A Model of Factors Influencing Glycemic Control Behavior among Pregnant Women with Gestational Diabetes Mellitus A1


  • Vorrapun Phadungyotee PhD (Candidate), Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University and Faculty of Nursing, Mahidol University, Thailand.
  • Srisamorn Phumonsakul Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand.
  • Natkamol Chansatitporn Faculty of Public Health, Mahidol University, Thailand.
  • Noppawan Piaseu Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand.




Attitude, Belief, Gestational diabetes mellitus, Glycemic control behavior, Intention, Pregnancy, Self-control behavior, Subjective norm


Gestational diabetes mellitus is glucose intolerance during pregnancy, increasing health risk in the mothers, feti, and subsequent children. Understanding the factors influencing glycemic control behaviors is necessary to control plasma glucose levels. This study developed and tested the Model of Factors Influencing Glycemic Control Behavior among Pregnant Women with Gestational Diabetes Mellitus A1. The Theory of Planned Behavior was used as a conceptual framework to guide the study. The participants were 252 pregnant women with the condition from two tertiary hospitals in Thailand, and whose blood glucose could be controlled by exercise and diet. Data were collected using a demographic data form and five scales on attitude, subjective norm, belief in self-control behavior, intention, and glycemic control behavior. Statistical analysis was conducted using SPSS version 18.0 and the Mplus statistical package version 7.0.

Results showed that the modified model fitted with the empirical data and accounted for 51.8% of the variance of glycemic control behavior. Intention and belief in self-control behavior directly affected glycemic control behavior. Attitude, subjective norm and belief in self-control behavior indirectly affected glycemic control behavior via intention. Among these factors, intention had the most substantial effect on glycemic control behavior. These findings suggest that nursing interventions should enhance intention by reinforcing positive attitudes, belief in self-control behavior, and support from subjective norms to promote glycemic control behavior. This model needs to be applied and tested for effectiveness in clinical practice.


Szmuilowicz ED, Josefson JL, Metzger BE. Gestational diabetes mellitus. Endocrinol Metab Clin North Am. 2019; 48(3):479-93. doi: 10.1016/j.ecl.2019.05.001. DOI: https://doi.org/10.1016/j.ecl.2019.05.001

Juan J, Yang H. Prevalence, prevention, and lifestyle intervention of gestational diabetes mellitus in China. Int J Environ Res Public Health. 2020;17(24):9517. doi: 10.3390/ijerph17249517. DOI: https://doi.org/10.3390/ijerph17249517

Johns EC, Denison FC, Norman JE, Reynold RM. Gestational diabetes mellitus: mechanisms, treatment, and complications. Trends Endocrinol Metab. 2018;29(11):743-54. doi: 10.1016/j.tem.2018.09.004. DOI: https://doi.org/10.1016/j.tem.2018.09.004

American Diabetes Association. Classification and diagnosis of diabetes: standards of medical care in diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S14-31. doi: 10.2337/dc20-s002. DOI: https://doi.org/10.2337/dc20-S002

White SL, Ayman G, Bakhai C, Hiller TA, Magee LA. Screening and diagnosis of gestational diabetes. BMJ. 2023;381: e071920. doi: 10.1136/bmj-2022-071920. DOI: https://doi.org/10.1136/bmj-2022-071920

Sweeting A, Wong J, Murphy HR, Ross GP. A clinical update on gestational diabetes mellitus. Endocr Rev. 2022;43(5): 763-93. doi: 10.1210/endrev/bnac003. DOI: https://doi.org/10.1210/endrev/bnac003

Hosseini E, Janghorbani M, Aminorroaya A. Incidence, risk factors, and pregnancy outcomes of gestational diabetes mellitus using one-step versus two-step diagnostic approaches: a population-based cohort study in Isfahan, Iran. Diabetes Res Clin Pract. 2018;140:288-94. doi: 10.1016/j.diabres.2018.04.014. DOI: https://doi.org/10.1016/j.diabres.2018.04.014

Shou C, Wei YM, Wang C, Yang HX. Updates in long-term maternal and fetal adverse effects of gestational diabetes mellitus. Matern Fetal Med. 2019;1(2):91-4. doi: 10. 1097/FM9.0000000000000019. DOI: https://doi.org/10.1097/FM9.0000000000000019

Wang YX, Mitsunami M, Manson JE, et al. Association of gestational diabetes with subsequent long-term risk of mortality. JAMA Intern Med.2023;183(11):1204-13. doi: 10.1001/jamainternmed.2023.4401. DOI: https://doi.org/10.1001/jamainternmed.2023.4401

Kramer CK, Campbell S, Retnakaran R. Gestational diabetes and the risk of cardiovascular disease in women: a systematic review and meta-analysis. Diabetologia. 2019;62(6):905-14. doi: 10.1007/s00125-019-4840-2. DOI: https://doi.org/10.1007/s00125-019-4840-2

Venkatesh KK, Khan SS, Powe CE. Gestational diabetes and long-term cardiometabolic health. JAMA. 2023; 330(9):870-1. doi: 10.1001/jama.2023.14997. DOI: https://doi.org/10.1001/jama.2023.14997

Mackin ST, Nelson SM, Wild SH, Cokhoun HM, Wood R, Lindsay RS, et al. Factors associated with stillbirth in women with diabetes. Diabetologia. 2019;62(10):1938-47. doi: 10.1007/s00125-019-4943-9. DOI: https://doi.org/10.1007/s00125-019-4943-9

Wang J, Wang L, Liu H, Zhang S, Leng J, Li W, Zhang T, Li N, Li W, Baccarell AA, et al. Maternal gestational diabetes and different indicators of childhood obesity: a large study. Endocr Connect. 2018;7(12):1464-71. doi: 10.1530/ EC-18-0449. DOI: https://doi.org/10.1530/EC-18-0449

Reitzle L, Heidemann C, Baumert J, Kaltheuner M, Adamczewski H, Icks A, Scheidt-Nave C. Pregnancy complications in women with pregestational and gestational diabetes mellitus. Dtsch Arztebl Int. 2023;120(6):81-6. doi: 10.3238/arztebl.m2022.0387. DOI: https://doi.org/10.3238/arztebl.m2022.0387

He J, Hu K, Wang B, Chen Z, Wang H. Does- response relationship between gestational weight gain and neonatal birthweight in Chinese women with excess weight/obesity and gestational diabetes mellitus. Healthcare (Basel). 2023; 11(16):2358. doi: 10.3390/healthcare11162358. DOI: https://doi.org/10.3390/healthcare11162358

World Health Organization. Physical activity. 2022 Oct 5 [ cited 2024 Feb 8]. Available from: https://www.who.int/news-room/fact-sheets/detail/physical-activity

Mnatsakanyan K, Rosario-Sim M, Caboral-Stevens M. A review of the treatment options for gestational diabetes: the evidence base. J Diabetes Nurs. 2014;18(4):156-61.

Luo JY, Chen LG, Yan M, Mei YJ, Cui YQ, Jiang M. Effect of individualized nutrition interventions on clinical outcomes of pregnant women with gestational diabetes mellitus. World J Diabetes. 2023;14(10):1524-31. doi: 10.4239/wjd.v14.i10.1524. DOI: https://doi.org/10.4239/wjd.v14.i10.1524

Moholdt T. Diet, exercise and gestational diabetes mellitus. Nutrients. 2023;15(10):2251. doi: 10.3390/nu15102251. DOI: https://doi.org/10.3390/nu15102251

Hausenblas HA, Downs DS. Prospective examination of the Theory of Planned Behavior applied to exercise behavior during women’s first trimester of pregnancy. J Reprod Infant Psychol. 2004;22(3):199-210. doi: 10.1080/02646830410001723788. DOI: https://doi.org/10.1080/02646830410001723788

Shankar A, Conner M, Bodansky HJ. Can the theory of planned behaviour predict maintenance of frequently repeated behaviour? Psychol Health Med. 2007;12(2): 213-24. doi: 10.1080/09540120500521327. DOI: https://doi.org/10.1080/09540120500521327

Retnakaran R, Ye C, Hanley AJ, Connelly PW, Sermer M, Zinman B. Treatment of gestational diabetes mellitus and maternal risk of diabetes after pregnancy. Diabetes Care. 2023;46(3):587-92. doi: 10.2337/dc22-1786. DOI: https://doi.org/10.2337/dc22-1786

Boudreau F, Godin G. Understanding physical activity intentions among French Canadians with type 2 diabetes: an extension of Ajzen’s theory of planned behavior. Int J Behav Nutr Phys Act. 2009;6:35. doi: 10.1186/1479-5868-6-35. DOI: https://doi.org/10.1186/1479-5868-6-35

Plotnikoff RC, Lippke S, Courneya K, Birkett N, Sigal R. Physical activity and diabetes: an application of the theory of planned behaviour to explain physical activity for type 1 and type 2 diabetes in an adult population sample. Psychol Health. 2010;25(1):7-23. doi: 10.1080/088704408 02160984. DOI: https://doi.org/10.1080/08870440802160984

Supavititpatana B, Phancharoenworakul K, Yeo SA, Sinsuksai N, Vorapongsathorn T. Using theory of planned behavior to predict physical activity intention among pregnant Thais. Pacific Rim Int J Nurs Res.[Internet]. 2012 Feb 6[cited 2023 Nov 12]; 16(3):192-205. Available from: https://he02tci-thaijo.org/index.php/PRIJNR/article/view/5864

Khadivzadeh T, Hoseinzadeh M, Azhari S, Esmaily H, Akhlaghi F, Sardar MA. Self-care behaviors of mothers with gestational diabetes treated with insulin based on the theory of planned behavior. J Midwifery Reprod Health. 2016;4(3):654-72. doi: 10.22038/JMRH.2016.7093.

Whitaker KM, Wilcox S, Liu J, Blair SN, Pate RR. Pregnant women’s perceptions of weight gain, physical activity, and nutrition using Theory of Planned Behavior constructs. J Behav Med. 2016; 39:41-54. doi: 10.1007/s10865-015-09672-Z. DOI: https://doi.org/10.1007/s10865-015-9672-z

Sklempe KI, Ivanisevic M, Biolo G, et al. Combination of structured aerobic and resistance exercise improves glycaemic control in pregnant women diagnosed with gestational diabetes mellitus. A randomized controlled trial. Women Birth. 2018; 31(4):e232-8. doi: 10.1016/j.wombi.2017.10.004. DOI: https://doi.org/10.1016/j.wombi.2017.10.004

Kim YS, Kim HS, Kim YL. Effects of a web-based self-management program on the behavior and blood glucose levels of women with gestational diabetes mellitus. Telemed J E Health. 2019;25(5):407-14. doi: 10.1089/tmj.2017.0332. DOI: https://doi.org/10.1089/tmj.2017.0332

Youngwanichsetha S, Phumdoung S, Ingkathawornwong. The effects of mindfulness eating and yoga exercise on blood sugar levels of pregnant women with gestational diabetes mellitus. Appl Nurs Res. 2014;27(4):227-30. doi: 10.1016/j.apnr.2014.02.002. DOI: https://doi.org/10.1016/j.apnr.2014.02.002

Limruangrong P, Sinsuksai N, Ratinthorn A, Boriboonhirunsarn D. Effectiveness a self-regulation program on diet control, exercise, and two-hour postprandial blood glucose levels in Thais with gestational diabetes mellitus. Pacific Rim Int J Nurs Res [Internet]. 2013 Feb 6 [cited 2023 Nov 12]; 15(3):173-87. Available from: https://he02tci-thaijo.org/index.php/PRIJNR/article/view/6494

Thongwon T, Muangpin S. The effect of self-regulation with flexercise program on blood glucose level and insulin requirement among pregnant women with gestational diabetes mellitus type A2. J Nurs Sci Health [Internet] 2016 Sep 12 [cited 2023 Nov 12];39(2):54-65 (in Thai). Available from: https://he01.tci-thaijo.org/index.php/nah/article/view/39214

Ajzen I. From intentions to action: a theory of planned behavior. In: Kuhl J, Beckman J, editors. Action control: from cognition to behavior. Springer-Verlag, Heidelberg. 1985. pp. 11-39. http://dx.doi.org/10.1007/978-3-642-69746-3_2 DOI: https://doi.org/10.1007/978-3-642-69746-3_2

Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Processes. 1991;50(2):179-211. doi: 10.1016/ 0749-5978(91)90020-T. DOI: https://doi.org/10.1016/0749-5978(91)90020-T

Hair JF, Black WC, Babin BJ, Anderson RE. Multivariate data analysis. 7th ed. New Jersey: Pearson Prentice Hall; 2010.

Bootsri W, Sirisophon A. Predicting factors of promoting behavior among pregnant women receiving antenatal care services at community hospital, Nakonsawan Province. JAHS SSRU. 2020;5(1):60-70 (in Thai). https://he04.tci-thaijo.org/index.php/JAHS/article/view/249/118

Cheung NM. The management of gestational diabetes. Vasc Health Risk Manag. 2009;5(1):153-64. doi: 10.2147/uhrm.s3405. DOI: https://doi.org/10.2147/VHRM.S3405

Gascoigne EL, Webster CM, Honart AW, Wang P, Smith-Ryan A, Manuck TA. Physical activity and pregnancy outcomes: an expert review. Am J Obstet Gynecol MFM 2023;5(1): 100758 doi: 10.1016/j.ajogmf.2022.100758. DOI: https://doi.org/10.1016/j.ajogmf.2022.100758




How to Cite

Phadungyotee V, Phumonsakul S, Chansatitporn N, Piaseu N. A Model of Factors Influencing Glycemic Control Behavior among Pregnant Women with Gestational Diabetes Mellitus A1. PRIJNR [Internet]. 2024 Mar. 21 [cited 2024 May 23];28(2):377-89. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/266392