Sustaining a sense of unknowing about the risk for coronary artery disease following a diagnosis of gestational diabetes mellitus: a grounded theory study

While both men and women possess traditional risk factors for coronary artery disease (CAD), such as smoking and obesity, they are also confronted with non-traditional risk factors, including gestational diabetes mellitus (GDM). Women diagnosed with GDM have a fourfold increased risk of CAD compared to women without the condition, meaning they have an increased risk for future CAD compared with women without a history of GDM. The aim of this study was to examine women’s experiences as they receive a diagnosis of GDM and start to explore how to manage their health risks. A grounded theory approach guided the study. Data analysis occurred concurrently with data collection using a constant comparative approach that involved substantive and theoretical coding, memoing, and diagramming to support theory development. Twenty-six semi-structured interviews were conducted with women diagnosed with GDM in Newfoundland and Labrador (NL), Canada. Participants’ narratives described the process that sustained women in a state of unknowing about their increased CAD risk post-GDM compared to women who did not have GDM. Participants’ health care trajectory towards acknowledging and living with their risk of CAD was hindered by the perception that they had no future health risks once GDM resolved. Two categories that explain how participants sustained a sense of unknowing about their risk for CAD are (1) Communicating Risk, and (2) Drawing Conclusions About One’s Risk. This study highlights gaps in CAD risk communication among women with a history of GDM in NL. Participants reported being unaware of their risk, with limited HCP communication and gendered norms emerging as important factors in their experiences. Findings suggest opportunities to strengthen HCP education and integrate structured risk communication into perinatal and postpartum care. Addressing these gaps may support women in understanding their CAD risk and making informed health decisions.