Awareness of Future Type 2 Diabetes Risk Among Parous Women With and Without Self-Reported Prior Gestational Diabetes in Riyadh, Saudi Arabia: A Questionnaire-Based Cross-Sectional Survey

Background: Gestational diabetes mellitus (GDM) is a major opportunity for type 2 diabetes mellitus (T2DM) prevention, yet gaps remain in the transition from postpartum care to long-term diabetes prevention despite clear management guidelines. This study evaluated awareness of future T2DM risk among parous women in Riyadh, Saudi Arabia, comparing women with and without a self-reported history of GDM, and identified sociodemographic and clinical determinants of risk awareness and adherence to follow-up and preventive measures. Methods: This observational, questionnaire-based cross-sectional survey included 316 parous women in Riyadh (n = 88 with self-reported prior GDM; n = 228 without), recruited non-probabilistically via a self-administered Google Forms questionnaire distributed through WhatsApp. GDM status, risk awareness, sociodemographic parameters, and postpartum screening and lifestyle-modification outcomes were all self-reported and not verified against medical records. Full awareness was defined a priori as selecting the highest of three ordered response options (“Yes, I am fully aware”) on a single item assessing whether GDM increases future T2DM risk; the remaining two options were combined as low/moderate awareness. Analyses used Pearson’s Chi-square tests and multivariable logistic regression to compute adjusted Odds Ratios (aOR). The primary between-group comparison was adjusted for age and educational attainment, with equivalence assessed by two one-sided tests (TOST) and subgroup differences by likelihood-ratio interaction tests. Results: A prior self-reported history of GDM was not associated with significantly elevated long-term risk awareness when compared with parous women without self-reported prior GDM (71.6% vs. 66.2% full awareness; p = 0.361, phi coefficient, φ = 0.06); this remained the case after adjustment for current age and education (aOR = 1.02, 95% CI 0.57–1.82, p = 0.936), and formal equivalence could not be established at a ±10 percentage-point margin (TOST p = 0.209). Older current age (≥45 years) was associated with higher awareness (78.0% vs. 60.3%; OR = 2.34, 95% CI 1.41–3.88, p = 0.0009). Within the GDM subset, structured postpartum counseling was associated with higher awareness levels (89.5% for scheduled appointments vs. 50.0% for no counseling; p = 0.002). In the whole sample of 316 parous women, multivariable analysis identified high awareness as the strongest independent correlate of self-reported adherence to postpartum glucose screening (aOR = 3.57, 95% CI 2.04–6.23, p < 0.001), with prior GDM diagnosis also independently associated with screening (aOR = 2.18, 95% CI 1.27–3.74, p = 0.005). Because postpartum glucose screening is specifically indicated only after GDM, a corresponding analysis was restricted to the 88 women with self-reported prior GDM, in whom 66.7% of those with full awareness reported having been screened compared with 16.0% of those with low/moderate awareness (OR = 10.50, p < 0.001). Conclusions: A prior history of GDM did not translate into higher self-reported awareness of future T2DM risk. Within the prior-GDM subgroup, structured postpartum counselling was associated with higher risk awareness, which was in turn associated with greater self-reported adherence to postpartum screening. Given the cross-sectional design and self-reported exposures and outcomes, these findings represent associations only and cannot establish causality or direction of effect.