Predictors of low diabetes risk perception in a multi-ethnic cohort of women with gestational diabetes mellitus

Aim To determine what proportion of women with gestational diabetes underestimate their diabetes risk and identify factors associated with low diabetes risk perception. Methods Participants included pregnant adult women with gestational diabetes between 2009 and 2012 across seven diabetes clinics in Ontario, Canada. Data were collected through chart review and a survey that included a diabetes risk perception question. Results Of the 614 of 902 women (68% response rate) with gestational diabetes, 89% correctly responded that gestational diabetes increases the risk for developing diabetes. However, 47.1% of women perceived themselves to be at low risk for developing diabetes within 10 years. On multivariable analysis, BMI < 25 kg/m2, absent previous gestational diabetes history, absent diabetes family history and absent insulin use were appropriately associated with low diabetes risk perception. However, compared with Caucasian ethnicity, high‐risk ethnicity (Aboriginal, Latin American, West Indian, South Asian, Middle Eastern, Filipino, Black, Pacific Islander) [odds ratio (OR) 2.07; 95% CI 1.30–3.31] and East and South East Asian ethnicity (OR 2.01; 1.10–3.67) were associated with low diabetes risk perception. After further adjustment for immigration, only high‐risk ethnicity remained a predictor of low diabetes risk perception (OR 1.86; 1.09–3.19), whereas East and South East Asian ethnicity did not (OR 1.67; 0.86–3.22). Conclusions Although the majority of women recognized gestational diabetes as a risk factor for diabetes, almost half underestimated their personal high diabetes risk despite prenatal care. Furthermore, women from high‐risk ethnic groups were more likely to underestimate their risk, even after adjusting for immigration. Interventions tailored to these groups are necessary to enhance perceived diabetes risk. What's new? This study is among the first to report on risk perception for diabetes among pregnant women with gestational diabetes within a universal healthcare setting. Findings demonstrate that among a large and diverse representative sample of pregnant women with gestational diabetes, almost half do not recognize their high future diabetes risk. This indicates a need to implement better strategies to translate risk of future Type 2 diabetes among pregnant women with gestational diabetes. Women with gestational diabetes from non‐Caucasian ethnic backgrounds were more likely to underestimate their risk perception for diabetes, even a