{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T18:17:56Z","timestamp":1793038676091,"version":"4.5.0"},"reference-count":40,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"unspecified","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Aarhus University"},{"DOI":"10.13039\/501100004191","name":"Novo Nordisk","doi-asserted-by":"publisher","award":["NNF17OC0027826"],"award-info":[{"award-number":["NNF17OC0027826"]}],"id":[{"id":"10.13039\/501100004191","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,12,21]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To develop and validate the Internalised Stigma Scale for Gestational Diabetes Mellitus (ISS-GDM), a questionnaire measuring self-reported internalised stigma among women with prior gestational diabetes mellitus (GDM). We hypothesised that internalised GDM stigma could be reliably and validly assessed through a short psychometric instrument.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional validation study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Follow-up data from the Danish, multicentre Face-it trial for women with prior GDM and their families.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>In total, 248\u2009women completed the ISS-GDM approximately 1 year after their GDM affected pregnancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was psychometric properties of the ISS-GDM, assessed using Cronbach\u2019s alpha, confirmatory factor analysis (CFA) and Rasch analysis (RA). Secondary outcomes included identification of item anomalies (local response dependence, differential item functioning).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A large proportion of respondents endorsed statements reflecting self-disappointment, self-blame and an altered self-perception. Less endorsed statements included feeling inferior to other mothers or guilt towards family members due to GDM. The ISS-GDM demonstrated satisfactory psychometric properties. CFA indicated that item 2 assessing self-perceived capabilities as a mother did not load onto the main factor, while CFA and RA identified local response dependence and differential item functioning by body mass index. After adjustments, a two-factor solution supported calculating a sum score of items 1 and 3\u201311, with item 2 retained as a stand-alone indicator of perceived parenting capabilities. The 10-item scale demonstrated acceptable reliability (Cronbach\u2019s alpha=0.78).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The ISS-GDM is a reliable and valid tool for assessing internalised stigma among women with prior GDM. Our findings further suggest that a substantial proportion of women with prior GDM experience self-blame and an altered self-perception due to their diagnosis. The ISS-GDM scale enables research into its prevalence, severity and consequences.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-098109","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T12:40:46Z","timestamp":1767789646000},"page":"e098109","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Psychometric validation of the Internalised Stigma Scale for Gestational Diabetes Mellitus (ISS-GDM): a cross-sectional study"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct03997773","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1753-1858","authenticated-orcid":false,"given":"Emma","family":"Davidsen","sequence":"first","affiliation":[{"name":"Department of Prevention, Steno Diabetes Center Copenhagen, Herlev, Denmark"},{"name":"Department of Public Health, Aarhus University, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helle Terkildsen","family":"Maindal","sequence":"additional","affiliation":[{"name":"Department of Prevention, Steno Diabetes Center Copenhagen, Herlev, Denmark"},{"name":"Department of Public Health, Aarhus University, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4518-5187","authenticated-orcid":false,"given":"Karl Bang","family":"Christensen","sequence":"additional","affiliation":[{"name":"University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Damm","sequence":"additional","affiliation":[{"name":"Rigshospitalet, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly","family":"Byrne","sequence":"additional","affiliation":[{"name":"University of Galway, Galway, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inger K","family":"Dahl-Petersen","sequence":"additional","affiliation":[{"name":"Department of Prevention, Steno Diabetes Center Copenhagen, Herlev, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth R","family":"Mathiesen","sequence":"additional","affiliation":[{"name":"Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark"},{"name":"Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorte M","family":"Jensen","sequence":"additional","affiliation":[{"name":"Odense University Hospital, Odense, Denmark"},{"name":"Steno Diabetes Center Odense, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5084-6053","authenticated-orcid":false,"given":"Christina","family":"Vinter","sequence":"additional","affiliation":[{"name":"Steno Diabetes Center Odense, Odense, Denmark"},{"name":"Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulla","family":"Kampmann","sequence":"additional","affiliation":[{"name":"Steno Diabetes Center Aarhus, Aarhus, Denmark"},{"name":"Department of Clinical Medicine, Aarhus University, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per G","family":"Ovesen","sequence":"additional","affiliation":[{"name":"Steno Diabetes Center Aarhus, Aarhus, Denmark"},{"name":"Department of Clinical Medicine, Aarhus University, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4058-0615","authenticated-orcid":false,"given":"Karoline","family":"Kragelund Nielsen","sequence":"additional","affiliation":[{"name":"Steno Diabetes Center Copenhagen, Herlev, Capital Region of Denmark, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"2026010704403494000_16.1.e098109.1","unstructured":"International Diabetes Federation . 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