (%)	Average (%)	Good (%)	Chi-Square (χ²)	df	p-value	Significance
Educational Status	Below High School	27.5	8.04	24.24	0.058	4	< 0.001	***
	Higher Secondary	50	29.88	33.33
	Graduate and Above	22.5	62.06	42.42
Occupation	Employed	17.85	36.04	32.5	0.035	2	0.002	***
	Unemployed	82.14	63.9	67.5
Economic Status	APL	16.1	41.8	53.8	12.79	2	0.002	***
	BPL	83.9	58.2	46.2
BMI	Normal/Underweight	37	66	47	0.91	2	0.004	***
	Overweight/Obese	63	34	53
Anti-diabetic Treatment	Oral Hypoglycaemic Drugs	28.6	80	67.0	1.068	2	< 0.001	***
	Insulin	71.4	20	33.0
Family History of Diabetes	Yes	29	63.7	63.0	12.644	2	0.002	***
	No	71	36.3	37.14

Table 8. Association between preventive self-efficacy and socio-personal/clinical variables (n=160)

Variables	Category	Poor (f%)	Moderate (f%)	Good (f%)	χ²	df	p-value	Significance
Age	20–24	16 (48.5%)	32 (46.4%)	21 (36.2%)	16.2	4	0.003	***
	25–29	9 (27.3%)	32 (46.4%)	35 (60.3%)
	>30	8 (24.2%)	5 (7.2%)	2 (3.4%)
Educational Status	Below High School	5 (22.72%)	12 (15.18%)	5 (8.47%)	0.033	4	<0.001	***
	Higher Secondary	10 (45.45%)	39 (49.36%)	11 (18.64%)
	Graduate and Above	7 (32.1%)	28 (35.44%)	43 (72.88%)
Occupation	Employed	9 (23.70%)	21 (30.90%)	30 (55.6%)	0.05	2	0.002	***
	Unemployed	29 (76.3%)	47 (69.10%)	24 (44.41%)
Economic Status	APL	6 (18.2%)	15 (21.7%)	33 (56.9%)	21.93	2	<0.001	***
	BPL	27 (81.8%)	54 (78.3%)	25 (43.1%)
BMI	Normal/Underweight	10 (30%)	30 (43.5%)	39 (67%)	0.02	2	<0.001	***
	Overweight/Obese	23 (70%)	39 (56.4%)	19 (33%)
Comorbidities	Lifestyle Disorders	6 (18.8%)	3 (4.3%)	2 (3.4%)	16.1	4	0.03	*
	Thyroid Disorders	9 (28.1%)	20 (29%)	30 (51.7%)
	Nil	17 (53.1%)	46 (66.7%)	26 (44.8%)
Treatment	Oral Hypoglycemic Drug	10 (67%)	40 (80%)	55 (58%)	0.54	2	0.003	***
	Insulin	5 (33%)	10 (20%)	40 (42%)
Family History	Yes	8 (29%)	60 (64.5%)	20 (60.6%)	3.28	2	0.002	***
	No	20 (71%)	33 (35.5%)	13 (39.4%)

Table 8 illustrates that preventive self-efficacy showed significant associations with age, education, occupation, economic status, BMI, comorbidities, treatment during pregnancy, and family history of diabetes (p < 0.05).

Section G: Correlation between perceived susceptibility and self-efficacy.

Figure 1. Correlation between perceived susceptibility and preventive self-efficacy toward Type 2 Diabetes among mothers after Gestational Diabetes. (n=160)

A strong positive correlation (r = 0.870, p = 0.01) was observed between perceived susceptibility and preventive self-efficacy.

DISCUSSION:

This study assessed perceived susceptibility and preventive self-efficacy toward Type 2 Diabetes Mellitus (T2DM) among mothers with a history of Gestational Diabetes Mellitus (GDM). More than half of the participants demonstrated average perceived susceptibility, while nearly half showed moderate preventive self-efficacy.

These findings are consistent with previous studies from India and abroad, which revealed that postnatal mothers often underestimate their risk despite being at high risk of developing T2DM^12–15. A study from Kochi, Kerala, also found that most postnatal women with GDM history had only moderate levels of self-efficacy¹⁵. Similarly, Iranian and Chinese studies confirmed that lack of awareness contributes to poor adoption of preventive practices^16,20.

The present study found significant associations between susceptibility/self-efficacy and education, occupation, BMI, economic status, type of treatment, and family history of diabetes. These findings are in agreement with research conducted in Australia and the US, which showed that higher education and awareness increased preventive health behaviors^17,18.

The strong positive correlation between perceived susceptibility and preventive self-efficacy observed here (r = 0.870, p = 0.01) suggests that women who recognize their risk are more confident in adopting lifestyle modifications. This finding echoes results from China²⁰, emphasizing the need for structured postpartum education and empowerment programs to improve awareness and motivation simultaneously.

CONCLUSION:

The study concludes that:

· More than half of mothers with GDM had average perceived susceptibility, and nearly half reported moderate preventive self-efficacy toward T2DM.

· Both constructs were significantly influenced by education, occupation, BMI, economic status, treatment type, and family history of diabetes.

· A strong positive correlation was established between perceived susceptibility and preventive self-efficacy, highlighting the need for interventions that address both awareness and confidence.

IMPLICATIONS FOR NURSING PRACTICE:

Nurses and midwives must take a proactive role in postpartum care by reinforcing the long-term risks of T2DM and strengthening women’s self-efficacy through education, counseling, and lifestyle modification programs.

CONFLICT OF INTEREST:

The authors declare no conflict of interest.

FUNDING:

This research received no external funding.

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Received on 06.08.2025 Revised on 26.08.2025

Accepted on 13.09.2025 Published on 31.10.2025

Available online from November 10, 2025

Int. J. of Advances in Nursing Management. 2025;13(4):257-261.

DOI: 10.52711/2454-2652.2025.00047

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