Educational Attainment, Decision-Making Preferences, and Interest in Evidence-Based Diabetes Prevention among Women with a History of Gestational Diabetes Mellitus

Associations of education attainment with gestational diabetes mellitus and the mediating effects of obesity: A Mendelian randomization study

We aim to assess the causal association between educational attainment and gestational diabetes mellitus, and the mediating effect of obesity on this association. We estimated the causal effects of educational attainment on gestational diabetes mellitus using European ancestry genome-wide association study summary data with two-sample univariate Mendelian randomization (UVMR) approach. Two-stage Mendelian randomization analysis was performed to assess the potential mediating role of obesity traits in this association and to calculate the mediating proportion. UVMR analysis demonstrated that higher educational attainment was associated with a reduced risk of GDM (OR 0.76, 95% CI 0.67-0.86; p < 0.01). EA has also been associated with decreased obesity in women. Mediation Mendelian randomization results indicated that body mass index (BMI) was the most significant mediating factor in the relationship between educational attainment and GDM, accounting for 42.52% (95% CI 37.75-55.44%) of the effect, followed by waist-to-hip ratio (WHR) at 34.35% (95% CI 29.82-46.41%), body fat percentage at 28.95% (95% CI 35.99-46.81%), and WHR adjusted for BMI (WHRadjBMI) at 12.51% (95% CI 36.2-58.5%). educational attainment exerts a potential causal protective effect against gestational diabetes mellitus, and obesity-related risk factors play a mediating role. Attention should be paid to the educational attainment of women, and obese women with lower educational attainment may represent a higher risk group for GDM than those with higher educational attainment.

Reach, acceptability, and perceived success of a telehealth diabetes prevention program among racially and ethnically diverse patients with gestational diabetes: the GEM cluster-randomized trial

Patients with gestational diabetes mellitus and from racial/ethnic minority groups face disproportionate risk for type 2 diabetes. Lifestyle interventions, if accessible and acceptable to diverse patients, could advance diabetes prevention and mitigate racial/ethnic disparities. Here we describe overall and race/ethnicity-specific reach, acceptability, and perceived success from an effective telehealth diabetes prevention lifestyle program for patients with gestational diabetes mellitus, implemented in the Gestational Diabetes Effects on Moms (GEM) cluster-randomized controlled trial. GEM tested a program of 13 telephone sessions and behavior change techniques (BCTs, e.g., goal setting) in a healthcare system. We evaluated participation (completing ≥1 session), acceptability of BCTs, and perceived success reaching program goals. Among 1,087 patients (75.2% from minority groups), 50.3% participated. Participation rates were 61.7% among Black, 56.4% among Hispanic, 55.6% among multiracial/other, 53.0% among White, and 43.7% among Asian/Pacific Islander patients. Evaluation survey respondents (n = 433/547; 79.2%) largely rated BCTs as very helpful (range 40.9%-58.4%) or moderately helpful (27.3%-34.9%). Respondents from minority groups largely rated goal setting for weight management as very or moderately helpful, with fewer minority respondents rating it as only a little/not at all helpful than White respondents (p = .02). Black and White respondents reported more limited success reaching a healthy weight than Asian/Pacific Islander, Hispanic, and multiracial/other women (p = .005). A telehealth diabetes prevention lifestyle program demonstrated reach and acceptability across racial/ethnic groups. While perceived success can be improved among Black and White participants, such programs could promote access to preventive care and help mitigate disparities in diabetes risk.