Dietary Quality and Cardiometabolic Risk after Gestational Diabetes Open Access

Ferranti, Erin (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/9c67wn070?locale=en
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Abstract

Background : Women with previous gestational diabetes mellitus (pGDM) are at significant risk for the development of type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS). Healthy diets, particularly the Alternate Healthy Eating Index (AHEI) dietary pattern is protective for disease development, but women with pGDM have suboptimal diet quality. Few studies have investigated the influences of diet quality in women with pGDM.

Purpose : This study examined individual, family, and social-level influences of diet quality. An exploratory focus assessed cardiometabolic risk status in relationship to AHEI diet quality.

Sample and Design : This was a cross-sectional descriptive study guided by a synthesis of the Health Belief Model and the ecological framework for eating behavior. Women aged 18-45 years, within five years of their pGDM pregnancy, completed questionnaires about demographic factors, individual perceptions of risk, benefits and barriers to healthy eating, dietary self-efficacy, general social support, components of family functioning, and habitual dietary intake. A basic cardiometabolic health assessment was performed to determine the presence of MetS or T2DM risk defined by abnormal hemoglobin A1C values. Analyses included descriptive, bivariate, multivariate linear and logistic regression.

Results : Participants (n = 75) included women (55% Minority) who were within a mean of 2.6 years since their pGDM pregnancy. AHEI diet quality was suboptimal (M = 47.6, SD = 14.3). Individual factors that significantly predicted better AHEI diet quality were higher levels of education status and dietary self-efficacy (R2 = .36, F(6, 66) = 6.19, p =

Discussion : These findings highlight the prevalence of cardiometabolic risk factors, the suboptimal AHEI diet quality, and the modifiable influences that contribute to AHEI dietary quality in women with pGDM. Interventions designed to improve diet quality in women with pGDM should incorporate enhancing dietary self-efficacy. This study provides a foundation to further investigate dietary influences in a longitudinally designed study to assess the causal direction of the associations.

Table of Contents

Chapter 1 - Introduction.....................................................................................................................................................................1


Figure 1.1 Synthesis of the Health Belief Model and the Ecological Framework for Eating Influences .............................................................8

Table 1.1 Recruitment Strategies and Success Rates............................................................................................................................28


Table 1.2 AHEI Scoring Criteria..........................................................................................................................................................40


Table 1.3 Variables, Instruments and Reliability...................................................................................................................................43

Chapter 2 - Intrapersonal Influences of Diet Quality in Women with Previous Gestational Diabetes..............................................................86


Figure 2.1 Intrapersonal Influences of Diet Quality in Women with pGDM...............................................................................................116


Table 2.1 Characteristics of the Sample.............................................................................................................................................117


Table 2.2 AHEI Scoring Method and Total Scores................................................................................................................................118


Table 2.3 Participant Scores on Intrapersonal Measures.......................................................................................................................119

Table 2.4 Summary of Bivariate Associations with AHEI Diet Quality.....................................................................................................120


Table 2.5 Multiple Linear Regression Analyses Summary for IntrapersonalVariables and AHEI Diet Quality.................................................121

Chapter 3 - The Influence of Family and Social Factors on Diet Quality in Women withPrevious Gestational Diabetes...................................122


Figure 3.1 Inter- and Intrapersonal Influences of Diet Quality in Women with pGDM................................................................................152

Table 3.1 Characteristics of the Sample.............................................................................................................................................153

Table 3.2 AHEI Scoring Method and Total Scores................................................................................................................................154


Table 3.3 Participant Scores on Individual, Family, and Social Measures................................................................................................155


Table 3.4 Summary of Bivariate Associations with AHEI Diet Quality.....................................................................................................156


Table 3.5 Multiple Linear Regression Analyses Summary for Family and Social Influences on AHEI Diet Quality...........................................157


Table 3.6 What is New?...................................................................................................................................................................158


Additional Tables............................................................................................................................................................................159


Chapter 4 - Diet Quality and Cardio-metabolic Risk in Women with a Recent History of Gestational Diabetes..............................................162


Table 4.1 Characteristics of the Sample.............................................................................................................................................200


Table 4.2 Clinical Characteristics of Participants..................................................................................................................................201


Table 4.3 AHEI Scoring Method and Total Scores................................................................................................................................202


Table 4.4 Summary of Bivariate Associations with AHEI Diet Quality.....................................................................................................203


Table 4.5 Logistic Regression Analysis for AHEI Diet Quality and Metabolic Syndrome.............................................................................204


Table 4.6 Logistic Regression Analysis for AHEI Diet Quality and T2DM Risk...........................................................................................205

Chapter 5 - Conclusion....................................................................................................................................................................206


Appendix A - Institutional Review Board Documents


Emory IRB Approval Letter

Grady Research Oversight Committee Approval Letter Hall County Health Department Memorandum of Agreement Northside Hospital Denial Letter Verbal Informed Consent

Written Informed Consent

HIPAA Authorization Spanish-version Verbal Informed Consent Spanish-version Written Informed Consent Spanish-version HIPAA Authorization Appendix B - Recruitment Strategies General Flyer Spanish-version General Flyer Tabbed Flyer Spanish-version Tabbed Flyer Trifold Flyer

Spanish-version Trifold Flyer

Emory Healthcare Phone-Wait Script

Emory Clinic Letter of Study Invitation Grady Health System Letter of Study Invitation Medical Chart Flyer
Spanish-version Medical Chart Flyer Facebook Survey Monkey Questionnaire Email Response for Survey Monkey Study Appointment Letter


Appendix C - Permissions

Permission for Figure Use and Adaptation

Permission for use of Barriers to Healthy Eating Scale


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