A model of pregnancy outcome in gestational diabetes mellitus: The roles of psychological and behavioral factors

Date of Award




Degree Name

Doctor of Philosophy (Ph.D.)



First Committee Member

Neil Schneiderman - Committee Chair

Second Committee Member

Alan Delamater - Committee Member


Lower income, minority women with gestational diabetes (GDM) were compared to healthy controls on measures of perceived stress, social support, and their relationship with the medical staff. Overall, women with GDM were found to be similar to controls. Although diabetes knowledge was poor, adherence to diet, appointment, and insulin treatment was generally good. However, a subset of women had more problematic adherence. Multiple regression models for women with GDM indicated that several psychosocial and demographic variables significantly predicted adherence levels. Most notably, a more positive relationship with the medical practitioner was related to higher diet and appointment adherence. Models of glycemic control revealed that adherence was a significant predictor of glycemia. The importance of adherence to diet and appointment recommendations differed according to the subject's treatment regimen. Maternal glycemic control was adequate in women on diet intervention, but sub-standard in women on insulin. General measures of infant health indicated positive outcomes, although infants of women on insulin experienced greater fetal overgrowth and higher rates of perinatal morbidity. Finally, maternal glycemic control was a significant predictor of both infant birth weight and morbidity. These findings empirically demonstrate the link between adherence with medical recommendations and maternal glycemic control in minority women with GDM. Because worse glycemic control was associated with poorer infant outcomes, the attainment of euglycemia is of paramount importance in these women. Therefore, interventions to facilitate adherence, and thereby tighter metabolic control, should be implemented in women at high-risk for non-adherence.


Psychology, Behavioral; Health Sciences, Public Health

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