Journal of Community Health

, Volume 42, Issue 3, pp 500–510 | Cite as

The Impact of Health Education Intervention for Prevention and Early Detection of Type 2 Diabetes in Women with Gestational Diabetes

  • Mirella Youssef Tawfik
Original Paper


This study aims to investigate the impact of a health belief model (HBM)-based educational intervention on knowledge, beliefs, self-reported practices, gestational and postpartum weight in women with gestational diabetes mellitus (GDM). Subjects and Methods: A cluster randomized controlled trial was performed, with randomization at the level of Primary Health Care centers in three Egyptian cities. Eligible women with GDM were enrolled at 24 weeks pregnancy. The intervention group (n = 103) received health education intervention based on the HBM construct. Control subjects (n = 98) received the usual care. The outcomes measured were: women’s knowledge, beliefs, self-reported practices, gestational weight gain (GWG), and postpartum weight retention. Patients were investigated at baseline, at end of pregnancy, and at 6 weeks postpartum. Results: After the intervention, percentages of women who had high knowledge and beliefs scores had significantly increased from less than 50 % to more than 70 % in the intervention group (p < 0.001). More women in the intervention group reported practicing exclusive breast feeding (85.4 %) and screening for T2DM (43.7 %) at 6 weeks postpartum compared to the control group (63.3 and 19.4 % respectively) (p < 0.001). More women with excessive body mass index in the intervention group (65 %) compared to the control group (11.6 %) were meeting recommended GWG (p < 0.001), and postpartum weight (37.7, and 20.3 % respectively) (p < 0.01). Conclusion: This intervention significantly improved knowledge, beliefs, self-reported practices, and gestational and postpartum weight in patients with GDM. Further research is needed for investigating the effectiveness of applying early, multi-phase, and longer intervention.


Gestational diabetes Health belief model Type 2 diabetes mellitus Gestational weight gain Postpartum weight retention 



There was no funding support for this research. The author thanks physicians, and nurses of the primary health care centers, and all patients who participated in the current study for their important contributions. The author thanks Diane See O.D. Optometrist Eye and Vision Care of Santa Barbara, for her careful revision and editing of the manuscript.

Compliance with Ethical Standards

Conflict of Interest

The author declares that she has no conflict of interest.

Ethical Approval

All procedures performed in the current study were in accordance with the ethical standards of the Research Ethics Committee of Suez Canal University in Ismailia-Egypt (approval number: 2619) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

All individual participants included in the study have signed an informed consent.


  1. 1.
    American Diabetic Association (2015). Classification and diagnosis of diabetes mellitus. Diabetes Care, 38, (Suppl 1):S8–S16. doi: 10.2337/dc15-S005.CrossRefGoogle Scholar
  2. 2.
    Karamanos, B., Thanopoulou, A., Anastasiou, E., et al. (2014). Relation of the Mediterranean diet with the incidence of gestational diabetes. European Journal of Clinical Nutrition, 68, 8–13.CrossRefPubMedGoogle Scholar
  3. 3.
    Popkin, B. M., Adair, L. S., & Ng, S. W. (2012). Global nutrition transition and the pandemic of obesity in developing countries. Nutrition Reviews, 70, 3–21.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Anna, V., van der Ploeg, H. P., Cheung, N. W., Huxley, R. R., & Bauman, A. E. (2008). Sociodemographic correlates of the increasing trend in prevalence of gestational diabetes mellitus in a large population of women between 1995–2005. Diabetes Care, 31, 2288–2293.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Bellamy, L., Casas, J.-P., Hingorani, A. D., & Williams, D. (2009). Type 2 diabetes mellitus after gestational diabetes: A systematic review and meta-analysis. Lancet, 373, 1773–1779.CrossRefPubMedGoogle Scholar
  6. 6.
    International Diabetes Federation. Global guideline on pregnancy and diabetes (2009). Retrieved April 2015, from
  7. 7.
    Morrison, M. K., Lowe, J. M., & Collins, C. E. (2014). Australian women’s experiences of living with gestational diabetes. Women and Birth, 27, 52–57.CrossRefPubMedGoogle Scholar
  8. 8.
    Bayat, F., Shojaeezadeh, D., Baikpour, M., Heshmat, R., Baikpour, M., & Hosseini, M. (2013). The effects of education based on extended health belief model in type 2 diabetic patients: a randomized controlled trial. Journal of Diabetes and Metabolic Disorders, 12, 45. doi: 10.1186/2251-6581-12-45.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Hochbaum, G., Rosenstock, I., Kegels, S. (1952). Health Belief Model. United States Public Health Service. Retrieved February 2015, from
  10. 10.
    Glanz, K., Rimer, B. K., & Lewis, F. M. (2002). Health behavior and health education: Theory, research, and practice. The health belief model (pp. 45–66). San Francisco, CA: Jossey-Bass publishing.Google Scholar
  11. 11.
    Jones, E. J., Roche, C. C., & Appel, S. J. (2009). A review of the health beliefs and lifestyle behaviors of women with previous gestational diabetes. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 38, 516–526.CrossRefGoogle Scholar
  12. 12.
    Ferrara, A., Hedderson, M., Albright, C. L., et al. (2011). A pregnancy and postpartum lifestyle intervention in women with gestational diabetes mellitus reduces diabetes risk factors: A feasibility randomized control trial. Diabetes care, 34, 1519–1525.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Rasmussen, K.M. & Yaktine, A.L. (2009). Weight gain during pregnancy: Reexamining the guidelines. Institute of Medicine (US) and National Research Council (US) Committee to reexamine IOM pregnancy weight guidelines. Washington, DC: National Academies Press.Google Scholar
  14. 14.
    World Health Organization. (2000). Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organization Technical Report Series 984. Retrieved March 2015, from
  15. 15.
    National Diabetes Education Program (2014) A program of the National Institute of Health and the Centers for Disease Control and Prevention. Guiding principles for the care of people with or at risk for diabetes. Retrieved June 2015, from
  16. 16.
    McIntyre, H. D., Peacock, A., Miller, Y. D., Koh, D., & Marshall, A. L. (2012). Pilot study of an individualised early postpartum intervention to increase physical activity in women with previous gestational diabetes. International Journal of Endocrinology, 2012, 892019. doi: 10.1155/2012/892019.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Shyam, S., Arshad, F., Ghani, R. A., et al. (2013). Low glycaemic index diets improve glucose tolerance and body weight in women with previous history of gestational diabetes: A 6 months randomized trial. Nutrition Journal, 12, 68. doi: 10.1186/1475-2891-12-68.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Morrison, M. K., Lowe, J. M., & Collins, C. E. (2010). Perceived risk of type 2 diabetes in Australian women with a recent history of gestational diabetes mellitus. Diabetic Medicine, 27, 882–886.CrossRefPubMedGoogle Scholar
  19. 19.
    Jones, E. J., Appel, S. J., Eaves, Y. D., Moneyham, L., Oster, R. A., & Ovalle, F. (2012). Cardiometabolic risk, knowledge, risk perception, and self-efficacy among American Indian women with previous gestational diabetes. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 41, 246–257.CrossRefGoogle Scholar
  20. 20.
    Tang, J. W., Foster, K. E., Pumarino, J., Ackermann, R. T., Peaceman, A. M., & Cameron, K. A. (2015). Perspectives on prevention of type 2 diabetes after gestational diabetes: A qualitative study of Hispanic, African-American and White women. Maternal and Child Health Journal, 19, 1526–1534.CrossRefPubMedGoogle Scholar
  21. 21.
    Koh, D., Miller, Y. D., Marshall, A. L., Brown, W. J., & McIntyre, D. (2010). Health enhancing physical activity behaviour and related factors in postpartum women with recent gestational diabetes mellitus. Journal of Science and Medicine in Sport, 13, 42–45.CrossRefPubMedGoogle Scholar
  22. 22.
    Amason, J. S., Lee, S. Y., Aduddell, K., Hewell, S. W., & Van Brackle, L. (2016). Pilot feasibility study of an educational intervention in women with gestational diabetes. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 45, 515–527.CrossRefPubMedGoogle Scholar
  23. 23.
    Kaiser, B., Razurel, C., & Jeannot, E. (2013). Impact of health beliefs, social support and self-efficacy on physical activity and dietary habits during the post-partum period after gestational diabetes mellitus: Study protocol. BMC Pregnancy and Childbirth, 13, 133. doi: 10.1186/1471-2393-13-133.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Chasan-Taber, L., Marcus, B. H., Rosal, M. C., et al. (2014). Estudio Parto: postpartum diabetes prevention program for hispanic women with abnormal glucose tolerance in pregnancy: A randomised controlled trial-study protocol. BMC Pregnancy and Childbirth, 14, 100. doi: 10.1186/1471-2393-14-100.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Nicklas, J. M., Zera, C. A., Seely, E. W., Abdul-Rahim, Z. S., Rudloff, N. D., & Levkoff, S. E. (2011). Identifying postpartum intervention approaches to prevent type 2 diabetes in women with a history of gestational diabetes. BMC Pregnancy and Childbirth, 11, 23. doi: 10.1186/1471-2393-11-23.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Harrison, C. L., Lombard, C. B., Strauss, B. J., & Teede, H. J. (2013). Optimizing healthy gestational weight gain in women at high risk of gestational diabetes: A randomized controlled trial., 21, 904–909.Google Scholar
  27. 27.
    Mamun, A. A., Kinarivala, M., O’Callaghan, M. J., Williams, G. M., Najman, J. M., & Callaway, L. K. (2010). Associations of excess weight gain during pregnancy with long-term maternal overweight and obesity: Evidence from 21 year postpartum follow-up. American Journal of Clinical Nutrition, 91, 1336–1341.CrossRefPubMedGoogle Scholar
  28. 28.
    Yang, Y., Wei, Q., Yu, H., et al. (2016). Higher pre-pregnancy body mass index is associated with excessive gestational weight gain in normal weight Chinese mothers with gestational diabetes. Journal of Obstetrics and Gynaecology Research, 42, 511–518.CrossRefPubMedGoogle Scholar
  29. 29.
    Oteng-Ntim, E., Varma, R., Croker, H., Poston, L., & Doyle, P. (2012). Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: Systematic review and meta-analysis. BMC Medicine, 10, 47. doi: 10.1186/1741-7015-10-47.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Nejad, L. M., Wertheim, E. H., & Greenwood, K. M. (2005). Comparison of the health belief model and the theory of planned behavior in the prediction of dieting and fasting behavior. E-journal of Applied Psychology: Social section, 1, 63–74.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department of Community Medicine, Faculty of MedicineSuez Canal UniversityIsmailiaEgypt

Personalised recommendations