Self-care educational guide for mothers with gestational diabetes mellitus: A systematic review on identifying self-care domains, approaches, and their effectiveness

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gestational diabetes mellitus
health education
blood glucose

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Haron, Z., Sutan, R., Zakaria, R., & Abdullah Mahdy, Z. (2023). Self-care educational guide for mothers with gestational diabetes mellitus: A systematic review on identifying self-care domains, approaches, and their effectiveness. Belitung Nursing Journal, 9(1), 6–16.
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Accepted for publication: 2023-01-08
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Background: Gestational Diabetes Mellitus (GDM) is a common form of poor carbohydrate intolerance, prevalent among pregnant women and associated with unhealthy lifestyle behaviors. Given the dearth of information on self-empowerment among mothers with GDM, a self-care health education package needs to be developed to prevent related complications.

Objective: This review aimed to identify self-care approaches, domains, and their effectiveness for a proper self-care educational guide package for women with GDM.

Design: A systematic review using electronic literature databases  published between January 2016 and December 2022 was conducted.

Data Sources: Web of Science, Scopus, and Ovid databases were used.

Review Methods: This review utilized the PICO (Population, Intervention, Comparison, and Outcomes) framework to screen the retrieved articles for eligibility in which mothers with GDM, educational materials, standard practice or intervention, and effectiveness were considered the PICO, respectively. The CIPP (Context, Input, Process, Product) model served as a framework for adopting the education development model. Mixed methods appraisal tool was used for quality assessment. Data extraction and synthesis without meta-analysis were presented as evidence tables.

Results: A total of 19 articles on GDM were included in the final analysis (16 Intervention studies, two qualitative studies, and one mixed-methods study). Four broad domains emerged from the analysis: 1) information or knowledge of GDM, 2) monitoring of blood glucose levels, 3) practice of healthy lifestyles, and 4) other non-specific activities. The majority of the articles employed a face-to-face approach in executing the educational group sessions, and most studies disclosed their positive effects on GDM management. Other methods of evaluating intervention effectiveness were described as improved self-care behavior, increased satisfaction score, enhanced self-efficacy, good glucose control, and better pregnancy outcome.

Conclusion: Knowledge or information about GDM, healthy diet, and exercise or physical activity was found to be the most applied domains of intervention. Framework domains based on the present review can be used in the future development of any interventional program for GDM women in enhancing health information reaching the targeted group in promoting self-efficacy.

PROSPERO registration number: CRD42021229610.


Copyright (c) 2023 Zarina Haron, Rosnah Sutan, Roshaya Zakaria, Zaleha Abdullah Mahdy

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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Declaration of Conflicting Interest

The authors declared no conflict of interest.


The publication of this manuscript was supported by the Universiti Kebangsaan Malaysia.

Authors’ Contributions

This study is a Doctoral project of the first author under the supervision of the second author and co-supervised by the third and fourth authors. RS, ZH, ZAM, and RZ conceived the scope of the review to meet the study objectives. Literature screening and review, data extraction and verification, and qualitative synthesis were conducted by ZH and verified by RS and RZ. ZH drafted the first iteration of the manuscript. All authors contributed substantially to the manuscript’s critical review, editing, and revision. All authors approved the final version of the manuscript.

Data Availability

See supplementary file.

Ethical Considerations

Not applicable.


Al Hashmi, I., Alsabti, H., Al Omari, O., Al Nasseri, Y., & Khalaf, A. (2022). Development, feasibility and acceptability of a self-efficacy-enhancing smartphone application among pregnant women with gestational diabetes mellitus: Single-arm pilot clinical trial. BMC Pregnancy Childbirth, 22(1), 358. https//

Al-Hashmi, I., Hodge, F., Nandy, K., Thomas, E., & Brecht, M. L. (2018). The effect of a self-efficacy-enhancing intervention on perceived self-efficacy and actual adherence to healthy behaviours among women with gestational diabetes mellitus. Sultan Qaboos University Medical Journal, 18(4), e513-e519.

Al-Ofi, E. A., Mosli, H. H., Ghamri, K. A., & Ghazali, S. M. (2019). Management of postprandial hyperglycaemia and weight gain in women with gestational diabetes mellitus using a novel telemonitoring system. Journal of International Medical Research, 47(2), 754-764.

Allehdan, S. S., Basha, A. S., Asali, F. F., & Tayyem, R. F. (2019). Dietary and exercise interventions and glycemic control and maternal and newborn outcomes in women diagnosed with gestational diabetes: Systematic review. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 13(4), 2775-2784.

American Diabetes Association. (2019). 5. Lifestyle management: Standards of medical care in diabetes—2019. Diabetes Care, 42(Supplement_1), S46-S60.

Ammulu, & Fasalu Rahiman O.M., M. R. K. P. (2019). Managing gestational diabetes: The role of patient counselling. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 8(3), 1011-1015.

Anjana, R. M., Sudha, V., Lakshmipriya, N., Anitha, C., Unnikrishnan, R., Bhavadharini, B., Mahalakshmi, M. M., Maheswari, K., Kayal, A., Ram, U., Ranjani, H., Ninov, L., Deepa, M., Pradeepa, R., Pastakia, S. D., Malanda, B., Belton, A., & Mohan, V. (2016). Physical activity patterns and gestational diabetes outcomes - The wings project. Diabetes Research and Clinical Practice, 116, 253-262.

Anuar, N. M., Yusof, B. N. M., Hasbullah, F. Y., Adznam, S. N. A., Ibrahim, Z., Zakaria, N. F., & Hashim, N. (2020). Levels of knowledge about the glycemic index concept among women with gestational diabetes mellitus. Malaysian Journal of Medicine and Health Sciences, 16(3), 185-191.

Aziz, S., Mahmood, M., & Rehman, Z. (2018). Implementation of CIPP model for quality evaluation at school level: A case study. Journal of Education and Educational Development, 5(1), 189-206.

Bahram Mohebbi, Azar Tol, Roya Sadeghi, & Seideh Fateme Mohtarami, A. S. (2019). Self-management intervention program based on the Health Belief Model (HBM) among women with gestational diabetes mellitus: A quazi-experimental study. Archives of Iranian Medicine, 22(4), 168-173.

Bhowmik, B., Afsana, F., Ahmed, T., Siddiquee, T., Ahmed, T., Pathan, F., Mahtab, H., & Khan, A. K. A. (2018). Evaluation of knowledge regarding gestational diabetes mellitus: A Bangladeshi study. Public Health, 161, 67-74.

Borgen, I., Garnweidner-Holme, L. M., Jacobsen, A. F., Bjerkan, K., Fayyad, S., Joranger, P., Lilleengen, A. M., Mosdol, A., Noll, J., Smastuen, M. C., Terragni, L., Torheim, L. E., & Lukasse, M. (2017). Smartphone application for women with gestational diabetes mellitus: A study protocol for a multicentre randomised controlled trial. BMJ Open, 7(3), e013117.

Borgen, I., Smastuen, M. C., Jacobsen, A. F., Garnweidner-Holme, L. M., Fayyad, S., Noll, J., & Lukasse, M. (2019). Effect of the Pregnant+ smartphone application in women with gestational diabetes mellitus: A randomised controlled trial in Norway. BMJ Open, 9(11), e030884.

Brown, J., Alwan, N. A., West, J., Brown, S., McKinlay, C. J., Farrar, D., & Crowther, C. A. (2017). Lifestyle interventions for the treatment of women with gestational diabetes. Cochrane Database of Systematic Reviews, 5(5), CD011970.

Campbell, M., McKenzie, J. E., Sowden, A., Katikireddi, S. V., Brennan, S. E., Ellis, S., Hartmann-Boyce, J., Ryan, R., Shepperd, S., Thomas, J., Welch, V., & Thomson, H. (2020). Synthesis without meta-analysis (SWiM) in systematic reviews: Reporting guideline. BMJ, 368, l6890.

Carolan-OIah, M. C. (2016). Educational and intervention programmes for gestational diabetes mellitus (GDM) management: An integrative review. Collegian, 23(1), 103-114.

Carolan-Olah, M., Duarte-Gardea, M., & Lechuga, J. (2017a). A systematic review of interventions for Hispanic women with or at risk of Gestational diabetes mellitus (GDM). Sexual and Reproductive Healthcare, 13, 14-22.

Carolan-Olah, M., Duarte-Gardea, M., Lechuga, J., & Salinas-Lopez, S. (2017b). The experience of gestational diabetes mellitus (GDM) among Hispanic women in a U.S. border region. Sexual and Reproductive Healthcare, 12, 16-23.

Carolan-Olah, M., & Sayakhot, P. (2019). A randomized controlled trial of a web-based education intervention for women with gestational diabetes mellitus. Midwifery, 68, 39-47.

Crawford, K. (2017). Review of 2017 diabetes standards of care. Nursing Clinics of North America, 52(4), 621-663.

Draffin, C. R., Alderdice, F. A., McCance, D. R., Maresh, M., Harper, R., Patterson, C. C., Bernatavicius, G., Brennan, S. F., Gough, A., McSorley, O., Holmes, V. A., & group, G. D. s. (2017). Impact of an educational DVD on anxiety and glycaemic control in women diagnosed with gestational diabetes mellitus (GDM): A randomised controlled trial. Diabetes Research and Clinical Practice, 126, 164-171.

Ge, L., Wikby, K., & Rask, M. (2016). 'Is gestational diabetes a severe illness?' exploring beliefs and self-care behaviour among women with gestational diabetes living in a rural area of the south east of China. Australian Journal of Rural Health, 24(6), 378-384.

Gharachourlo, M., Mahmoodi, Z., Akbari Kamrani, M., Tehranizadeh, M., & Kabir, K. (2018). The effect of a health literacy approach to counselling on the lifestyle of women with gestational diabetes: A clinical trial. F1000Res, 7, 282.

Ghasemi, F., Vakilian, K., & Khalajinia, Z. (2021). Comparing the effect of individual counseling with counseling on social application on self-care and quality of life of women with gestational diabetes. Primary Care Diabetes, 15(5), 842-847.

Gilbert, L., Gross, J., Lanzi, S., Quansah, D. Y., Puder, J., & Horsch, A. (2019). How diet, physical activity and psychosocial well-being interact in women with gestational diabetes mellitus: An integrative review. BMC Pregnancy Childbirth, 19(1), 60.

Guo, H., Zhang, Y., Li, P., Zhou, P., Chen, L. M., & Li, S. Y. (2019). Evaluating the effects of mobile health intervention on weight management, glycemic control and pregnancy outcomes in patients with gestational diabetes mellitus. Journal of Endocrinological Investigation, 42(6), 709-714.

Han, S., Middleton, P., Shepherd, E., Van Ryswyk, E., & Crowther, C. A. (2017). Different types of dietary advice for women with gestational diabetes mellitus. Cochrane Database of Systematic Reviews, 2, CD009275.

Hasbullah, F. Y., Mohd Yusof, B. N., Shariff, Z. M., Rejali, Z., Yong, H. Y., & Mitri, J. (2020). Factors associated with dietary glycemic index and glycemic load in pregnant women and risk for gestational diabetes mellitus. International Journal of Food Sciences and Nutrition, 71(4), 516-524.

He, R., Lei, Q., Hu, H., Li, H., Tian, D., & Lai, Z. (2022). The effect of health education combined with personalized psychological nursing intervention on pregnancy outcome of pregnant women with gestational diabetes mellitus. BioMed Research International, 2022, 3157986.

Hong, Q. N., Fàbregues, S., Bartlett, G., Boardman, F., Cargo, M., Dagenais, P., Gagnon, M.-P., Griffiths, F., Nicolau, B., & O’Cathain, A. (2018). The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. Education for Information, 34(4), 285-291.

Hussain, Z., Yusoff, Z. M., & Sulaiman, S. A. (2015). Evaluation of knowledge regarding gestational diabetes mellitus and its association with glycaemic level: A Malaysian study. Primary Care Diabetes, 9(3), 184-190.

Isa, A., Muhamad, N. A., Mustapha, N., Abdul Mutalip, M. H., Lodz, N. A., Mohd Royali, M. S., Baharin, M. F., Zaini, Z., & Sm, S. (2017). Association between self-efficacy and health behaviour in disease control: A systematic review. Global Journal of Health Science, 10(1).

Johnson, Q. B., & Berry, D. C. (2018). Impacting diabetes self-management in women with gestational diabetes mellitus using short messaging reminders. Journal of American Association of Nurse Practitioners, 30(6), 320-326.

Kennelly, M. A., Ainscough, K., Lindsay, K., Gibney, E., Mc Carthy, M., & McAuliffe, F. M. (2016). Pregnancy, exercise and nutrition research study with smart phone app support (Pears): Study protocol of a randomized controlled trial. Contemporary Clinical Trials, 46, 92-99.

Kim, Y. S., Kim, H. S., & Kim, Y. L. (2019). Effects of a web-based self-management program on the behavior and blood glucose levels of women with gestational diabetes mellitus. Telemedicine and e-Health, 25(5), 407-414.

Kolivand, M., Keramat, A., Rahimi, M., Motaghi, Z., Shariati, M., & Emamian, M. (2018). Self-care education needs in gestational diabetes tailored to the Iranian culture: A qualitative content analysis. Iranian Journal of Nursing and Midwifery Research, 23(3), 222-229.

Kolivand, M., Rahimi, M. A., Keramat, A., Shariati, M., & Emamian, M. H. (2019). Effect of a new self-care guide package on maternal and neonatal outcomes in gestational diabetes: A randomized control trial. Journal of Diabetes, 11(2), 139-147.

Kusumaningrum, N. S. D., Asmara, F. Y., & Nurmalia, D. (2022). Healthcare professionals’ opinions regarding health coaching for patients with diabetes: A pilot exploration in Indonesia. Belitung Nursing Journal, 8(1), 67-74.

Lee, S. Y., Shin, J.-S., & Lee, S.-H. (2019). How to execute Context, Input, Process, and Product evaluation model in medical health education. Journal of Educational Evaluation for Health Professions, 16, 40.

Lefkovits, Y. R., Stewart, Z. A., & Murphy, H. R. (2019). Gestational diabetes. Medicine, 47(2), 114-118.

Liu, C., Wang, D., Liu, C., Jiang, J., Wang, X., Chen, H., Ju, X., & Zhang, X. (2020). What is the meaning of health literacy? A systematic review and qualitative synthesis. Family Medicine and Community Health, 8(2), 000351.

Lucille S. Eller, Elise L. Lev, Changrong Yuan, and, F., & Watkins, A. V. (2018). Describing self-care self-efficacy definition, measurement, outcomes, and implications. International Journal of Nursing Knowledge, 29(1), 38-48.

Mackillop, L., Hirst, J. E., Bartlett, K. J., Birks, J. S., Clifton, L., Farmer, A. J., Gibson, O., Kenworthy, Y., Levy, J. C., Loerup, L., Rivero-Arias, O., Ming, W. K., Velardo, C., & Tarassenko, L. (2018). Comparing the efficacy of a mobile phone-based blood glucose management system with standard clinic care in women with gestational diabetes: Randomized controlled trial. JMIR Mhealth Uhealth, 6(3), e71.

Matarese, M., Lommi, M., De Marinis, M. G., & Riegel, B. (2018). A systematic review and integration of concept analyses of self-care and related concepts. Journal of Nursing Scholarship, 50(3), 296-305.

Mensah, G. P., van Rooyen, D. R. M., & Ten Ham-Baloyi, W. (2019). Nursing management of gestational diabetes mellitus in Ghana: Perspectives of nurse-midwives and women. Midwifery, 71, 19-26.

Mirfeizi M, M. T. Z., Asghari Jafarabadi M, Moghimi Hanjanim S, Hasanzad M. (2017). Health education in gestational diabetes mellitus and quality of life. Journal of Midwifery and Reproductive Health, 5(4), 1066-1074.

Mirghafourvand, M., Zandinava, H., Sehhatti Shafaei, F., Mohammad-Alizadeh-Charandabi, S., & Ghanbari-Homayi, S. (2019). Effectiveness of self-care training on pregnancy consequences in gestational diabetes: A randomized controlled clinical trial. Shiraz E-Medical Journal, 20(6), e82704.

Mohanty, S., Venkatarao, E., & Yasobant, S. (2020). Non-communicable disease care and physical activity promotion in India: Analysis of recent policies, guidelines and workplans. Family Medicine and Community Health, 8(2), e000206.

Mohebbi, Tol A, S. R., & Fateme Mohtarami S, S. A. (2019). Self-management intervention program based on the Health Belief Model (HBM) among women with gestational diabetes mellitus: A quazi-experimental study. Archives Iranian Medicine, 22(4), 168-173.

Muhwava, L. S., Murphy, K., Zarowsky, C., & Levitt, N. (2019). Experiences of lifestyle change among women with gestational diabetes mellitus (GDM): A behavioural diagnosis using the COM-B model in a low-income setting. PLoS One, 14(11), e0225431.

Mustad, V. A., Huynh, D. T. T., Lopez-Pedrosa, J. M., Campoy, C., & Rueda, R. (2020). The role of dietary carbohydrates in gestational diabetes. Nutrients, 12(2), 385.

Pinidiyapathirage, J., Jayasuriya, R., Cheung, N. W., & Schwarzer, R. (2018). Self-efficacy and planning strategies can improve physical activity levels in women with a recent history of gestational diabetes mellitus. Psychology and Health, 33(8), 1062-1077.

Qamar, M., Rashid, R., Ahmad, S., Shaikh, F. A., & Ismail, N. E. (2017). Awareness of diabetes mellitus among general public in Shah Alam, Malaysia: A cross-sectional study. Asian Journal of Pharmaceutical and Clinical Research, 10(9), 192-196.

Rasekaba, T. M., Lim, K., Blackberry, I., Gray, K., & Furler, J. (2016). Telemedicine for Gestational Diabetes Mellitus (TeleGDM): A mixed-method study protocol of effects of a web-based GDM support system on health service utilization, maternal and fetal outcomes, costs, and user experience. JMIR Research Protocols, 5(3), e163.

Rasmussen, L., Christensen, M. L., Poulsen, C. W., Rud, C., Christensen, A. S., Andersen, J. R., Kampmann, U., & Ovesen, P. G. (2020). Effect of high versus low carbohydrate intake in the morning on glycemic variability and glycemic control measured by continuous blood glucose monitoring in women with gestational diabetes mellitus-A randomized crossover study. Nutrients, 12(2), 475.

Rokni, S., Rezaei, Z., Noghabi, A. D., Sajjadi, M., & Mohammadpour, A. (2022). Evaluation of the effects of diabetes self-management education based on 5A model on the quality of life and blood glucose of women with gestational diabetes mellitus: An experimental study in eastern Iran. Journal of Preventive Medicine and Hygiene, 63(3), E442-E447.

Rollo, M. E., Aguiar, E. J., Williams, R. L., Wynne, K., Kriss, M., Callister, R., & Collins, C. E. (2016). eHealth technologies to support nutrition and physical activity behaviors in diabetes self-management. Diabetes, Metabolic Syndrome and Obesity, 9, 381-390.

Rollo, M. E., Baldwin, J. N., Hutchesson, M., Aguiar, E. J., Wynne, K., Young, A., Callister, R., Haslam, R., & Collins, C. E. (2020). The feasibility and preliminary efficacy of an ehealth lifestyle program in women with recent gestational diabetes mellitus: A pilot study. International Journal of Environmental Research and Public Health, 17(19), 7115.

Sayakhot, P., Carolan-Olah, M., & Steele, C. (2016). Use of a web-based educational intervention to improve knowledge of healthy diet and lifestyle in women with Gestational Diabetes Mellitus compared to standard clinic-based education. BMC Pregnancy Childbirth, 16(1), 208.

Skar, J. B., Garnweidner-Holme, L. M., Lukasse, M., & Terragni, L. (2018). Women's experiences with using a smartphone app (the Pregnant+ app) to manage gestational diabetes mellitus in a randomised controlled trial. Midwifery, 58, 102-108.

Sleet, D. A., & Dellinger, A. M. (2020). Using behavioral science theory to enhance public health nursing. Public Health Nursing, 37(6), 895-899.

Surendran, S., Lim, C. S., Koh, G. C. H., Yew, T. W., Tai, E. S., & Foong, P. S. (2021). Women's usage behavior and perceived usefulness with using a mobile health application for gestational diabetes mellitus: Mixed-methods study. International Journal of Environmental Research and Public Health, 18(12), 6670.

Tavakkoli, Mahmoodi M, & S, A. (2018). Study the effect of educational intervention based on the Health Belief Model (HBM) on quality of life among women with gestational diabetes. Journal of Research in Medical and Dental Sciences, 6(2), 245-252.

Tian, Y., Zhang, S., Huang, F., & Ma, L. (2021). Comparing the efficacies of telemedicine and standard prenatal care on blood glucose control in women with gestational diabetes mellitus: Randomized controlled trial. JMIR Mhealth Uhealth, 9(5), e22881.

Wah, Y. Y. E., McGill, M., Wong, J., Ross, G. P., Harding, A. J., & Krass, I. (2019). Self-management of gestational diabetes among Chinese migrants: A qualitative study. Women Birth, 32(1), e17-e23.

World Health Organization. (2019). WHO consolidated guideline on self-care interventions for health: Sexual and reproductive health and rights. Geneva: WHO.

Xie, Y., Zhao, H., Zhao, M., Huang, H., Liu, C., Huang, F., & Wu, J. (2022). Effects of resistance exercise on blood glucose level and pregnancy outcome in patients with gestational diabetes mellitus: A randomized controlled trial. BMJ Open Diabetes Research & Care, 10(2), e002622.

Yang, X., Zhang, J., Wang, X., Xu, Y., Sun, L., Song, Y., Bai, R., Huang, H., Zhang, J., Zhang, R., Guo, E., & Gao, L. (2022). A self-efficacy-enhancing physical activity intervention in women with high-risk factors for gestational diabetes mellitus: Study protocol for a randomized clinical trial. Trials, 23(1), 461.

Yong, H. Y., Shariff, Z. M., Rejali, Z., Yusof, B. N. M., Yasmin, F., & Palaniveloo, L. (2018). Seremban Cohort Study (SECOST): A prospective study of determinants and pregnancy outcomes of maternal glycaemia in Malaysia. BMJ Open, 8(1), e018321.

Zandinava, H., Sehhatti Shafaei, F., Mohammad-Alizadeh Charandabi, S., Ghanbari Homayi, S., & Mirghafourvand, M. (2017). Effect of educational package on self-care behavior, quality of life, and blood glucose levels in pregnant women with gestational diabetes: A randomized controlled trial. Iranian Red Crescent Medical Journal, 19(4).

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