The correlation between risk perception and glycemic management decision-making behavior in pregnant women with gestational diabetes: a cross-sectional study

Enhancing risk perception is pivotal for pregnant women with gestational diabetes to manage disease risks and forms the foundation for health-related decision-making behavior, primarily adhering to standardized glycemic management. Given that the association between risk perception and decision-making behavior, along with influencing factors, remains poorly defined, elucidating their interrelationship is crucial. This research may also provide theoretical underpinnings for clinical disease management strategies. The study employed convenience sampling to select pregnant women with gestational diabetes who underwent regular prenatal checkups at a Grade A tertiary hospital in Fujian Province from January to July 2025 as the study participants. Data were collected using an interviewer-administered structured questionnaire package, which included an author-developed general information questionnaire and five validated scales: the gestational diabetes risk perception scale, the behavioral decision-making scale for glycemic management in pregnant women with gestational diabetes, the perceived social support scale, the chronic disease self-efficacy scale, and the e-Health literacy scale. Path analysis was conducted using structural equation modelling. Among the 315 participants, risk perception was positively correlated with glycemic management decision-making behavior ( r = 0.386, P < 0.01). Both risk perception and glycemic management decision-making behavior were positively correlated with e-health literacy, social support, and self-efficacy ( r = 0.368–0.496, all P < 0.01). Social support had a significant direct effect on risk perception (β = 0.492, P < 0.001) and a significant total effect on glycemic management decision-making behavior (β = 0.558, P < 0.001), while its direct effect on decision-making behavior was not statistically significant (β = 0.062, P = 0.471). Risk perception had a significant direct effect on glycemic management decision-making behavior (β = 0.612, P < 0.001). Self-efficacy had a significant direct effect (β = 0.253, P = 0.002) and a significant total effect (β = 0.285, P = 0.001) on decision-making behavior. The direct effect of e-health literacy on decision-making behavior was not statistically significant (β = 0.125, P = 0.072) and was identical to its total effect. The risk perception and glycemic management decision-making behavior of pregnant women with gestational diabetes are influenced by multiple factors. During disease management, both the individual’s level of perceived disease risk and behavioral factors should be taken into account. This approach assists patients in developing accurate risk cognition, thereby enhancing their capacity to make health-related decisions within complex real-world settings and ultimately improving health outcomes.