Effects of Self-care Education on Perceived Stress in Women with Gestational Diabetes under Insulin Treatment

Document Type : Original Quantitative and Qualitative Research Paper


1 Evidence Based Care Research Centre, Associate professor of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

2 MS in Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

3 Evidence Based Care Research Centre, Instructor of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

4 Associate Professor of Biostatistics, School of health, Mashhad University of Medical sciences, Mashhad, Iran

5 Professor of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

6 Associate Professor of General Courses, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


Background: Gestational diabetes (GA) is a common complication, associated with adverse prenatal outcomes and perceived stress. The effects of education on perceived stress have been widely investigated, whereas the role of self-care in GA has been less noted.
Aim: to determine the effects of self-care education on perceived stress in women with GA under insulin treatment.
Methods: In this randomized controlled trial, 60women with GA under insulin treatment (at 24-30 weeks of gestation), referring to the diabetes clinic of Mashhad Omolbanin Hospital, were divided into intervention and control groups in 2014. Self-care education included four one-hour sessions (one-week intervals) in groups consisting of 6-8 members. The researcher-made self-care questionnaire and Cohen’s Perceived Stress Scale were completed before and four weeks after the intervention. Independent t-test, Mann-Whitney and covariance analysis were performed, using SPSS version 16.
Results: The mean age of the participants was 32.4±0.5 years in the intervention group and 31.4±4.8 years in the control group. Before the intervention, the perceived stress score in the intervention group (27.6±8.0) was not significantly different from that of the control group (27.5±6.8) (P=0.74). However, after the intervention, the scores significantly reduced in the intervention group (23.4±8.3), compared to the control group (28.1±7.5) (P<0.001).
Conclusion: Self-care education might improve self-care and reduce perceived stress in patients with GA. Therefore, self-care is suggested as an effective method for reducing stress in these patients.


Main Subjects

1.Bastani F, Zarrabi R. Correlations of Self-efficacy among Women with Gestational Diabetes. Hayat 2011;16(3):56-107. (persian)
2.Cuninngham FG, Leveno Kj, Bloom SL, Spong CY, Dashe JS, Hofman BL, et al. Williams Obstetrics. 24nd ed. United States America: Mc Graw Hill Education; 2014.
3.Boozari Z, Yazdani S, Abedi M, Mohammad Nataj M, Imami Meybodi S. Examining  the Prevalence and Associated Factors of Gestational Diabetes in Pregnant Women Attending Health Centers -Medical City of Babol. IJOGI 2013;16(43):6-13. (persian)
4.Khoshniat Nikoo MK, Ahranjani SA, Larijani B. A Review on the Prevalence of Gestational Diabetes Mellitus in Different Regions of Iran. Iranian Journal of Diabetes & Lipid Disorders 2008;8(1):1-10. (persian)
5.Cheung KW, Wong SF. Gestational Diabetes Mellitus Update and Review of Literature 2012; Available at: URL: http://www.omicsonline.org/gestational-diabetes-mellitus-update-and-review-of-literature.
6.Keshavarz M, Cheung NW, Babaee GR, Kalalian moghadam H, Ajami ME, Shariati M. Gestational Diabetes in Iran: Incidence, Risk Factors and Pregnancy Outcomes. Diabetes Res Clin Pract 2005;69(3):279–86. (persian)
7.Afkhami Ardakani M, Rashidi M. Gestational Diabetes Mellitus (Review article). Medical Journal of Hormozgan 2008;11(1):1-12. (persian)
8. Larejani B, Hossein nezhad A. Diabetes Mellitus and Pregnancy.IJDLD 2001;1(1):9-22.  (persian)
9.Horri N, Haghighi S, Amini M, Zare M, Abazari P, Hassanzadeh A. Relation Between the Number of Major Negative Stressful Life Events and Undiagnosed Glucose Metabolism Disorders (IGT, Diabetes) in First-Degree Relatives of Type 2 Diabetics.Iranian Journal of Endocrinology and Metabolism 2008;10(1):17-23. (persian)
10.Hayase  M, Shimada  M, Seki H. Sleep Quality and Stress in Women with Pregnancy-Induced Hypertension and Gestational Diabetes Mellitus.Women and Birth 2014;27(3): 190–5.
11.Hamid N. Effects of Stress Management Training on Glycemic Control in Women with Type 2 Diabetes. Iranian Journal of Endocrinology and Metabolism 2011;13(4):346-53.(persian)
12.Salari P, Alavian F, Habibi rad A, Tara F. The Relationship between Stress, Anxiety and Pain with Salivary Cortisol Levels in First Stage of Labor in Primiparous Women. IGOJI 2013;16(55):14-21.(persian)
13.Hui A, Sevenhuysen G, Harvey D, Salamon E. Stress and Anxiety in Women with Gestational Diabetes during Dietary Management. Diabetes Educ 2014;40(5):668-77.
14.Lazarus RS, Folkman S, editors. Stress, Appraisal and Coping. New York: Springer;1984.
15.Bjorntorp P HG, Rosmond R. Hypothalamic Arousal, Insulin Resistance and Type2 Diabetes Mellitus.Diabet Med 1999;16(5):373-83.
16.Keshavarz Z, Simbar M, Ramezankhani A. Effective Factors on Coping with Stress among Employed Women based on Integrated Model of Planned Behavior and Self-Efficacy. Payesh 2012;11(5):685-96.(persian)
17.Karasek R, Theorell T. Healthy work: Stress, Productivity, and the Reconstruction of Working Life1992; Available at: URL: http://www.amazon.com/Healthy-Work-Productivity-Reconstruction-Working.
18.Hjelm K, Bard K, Nyberg P, Apelqvist J. Management of Gestational Diabetes from the Patient’s Perspective – A Comparison of Swedish and Middle-Eastern born Women. J Clin Nurs 2007;16(1):168-78.
19.Honarpishe Z. To Self-Care 2014; Available at:URL: http://www.qums.ac.ir. (persian)
20.Momeni javid F, Simbar M, Dolatian M, Alavi majd H. Comparison of Pregnancy Self-Care, Perceived Social Support and Perceived Stress of Women with Gestational Diabetes and Healthy Pregnant Women.  Iranian Journal of Endocrinology and Metabolism 2014;16(3):156-222.(persian)
21.Heisler M, Bouknight RR, Hayward RA, Smith DM, Kerr EA. The Relative Importance of Physician Communication, Participatory Decision Making, and Patient Understanding in Diabetes Self‐Management. J Gen Intern Med 2002;17(4):243-52.
22.Jafarian AS, Zabihi A, Babaieasl F, Eshkevari N, Bijani A. Self Care Behaviors in Diabetic Patients Referring to Diabetes Clinics in Babol City, Iran. JBUMS 2010;12 (4):72-8. (persian)
23.Mendelson SG, McNeese‐Smith D, Koniak‐Griffin D, Nyamathi A, Lu MC. A Community‐Based Parish Nurse Intervention Program for Mexican American Women with Gestational Diabetes. J Obstet Gynecol Neonatal Nurs 2008;37(4):415-25.
24.Bell J. Reducing Barriers to Glucose Control in Patients with Gestational Diabetes. Am Nurse Today 2015;10(1):1-3.
25.Shirazi M, Anousheh M. Review of History and Changes in Self Care Education to Diabetic Patients in the World, Iran and the Nurses Position in this Field. Iranian Journal of Medical Education 2011;10(5):972-81.(persian)
26.Nielsen KK, De courten M, Kapur A. Health System and Societal Barriers for Gestational Diabetes Mellitus Services - Lessons from World Diabetes Foundation Supported GDM projects. BMC Int Health Hum Rights 2012;12(33):3-10.
27.Shojafard J, Nadrian H, Baghiani Moghadam M, Mazlumi Mahmudabad S, Sanati H, Asgar Shahi M. Effects of an Educational Program on Self-Care Behaviors and Its Perceived Benefits and Barriers in Patients with Heart Failure in Tehran. payavard 2009;2(4):43-55. (persian)
28.Safaei M, Shokri O. Assessing Stress in Cancer Patients: Factorial Validity of the Perceived Stress Scale in Iran. IJPN 2014;2(1):13-22.(persian)
29.Saeidpour J, Jafari M, Ghazi Asgar M, Dayani Dardashti H. Effect of Educational Program on Quality of Life in Diabetic Patients. Journal of Health Administration 2013;16(52):26-36. (persian)
30.Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy. 2013; Available at: URL: www. bookorders@who.int.
31.About Diabetes 2014; Available at:URL: http://www.who.int/diabetes/ action_online/ basics/en/ index1.
32.Larijani B, Pajouhi M, Aghaei Meybodi H,Khoshniat Nikoo M, Sharghi S,Mohajeri Tehrani MR 'et al". The Principles of Nutrition in Diabetes 2010; Available at:URL: http://emri.tums.ac.ir. (persian) 
33. Delavari A, Hazaveh A, Norouzi Nejad A, Yar Ahmadi Sh. National Program to Prevent and Control Diabetes 2004; Available at:URL: http://behdasht.gov.ir. (persian)
34.Delavari A, Hazaveh A, Norouzi Nejad A, Yar Ahmadi Sh. Physician and Diabetes. National Program of Prevention and Control of Diabetes 2004; Available at:URL: http://www.behdasht.gov.ir. (persian)
35.Torabi P, Abdullahi Z, Minaie M, Zarei M, Maani S, Sadeghi Ghotabadi F 'et al'. Country Guidelines of Nutrition for Family Physician Program 2013; Available at:URL: http://nut.behdasht.gov.ir.(persian)
36.Metzger BE, Biastre SA, Gardner B. What I Need to Know about Gestational Diabetes 2013; Available at:URL: http://www.niddk.nih.gov/health-information/health-topics/Diabetes/ gestational-diabetes/Pages/index.aspx.
37. National Diabetes Services Scheme (NDSS). Gestational Diabetes Caring for Yourself and Your Babys 2010; Available at:URL: https://www.diabetesqld.org.au/media/33447/ gestational_diabetes_booklet.
38.Kim H, Kim S. Effects of an Integrated Self-Management Program on Self-Management, Glycemic Control, and Maternal Identity in Women with Gestational Diabetes Mellitus. Korean Acad Nurs 2013;43(1):69-80.
39.Limruangrong P, Sinsuksai N, Ratinthorn A, Boriboonhirunsarn D. Effectiveness of a Self-Regulation Program on Diet Control, Exercise, and Two-Hour Postprandial Blood Glucose Levels in Thais with Gestational Diabetes Mellitus. Pac Rim Int J Nurs Res Thail 2013; 15(3): 173-87.
40.White KM, Terry DJ, Troup C, Rempel LA, Norman P, Mummery K, et al. An Extended Theory of Planned Behavior Intervention for Older Adults with Type 2 Diabetes and Cardiovascular Disease. J Aging Phys Act 2012;20(3):281-99.
41.Khoshtarash M, Momeni M, Ghanbari A, Salehzadeh A, Rahmatpour P. Self-Care Behaviors and Related Factors in Patients with Heart Failure Reffering to Medical & Educational Center of Heart in Rasht. Holist Nurs Midwifery 2013;23(1):22-9. (persian)
42.Kim HS, Oh JA. Adherence to Diabetes Control Recommendations: Impact of Nurse Telephone Calls. J adv nurs 2003;44(3):256-61.
43.Parizad N, Hemmati Maslakpak M, Khalkhali HR. Promoting Self-Care in Patients with Type 2 Diabetes: Tele-education. Hakim 2013;16(3):220-7.(persian)
44.Jalilian F, Zinat Motlagh F, Solhi M. Effectiveness of Education Program on Increasing Self- Management among Patients with Type II Diabetes.  Journal of Llam University of Medical Sciences 2011;20(1):26-34. (persian)
45.Salsali M, Salehi H, Noktehdan H, Hoseini M, Nikoo MK, Ebrahimi S. Evaluation of the Effect of Using Symptom Focused Management Model on the Amount of HbA1c, Knowledge, and Self- Care Behavior of Type 2 Diabetes Patients. Evidence Based Care Journal 2013;3(2):27-36.
46. Ko JM, Lee JK. Effects of a Coaching Program on Comprehensive Lifestyle Modification for Women with Gestational Diabetes Mellitus. J Korean Acad Nurs 2014;44(6):672-81.