Physical Activity and Sedentary Behavior of Chinese Immigrants in the United States with Prior Gestational Diabetes Mellitus

Date of Award

Spring 2022

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Whittemore, Robin


Gestational Diabetes Mellitus (GDM) is one of the most common complications during pregnancy with short- and long-term consequences for mothers and children. In the long term, women with prior GDM have a ten-fold risk of progressing to type 2 diabetes (T2D) compared to those without prior GDM. Chinese immigrants in the US are disproportionately affected by GDM and T2D. Physical activity (PA) and sedentary behavior (SB) are two modifiable behaviors to prevent T2D. The aims of this dissertation study were: 1) to describe the patterns of objectively measured PA and SB among Chinese immigrants in the US with prior GDM, and 2) to identify knowledge & risk perception, cultural, and psychosocial factors associated with PA and SB.The collective results of the three dissertation manuscripts prepared for publication include the need for a continuous, comprehensive, and culturally sensitive care model for women with GDM. The first manuscript (Chapter 2) is a systematic review of lifestyle interventions for GDM in pregnancy and the postpartum period. We identified issues related to fragmentation of care highlighting the potential benefit of continuous care from prenatal to postpartum for women with GDM. The second manuscript (Chapter 3) was a secondary data analysis project that identified the prevalence and determinants of elevated depressive symptoms among Chinese women with GDM. In this study, we demonstrated a high co-occurrence of elevated depressive symptoms and GDM in our sample. While further research is indicated for Chinese immigrants with GDM, assessment of mental health status to ensure comprehensive care may be warranted among people with GDM. In the third manuscript (chapter 4) of the results of the dissertation study, we identified unique immigration and cultural factors related to PA and SB of Asian/Chinese immigrants with prior GDM. In the dissertation study, we conducted a cross-sectional study between 2020-2021 among Chinese immigrants with prior GDM (6 months to 5 years postpartum) across the US (n=106), recruited primarily via social media platforms (e.g., WeChat). PA and SB were measured by GT9X+ accelerometers. Validated questionnaires were used to assess knowledge & risk perception, cultural, and psychosocial characteristics available in English and Chinese. Descriptive, bivariate, and multiple regression analyses were performed to identify factors associated with activity levels. The mean age of participants was 34.3±3.7 years, and the mean BMI was 21.7±2.6 kg/m2. About 73% had a master’s degree or higher, and 67% were employed. Virtually all mothers were originally from mainland China and married with 1-2 children. The majority were US citizens (15%) or permanent residents (52%). About half were within 0.5-1 year postpartum. Only 27% of participants met the PA guidelines of 150 minutes or more of moderate- to vigorous-intensity activity (MVPA) per week. The duration of MVPA per week was 79 [IQR 38– 151] minutes. The average daily steps were 5908±2138 steps. Participants had an average of 9.2±1.4 hours of sedentary time per day, which was about 64.7±7.8% of the total wear time. The average prolonged SB time was 2.5±1.4 hours. In the final adjusted models, not living with parents was associated with fewer MVPA minutes per week, fewer steps per day, and lower a likelihood of meeting PA guidelines. Higher acculturative stress was associated with fewer MVPA minutes per week. Higher social support was associated with living with parents. Being employed was associated with both prolonged and percentage of SB time. Strategies are needed to increase MVPA among this high-risk group, including decreasing acculturative stress and increasing family social support. Different strategies are needed to decrease SB among this population. More research to develop culturally-sensitive PA interventions is warranted. Ultimately, more research is needed to incorporate all three aspects of GDM care by developing culturally-sensitive GDM programs with comprehensive components from pregnancy to postpartum for understudied high-risk groups.

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