Decision-making process of breastfeeding behavior in mothers with gestational diabetes mellitus based on health belief model

Abstract

Background Gestational diabetes mellitus (GDM) threatens GDM mothers and their offspring’s health and breastfeeding is one of the most effective ways to decrease the risk. However, the prevalence of breastfeeding among GDM mothers is far from optimal and how GDM mothers develop their feeding behavior is still unclear. Thus, this study aimed to explore the formation of GDM mothers’ breastfeeding behaviors based on the health belief model (HBM). Methods A questionnaire survey was conducted on 324 GDM mothers who have given birth within 6 months from January 1 to February 6, 2022. According to HBM, GDM mothers’ knowledge, the perceived threat from GDM, the perceived value of breastfeeding, self-efficacy, social support and GDM mothers’ breastfeeding behavior were measured. Exclusive breastfeeding (EBF) was defined as an infant who received only breast milk in the past 24 h before the survey. Structural equation modeling (SEM) was applied to explore how GDM mothers form their breastfeeding behaviors based on HBM. Results The prevalence of EBF among GDM mothers was 33.95%. GDM mothers had limited knowledge of GDM (average 63.14% correct answer to 7 questions), especially poor on the long-term effect of GDM (39.81%) and protective effect of breastfeeding (34.57%-45.99%). Although GDM mothers showed high perceived benefits (Mean: 3.35, SD: 0.46), high self-efficacy (Mean: 3.43, SD: 0.97) and high level of social support for breastfeeding (Mean: 3.74, SD: 0.74), the various barriers (Mean: 2.20, SD: 0.47) hindered their success in EBF. The SEM results showed that a higher level of social support and more self-efficacy of breastfeeding resulted in a higher likelihood of EBF, while the higher level of knowledge of GDM, perceived higher barriers and benefits of breastfeeding and higher susceptibility to GDM consequences led to less EBF. Conclusion To promote EBF, physicians’ education, emphasizing the protective effect of breastfeeding and how to correct breastfeeding, is highly recommended. In addition, social support for GDM mothers is also important to reduce their barriers to breastfeeding and help enhance self-efficacy in breastfeeding.

Effects of Breastfeeding Knowledge and Health Beliefs Regarding Gestational Diabetes Mellitus on the Breastfeeding Intention of Pregnant Women

“…Furthermore, most items on GDM-related breastfeeding knowledge with a low percentage of correct answers pertained to the bene ts of breastfeeding. Therefore, the long-term impacts of GDM on women and their babies and the protective effects of breastfeeding should be included in the design of breastfeeding education curricula [13]. Speci cally, the provision of GDM-related breastfeeding knowledge should be emphasized more in the early postpartum period than in the gestational period because breastfeeding intention decreases in the postpartum period [23].…”

“…Breastfeeding intention is higher when pregnant women are more aware of the bene ts of breastfeeding and have lower barriers to breastfeeding performance [10]. Therefore, to enhance breastfeeding con dence, the effects of breastfeeding on the long-term in uences of GDM should be highlighted [13]. In addition, since perceived barriers interfere with exclusive breastfeeding [13], the di culties women with GDM may experience when breastfeeding, including delayed breastfeeding initiation and di cultly in breastfeeding if the mother is obese or has given birth by caesarean section, should be explained [6].…”

“…Self-e cacy was also noted as an important factor that directly affects breastfeeding intention in several studies [11,15,16]. It is also a mediating factor for overcoming the intention-practice gap [24] and increases the possibility of exclusive breastfeeding [13]. To increase self-e cacy, strategies to enhance con dence in breastfeeding through positive experiences are needed [25].…”

“…Women's breastfeeding intentions and practices are related to obstetric, social, and cognitive factors, including breastfeeding knowledge and breastfeeding health beliefs [13]. Based on the health belief model, which promotes health behaviors [14], cognitive factors are, in particular, crucial determinants of breastfeeding practice [15,16].…”

“…Based on the health belief model, which promotes health behaviors [14], cognitive factors are, in particular, crucial determinants of breastfeeding practice [15,16]. Most importantly, women with GDM face more burdens and barriers regarding breastfeeding than healthy women due to complications from the condition and delayed breastfeeding initiation [13]. This highlights the need to explore GDM-related breastfeeding knowledge and breastfeeding health beliefs.…”