Background: Gestational diabetes mellitus (GDM) is a common pregnancy complication associated with adverse maternal and neonatal outcomes. Understanding pregnant women’s knowledge, attitude, and perception (KAP) towards GDM is crucial for early detection and proper management.

Objective: To assess the knowledge, attitude, and perception of pregnant women towards GDM at Abia State University Teaching Hospital (ABSUTH), Aba, Nigeria.

Materials and Methods:A descriptive cross-sectional study was conducted among 140 pregnant women systematically selected from the antenatal clinic at ABSUTH from January to June 2025. Data were collected using a pre-tested, interviewer-administered questionnaire covering socio-demographics, obstetric history, knowledge, attitude, and perception of GDM. Descriptive statistics summarised variables, while Chi-square and Pearson correlation tested associations between KAP domains (p < 0.05).

Results: Participants’ mean age was 31.2 ± 5.8 years; most were married (90.7%), multiparous (59.3%), and had a tertiary education (43.6%). Good knowledge of GDM was recorded in 42.1% of respondents, while 34.3% had fair knowledge and 23.6% had poor knowledge. Educational level (p = 0.001) and family history of diabetes (p = 0.012) were significantly associated with knowledge level. Attitudes were generally positive, with 80% agreeing that routine screening is important, and 80.7% supporting education on GDM. However, 32.1% agreed that GDM treatment is stressful. Perceptions showed that 42.9% believed they were at risk of developing GDM, and 62.1% agreed it could harm their baby. Significant positive correlations were found between knowledge and attitude (r = 0.482, p = 0.001), knowledge and perception (r = 0.391, p = 0.002), and attitude and perception (r = 0.415, p = 0.001).

Conclusion: Although pregnant women at ABSUTH demonstrated moderately good knowledge and positive attitudes towards GDM, gaps remain in awareness of personal risk and complications. Targeted educational interventions are recommended to improve early detection and current management practices.

Gestational diabetes mellitus (GDM), defined as any degree of glucose intolerance first recognized during pregnancy, has become an increasingly important public-health concern because of its immediate and long-term consequences for mothers and their offspring [1]. GDM increases the risk of antepartum and peripartum complications (including pre-eclampsia, macrosomia and birth injury), and it also predisposes affected women to later type 2 diabetes, while offspring face higher risks of childhood obesity and metabolic disease. The magnitude of these risks has driven calls for improved screening, early detection and appropriate education during antenatal care [2]. 

Global and regional data indicate a rising burden of diabetes and pregnancy-related hyperglycaemia that disproportionately affects low- and middle-income countries. World Health Organization and large epidemiologic studies report marked increases in diabetes prevalence over recent decades, and global/regional estimates of GDM vary widely depending on diagnostic criteria; the International Diabetes and Pregnancy Study Group (IADPSG) and Diabetes Atlas–based estimates suggest that the proportion of pregnancies affected may be substantial when universal screening and contemporary criteria are applied. This rising burden underscores the need for local data to guide antenatal services and policy [3,4]. 

In Nigeria, systematic reviews and meta-analyses place GDM prevalence substantially higher than many older regional estimates, with pooled national prevalence around 10 -14% in some analyses; common determinants identified across Nigerian studies include maternal obesity, advanced maternal age, previous macrosomic infant, family history of diabetes and prior adverse obstetric outcomes. Heterogeneity between studies is high because of differing screening strategies and diagnostic criteria, but the overall evidence indicates that GDM is a common and growing problem in Nigeria that requires context-specific interventions [5]. 

Knowledge, attitudes and perceptions (KAP) about GDM are central determinants of timely care-seeking, adherence to lifestyle recommendations, and acceptance of screening and treatment during pregnancy. Recent Nigerian KAP studies report that a substantial proportion of pregnant women have limited awareness of GDM, misunderstand its risk factors and complications, or do not perceive themselves as at risk — findings that have been reported in diverse settings such as secondary and tertiary antenatal clinics across the country. Low levels of knowledge and variable attitudes at the community and facility levels reduce the effectiveness of early detection and management efforts, and they limit the impact of routine antenatal counselling unless targeted health education is provided [5]. 

Despite indications that GDM is common in Nigeria and that pregnant women’s knowledge and perceptions are often insufficient, there is a relative paucity of recent, location-specific research for many states. Abia State has limited contemporary published data on pregnant women’s knowledge and perceptions specific to gestational diabetes; the few local studies that exist (for example, older glucose surveys from the region) are outdated and do not address current KAP, screening practices, or the influence of changing sociodemographic factors (rising urbanization, maternal obesity, and shifts in reproductive age). This lack of up-to-date, local evidence makes it difficult to design targeted health education, screening policies, and training for antenatal providers in Abia State [6]. 

Existing evidence motivates a focused KAP study in Abia State. This investigation aims to quantify current levels of knowledge, attitudes and perceptions among pregnant women attending antenatal clinics, identify sociodemographic and obstetric correlates of poor knowledge or negative attitudes, and reveal gaps in antenatal counselling and health system preparedness. Such evidence is essential to inform context-specific education interventions, strengthen screening uptake, and ultimately reduce the immediate and long-term burdens of GDM for women and children in Abia State and comparable settings across Nigeria. This study assessed the knowledge, attitude, and perception of pregnant women towards GDM at Abia State University Teaching Hospital (ABSUTH), Aba, Nigeria.

Study Design
A descriptive cross-sectional hospital-based study design was employed to assess the knowledge, attitude, and perception of pregnant women towards gestational diabetes mellitus (GDM). This design was chosen as it allows for the collection of data at a single point in time, providing a snapshot of participants’ understanding and opinions about GDM.
Study Area
The study was conducted at the Antenatal Clinic (ANC) of Abia State University Teaching Hospital (ABSUTH), Aba, Abia State, Nigeria. The hospital is a major tertiary health institution in the southeast geopolitical zone of Nigeria, providing specialist healthcare services, including obstetric and gynaecological care, to a diverse population within Abia State and neighbouring states. The ANC operates on weekdays and records a high patient turnover, with an average of 50–70 pregnant women attending each clinic day. The patient population is heterogeneous, comprising individuals from various socio-economic and educational backgrounds.
Study Population
The study population comprised pregnant women attending the antenatal clinic at ABSUTH during the study period, regardless of their gestational age, parity, or previous pregnancy outcomes.
Inclusion Criteria
Pregnant women registered and attending ANC at ABSUTH during the study period.
Women who gave informed consent to participate in the study.
Women aged 18 years and above.
Exclusion Criteria
Pregnant women who were critically ill at the time of the study.
Those who declined participation.
Women with cognitive or communication impairments that could hinder effective response to the questionnaire.
Sample Size Determination
The sample size was determined using Cochran's formula for estimating population proportions, as outlined by Ezebuiro et al. [8]:
n = (Z^2 (Pq))/e^2   
The formula components are defined as follows:
n represents the minimum required sample size.
Z is set at 1.96, corresponding to a 95% confidence level.
P denotes the established prevalence of contraceptive use among women in Nigeria.
e signifies the allowable margin of error, fixed at 5% (0.05).
q = 1 - p
A recent study conducted by Ajiboye et al. [9] reported the prevalence of GDM in Nigeria as 9% 
P = 9% = 0.09
q = 1 – 0.09
= 0.91
n = ((1.96)^2 (0.09 x 0.91))/〖(0.05)〗^2  
n = (3.8416 x (0.0819))/0.0025 
n = (0.3146)/(0.0025) = 125.85
The minimum sample size was 126, but it was adjusted to 140 to account for a 10% non-response rate.
Sampling Technique
A systematic random sampling technique was used. Using the ANC attendance register, the sampling interval was determined by dividing the estimated number of eligible pregnant women attending ANC during the study period by the required sample size [10]. The first participant was selected randomly, and every 5th eligible woman was subsequently recruited until the sample size was attained.
Study Duration
The study was conducted over a 6-month period from January to June 2025.
Study Instrument
Data were collected using a structured, pre-tested, interviewer-administered questionnaire, developed after reviewing relevant literature on GDM. The questionnaire was divided into four sections:
Section A: Socio-demographic and obstetric characteristics (e.g., age, parity, education, occupation, gestational age).
Section B: Knowledge of GDM (definition, risk factors, symptoms, complications, prevention).
Section C: Attitude towards GDM (using a 5-point Likert scale ranging from "strongly agree" to "strongly disagree").
Section D: Perception towards GDM (using a 5-point Likert scale ranging from "strongly agree" to "strongly disagree").
The knowledge component was scored, with correct answers assigned one point and incorrect answers assigned zero points. Scores were categorised as good, fair, or poor knowledge based on tertile cut-offs.
Pre-testing of the Instrument
The questionnaire was pre-tested on 20 pregnant women attending ANC at a different hospital (Rhema University Teaching Hospital, Aba) to ensure clarity, relevance, and reliability. Necessary modifications were made based on feedback. The reliability coefficients (Cronbach’s alpha) for the knowledge, attitude, and perception domains were 0.82, 0.79, and 0.81, respectively, indicating good internal consistency.
Data Collection Procedure
Data collection was carried out over a period of six Months by trained research assistants fluent in English and Igbo languages. For illiterate participants, the questionnaire was read aloud in their preferred language, and their responses were recorded accordingly. On average, each interview lasted 20–25 minutes.
Ethical Considerations
This study was approved by the Abia State University Teaching Hospital Research Ethics Committee with reference number ABSUTH/MAC/117//VOL.II/78. Written informed consent was obtained from each participant after a thorough explanation of the study objectives, procedures, and potential benefits. Confidentiality was maintained by using anonymised codes instead of personal identifiers, and participants were assured that their participation was voluntary and could be withdrawn at any stage without any consequences to their medical care.
Data Analysis
Data were entered into Statistical Package for the Social Sciences (SPSS) version 26.0 for analysis. Descriptive statistics such as frequencies, percentages, means, and standard deviations were used to summarise variables. Knowledge scores were categorised into good, fair, and poor based on tertile distribution. Attitude and perception scores were similarly categorised into positive/negative and favourable/unfavourable, respectively, based on median cut-offs. The Chi-square test was used to assess associations between categorical variables, while independent t-tests were applied for continuous variables. A p-value of less than 0.05 was considered statistically significant.

The study included 140 participants, most of whom were aged between 30–34 years (26.43%) or 35–39 years (22.14%), married (90.71%), and had tertiary (43.57%) or secondary education (37.14%). The predominant occupations were trading (33.57%) and civil service (27.86%) (Table 1). Obstetric history showed that the largest proportion had 3–4 pregnancies (44.29%) and were multiparous (59.29%), with 13.57% reporting a history of macrosomia, 10.71% with previous preeclampsia, 18.57% having a family history of diabetes, and 29.29% with a family history of hypertension (Table 2).

Knowledge of gestational diabetes mellitus (GDM) was varied, with 68.57% correctly identifying its definition, 62.86% recognizing at least three risk factors, and 53.57% identifying at least two complications for the baby. Overall, 42.14% demonstrated good knowledge, 34.29% fair, and 23.57% poor (Table 3).

Attitudes towards GDM were generally positive, with most participants agreeing that routine screening is important (80%) and that pregnant women should be educated about GDM (80.72%). The majority also believed lifestyle changes can reduce risk (76.43%), although a notable proportion disagreed that GDM treatment is too stressful (44.29%) (Table 4). Perceptions were moderate, with 42.86% agreeing they were at risk of developing GDM, 62.14% agreeing it can cause serious harm to the baby, and 56.43% acknowledging that cultural beliefs influence its management (Table 5).

Analysis revealed that knowledge was significantly associated with educational level (p = 0.001) and family history of diabetes (p = 0.012), but not age group (Table 6). Correlation analysis indicated significant positive relationships between knowledge and attitude (r = 0.482, p = 0.001), knowledge and perception (r = 0.391, p = 0.002), and attitude and perception (r = 0.415, p = 0.001) (Table 7).

Table 1: Sociodemographic Characteristics of Participants

Table 2: Obstetric and Medical History of Participants

Table 3: Knowledge of Gestational Diabetes Mellitus

Table 4: Attitude towards Gestational Diabetes Mellitus (n = 140)

Table 5: Perception towards Gestational Diabetes Mellitus (n = 140)

Table 6: Factors Associated with Knowledge Level on GDM (n = 140)

*Significant at p < 0>

Table 7: Correlation between Knowledge, Attitude and Perception Scores (n = 140)

*Significant at p < 0>

The sociodemographic profile of the study participants shows that most women were aged 25–39 years and were overwhelmingly married, with a high level of formal education (43.6% tertiary). This age and marital distribution are typical of antenatal clinic populations in Nigeria and other sub-Saharan settings, where married, mid-reproductive-age women constitute the majority of ANC attendants. The relatively high proportion with tertiary education in this sample helps explain some of the stronger knowledge scores observed, since education is strongly associated with greater awareness and understanding of pregnancy complications, including gestational diabetes mellitus (GDM). Large Nigerian hospital-based surveys and cross-sectional studies have similarly reported that higher educational attainment is associated with better awareness and knowledge of GDM and related preventive behaviours [11,12]. 

Overall knowledge in this study was mixed: 42.1% of participants had “good” knowledge, 34.3% “fair,” and 23.6% “poor.” This distribution places the cohort somewhat above several reports from the region that document generally low awareness of GDM but below studies from better-resourced tertiary centres that report higher awareness. For example, some Nigerian tertiary-centre studies have reported high overall awareness and that many antenatal women understand risk factors and effects of GDM, whereas community or lower-resourced settings often show much lower awareness or knowledge gaps. These disparities reflect heterogeneity in information transfer during ANC, differing outreach and health-education programs, and variable media and social networks as sources of information. The mixed knowledge levels in this study mirror a common regional picture: pockets of adequate knowledge mostly linked to education and healthcare exposure, but persistent gaps remain that leave a substantial minority with insufficient understanding [6,11]. 

The participants of this study showed favorable attitudes in several key areas: most agreed that routine screening is important (79.1% combined strongly agree/agree), that pregnant women should be educated about GDM (80.7%), and that lifestyle changes can reduce risk (76.4%). These positive attitudes are encouraging because they indicate receptivity to preventive interventions and screening programs. Other recent studies in Nigeria and neighbouring countries report similar positive attitudes toward screening and education when women are aware of GDM. However, the item showing many women disagreed that “GDM treatment is too stressful” suggests a notable proportion perceive GDM management as burdensome or anxiety-provoking; that perception can impair adherence to recommended dietary, glucose-monitoring, or treatment regimens and therefore requires attention in counselling. The coexistence of positive attitudes toward screening but concerns about treatment burden underscores that knowledge alone is not sufficient — supportive, practical counselling and health system measures (e.g., easy access to screening, simplified follow-up, peer support) are also needed [11]. 

Perception items reveal a moderate perceived personal risk (only 42.9% strongly agree/agree that “I am at risk of developing GDM”) and stronger belief that GDM can harm the baby (62.1% strongly agree/agree). The moderate perceived risk despite reasonable knowledge suggests a disconnect between general knowledge of GDM and women’s appraisal of their personal vulnerability. This is consistent with other studies in sub-Saharan Africa showing that even when women recognise GDM as harmful, many do not consider themselves personally at risk unless they have obvious risk markers (older age, prior macrosomia, obesity, or family history). The finding that many respondents agreed cultural beliefs influence GDM management (56.4% strongly agree/agree) aligns with qualitative and mixed-methods reports from Nigeria which emphasise that traditional beliefs, family norms, and local health-seeking behaviours shape how pregnancy complications are interpreted and managed. Interventions therefore must be culturally sensitive and involve family/community influencers to be effective [6]. 

The association analyses in this study showed two important determinants of good knowledge: educational level (p = 0.001) and family history of diabetes (p = 0.012). The education effect is well documented in the literature; multiple African and Nigerian studies find that women with secondary or tertiary education are significantly more likely to know about GDM, its risk factors, complications, and preventive strategies. Likewise, family history often raises awareness because family members with diabetes bring the disease into everyday conversation and increase the chance that women encounter information about diabetes. Such patterns were also reported in regional cross-sectional work and reinforce the need to target health education at less-educated women and those without personal or familial exposure to diabetes. Targeted messaging (simple, pictorial, community outreach) at lower-education groups will likely narrow knowledge gaps and improve early screening uptake [11,12]. 

The correlation analysis reveals significant, moderate positive relationships between knowledge and attitude (r = 0.482), knowledge and perception (r = 0.391), and attitude and perception (r = 0.415), all statistically significant. These correlations suggest that better factual knowledge is associated with more positive attitudes toward screening and prevention and with perceptions that recognise the seriousness of GDM. This pattern is concordant with health-behaviour theory and empirical findings: information and understanding shape attitudes, which in turn influence perceived susceptibility and readiness to adopt preventive measures. Several recent studies have reported similar positive links between knowledge and attitudes/practices in pregnancy-related conditions, implying that education efforts can have downstream benefits for uptake of screening and lifestyle interventions. However, correlation does not prove causation; multifaceted approaches that combine knowledge transfer with skills, motivation, and system facilitation are most likely to change behaviours [12]. 

When compared with national and regional syntheses, the findings of this present study sit within the documented heterogeneity of GDM awareness and knowledge in Nigeria. A systematic review and meta-analysis of GDM in Nigeria reported wide prevalence estimates (0.5–38%) and emphasised common determinants such as previous macrosomia, obesity, family history, and advanced age [5]. That broad epidemiologic heterogeneity is mirrored in awareness studies: some tertiary centres and urban cohorts report relatively high awareness and acceptable knowledge levels, while community-based or rural studies frequently find low awareness and knowledge. More recent multi-centre and regional reviews continue to show that a sizeable fraction of pregnant women remain unaware of GDM or its potential harms. The implication is that national maternal health programs should standardise GDM health education content in ANC and strengthen routine screening policies to detect and manage cases early [5]. 

Practically, these results point to several action priorities. First, ANC health education sessions should include explicit, repeated messaging on GDM, definition, risk factors, maternal and neonatal complications, the benefits of screening, and what management entails, tailored to literacy levels in the local population. Second, routine and accessible screening (with clear referral pathways) should be strengthened so positive attitudes toward screening translate into actual testing. Third, counselling must address concerns about the stress of treatment by explaining practical management strategies (dietary guidance, feasible glucose-monitoring routines, and where to get help) and by offering social support structures (peer groups, family counselling). Fourth, outreach should target groups with lower education and those without a family diabetes history, using community health workers, visual aids, and radio/WhatsApp channels that reach lower-literacy audiences. Finally, because cultural beliefs influence management, community leaders and family decision-makers should be engaged in health education to ensure interventions are acceptable and effective. These suggested responses are consistent with recommendations from recent regional studies emphasising health education, standardised ANC messaging, and context-appropriate screening strategies [6]. 

The findings of this present study demonstrate a mixed but promising picture: appreciable proportions of pregnant women possess good knowledge and positive attitudes toward GDM and screening, but nearly one quarter retain poor knowledge and many underestimate their personal risk. Education level and family history significantly predict knowledge, and knowledge correlates positively with attitude and perception. These findings are consistent with regional and national literature and highlight the urgent need to standardise GDM education across ANC services, expand routine screening, and design culturally sensitive interventions targeting less-educated women and those without familial exposure to diabetes. Implementing these steps will strengthen prevention, timely detection, and management of GDM, helping reduce adverse maternal and neonatal outcomes in Abia State and similar settings.