Original Article

The Impact of Socio Economic Factors on the Adherence of Patients with Gestational Diabetes Mellitus to Medical Recommendations


Background: Adherence to medical recommendations is very important to control gestational diabetes mellitus (GDM), as one of the most important disorders during pregnancy. In this study, we explored the impact of socio-economic status (SES) on the adherence of a cohort of GDM in Iran.

Methods: In this prospective study, 230 pregnant women with confirmed GDM were followed from Feb to Jun 2013 in a referral diabetic care center in Iran. The SES of subjects were quantified using a combined score generated by principal component analysis (PSA). Medical adherence score of subjects was measured in three follow up visits in a range of 0 to 10 and were linked to SES using linear regression model.

Results: The adherence scores women in the first, second, and third follow up visits were 5.06±2.12, 5.46±2.06, and 5.08±1, respectively. Women fourth quartile of SES (the highest level of SES) has a least compliance to medical orders in comparison to first quartile of SES (the lowest level of SES) with the OR -2.75 (95% Cl: -3.17, -2.23).

Conclusion: The medical adherence of pregnant women with GDM is significantly poorer in high SES groups. Therefore, as an important determinant, we may target high SES pregnant women to control the adverse effects of the disorder more efficiently.


1. Metzger BE, Buchanan TA, Coustan DR, et al (2007). Summary and recommenda-tions of the fifth international workshop-conference on gestational diabetes melli-tus. Diabetes Care, 30 Suppl 2:S251-60.
2. No Authors list (1997). Report of the expert committee on the diagnosis and classifi-cation of diabetes mellitus. Diabetes Care, 20(7):1183-97.
3. Ben‐Haroush A, Yogev Y, Hod M (2004). Epidemiology of gestational diabetes mellitus and its association with Type 2 diabetes. Diabet Med, 21(2):103-13.
4. Hossein-Nezhad A, Maghbouli Z, Larijani B (2004). The incidence of diabetes and ab-normal glucose tolerance in women at early postpartum with previous gestation-al diabetes. J Diabetes Metab Disord, 4(1):27-34.
5. Dabelea D, Snell-Bergeon JK, Hartsfield CL, et al (2005). Increasing prevalence of ges-tational diabetes mellitus (GDM) over time and by birth cohort. Diabetes Care, 28(3):579-84.
6. Chappuy H, Tréluyer JM, Faesch S, et al (2010). Length of the treatment and number of doses per day as major de-terminants of child adherence to acute treatment. Acta Paediatr, 99(3):433-37.
7. DiMatteo MR, Haskard-Zolnierek KB, Mar-tin LR (2012). Improving patient adher-ence: a three-factor model to guide prac-tice. Health Psychol Rev, 6(1):74-91.
8. Crowther CA, Hiller JE, Moss JR, et al (2005). Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med, 352(24):2477-86.
9. Metzger BE, Persson B, Lowe LP, et al (2010). Hyperglycemia and adverse preg-nancy outcome study: neonatal glycemia. Pediatrics, 126(6):e1545–52.
10. Haynes RB, McKibbon KA, Kanani R (1996). Systematic review of randomised trials of interventions to assist patients to follow prescriptions for medications. Lancet, 348(9024):383-86.
11. Schectman JM, Nadkarni MM, Voss JD (2002). The association between diabetes metabolic control and drug adherence in an indigent population. Diabetes Care, 25(6):1015-21.
12. Elliott WJ, Maddy R, Toto R, Bakris G (2000). Hypertension in patients with dia-betes: overcoming barriers to effective control. Postgrad Med, 107(3):29-32.
13. Braveman P, Gottlieb L (2014). The social determinants of health: it’s time to con-sider the causes of the causes. Public Health Rep, 129 Suppl 2:19-31.
14. Asefzadeh S, Asefzadeh M, Javadi H (2005). Care management: Adherence to thera-pies among patients at Bu-Alicina clinic, Qazvin, Iran. J Res Med Sci, 10(6):343-348.
15. Gnavi R, Petrelli A, Demaria M, et al (2004). Mortality and educational level among di-abetic and non-diabetic population in the Turin Longitudinal Study: a 9-year follow-up. Int J Epidemiol, 33:864-871.
16. Nilsson P, Johansson SE, Sundquist J (1998). Low educational status is a risk factor for mortality among diabetic peo-ple. Diabet Med, 15(3):213-219.
17. Noori A, Shokoohi M, Baneshi MR, et al (2014). Impact of socio-economic status on the hospital readmission of Conges-tive Heart Failure patients: a prospective cohort study. Int J Health Policy Manag, 3(5):251-7.
18. Stasenko M, Liddell J, Cheng YW, et al (2011). Patient counseling increases post-partum follow-up in women with gesta-tional diabetes mellitus. Am J Obstet Gyne-col, 204(6): 522-e1-6.
19. Gonzalez JS, Tanenbaum ML, Commissari-at PV (2016). Psychosocial factors in medication adherence and diabetes self-management: implications for research and practice. Am Psychol, 71(7):539–551.
20. Brown MT, Bussell JK (2011). Medication adherence: WHO cares? Mayo Clin Proc, 86(4):304–314.
IssueVol 48 No 9 (2019) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v48i9.3029
Gestational diabetes mellitus Socio-economic status Adherence Medical orders Factor analysis

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How to Cite
HAGHDOOST AA, BANESHI MR, RAZZAGHI A, NOORI A. The Impact of Socio Economic Factors on the Adherence of Patients with Gestational Diabetes Mellitus to Medical Recommendations. Iran J Public Health. 2019;48(9):1690-1696.