Pregnant Women Knowledge On The Consequence And Risks Factors Of Gestational Diabetes Mellitus And Self Care Measures In Uyo

Medical and Health Science Project and Seminar Material

Pregnant Women Knowledge On The Consequence And Risks Factors Of Gestational Diabetes Mellitus And Self Care Measures In Uyo


Abstract


Diabetes mellitus is a common complication in pregnancy. Its classification has been reviewed to reflect the various aetiological factors. Pre-conception care, early antenatal bookings dedicated multidisciplinary ante natal care, and delivery in a centre with neonatal facility would reduce morbidity and mortality associated with the condition. The study is aimed at accessing the Knowledge and attitude of gestational diabetes among pregnant women attending Uyo maternal and child centre Akwa-Ibom state. 250 pregnant women were recruited for the study, all in their second and third trimesters attending Uyo maternal and child centre Akwa-Ibom state. Questionnaires were administered on each woman and data was collected. Results showed presence of risk factors among respondents. These includes having miscarriages, stillbirths, glucosuria, having GDM in previous pregnancies, history of diabetes in first degree relative, being obese, being delivered of large and small babies in previous pregnancies etc. 11.2% of the respondents were diagnosed with gestational diabetes mellitus in this pregnancy. This could be attributed to lack of adequate exercise and feeding among respondents. Recommendations in this study include prenatal counseling, antenatal care, exercises, eating balanced diet etc. by pregnant women to improve maternal and child health and reduce morbidity and mortality of both mother and child.


Table of Content


  • Title Page
  • Certification
  • Dedication
  • Acknowledgement
  • Table of Content
  • List of Tables
  • Abstract

Chapter One:

Introduction

  • 1.1 Background of the Study
  • 1.2 Statement of the Problem
  • 1.3 Objective of the Study
  • 1.4 Research Questions
  • 1.5 Research Hypothesis
  • 1.6 Significance of the Study
  • 1.7 Scope of the Study
  • 1.8 Limitation of the Study
  • 1.9 Definition of Terms
  • 1.10 Organisations of the Study

Chapter Two:

Review of Literature

  • 2.1 Conceptual Framework
  • 2.2 Theoretical Framework
  • 2.3 Empirical Review

Chapter Three:

Research Methodology

  • 3.1 Research Design
  • 3.2 Population of the Study
  • 3.3 Sample Size Determination
  • 3.4 Sample Size Selection Technique and Procedure
  • 3.5 Research Instrument and Administration
  • 3.6 Method of Data Collection
  • 3.7 Method of Data Analysis
  • 3.8 Validity of the Study
  • 3.9 Reliability of the Study
  • 3.10 Ethical Consideration

Chapter Four:

Data Presentation and Analysis

  • 4.1 Data Presentation
  • 4.2 Analysis of Data
  • 4.3 Answering Research Questions
  • 4.4 Test of Hypotheses
  • 4.5 Discussion of Findings

Chapter Five:

Summary, Conclusion and Recommendation

  • 5.1 Summary
  • 5.2 Conclusion
  • 5.3 Recommendation
  • References
  • APPENDIX
  • QUESTIONNAIRE

Chapter One


Introduction

1.1 Background to the Study

Gestational diabetes mellitus is defined as glucose intolerance first identified during pregnancy (Mukerji et al, 2016). While glucose intolerance resolves with delivery 90% of the time, it continues to affect women’s health postpartum (American Diabetes Association, 2017). Diabetes predisposes a woman to obesity, high blood pressure, preeclampsia, unsatisfactory progress of labour, premature rupture of membranes, perineal tearing and shoulder dystocia (Di Bernardo et al, 2017; Prakash et al, 2017). Pregnant women with gestational diabetes are at higher risk of developing type 2 diabetes than pregnant women without gestational diabetes (Herath et al, 2017). There has been a rapid rise in the incidence of diabetes in pregnancy, which has been attributed to the increasing number of women of reproductive age with pre-gestational diabetes and an increase in accurate diagnosis of gestational diabetes (Chukwunyere et al, 2015).

A woman with gestational diabetes in pregnancy is 10.6 times more likely to develop diabetes within 10 years, after controlling for other variables, compared with women without gestational diabetes (Herath et al, 2017). While the overall prevalence of gestational diabetes in women is 12.8%, the prevalence of gestational diabetes increases in direct proportion to the prevalence of type 2 diabetes in a given population, making pregnant women with a pre-existing diagnosis of diabetes at greater risk of developing gestational diabetes (Muche et al, 2019). There are many morbidities associated with gestational diabetes; knowledge of the risks and timely screening of mothers could be beneficial in reducing the complications seen in diabetes in pregnancy (Chukwunyere et al, 2015).

Women with histories of gestational diabetes may not perceive themselves to be at risk for future diabetes. Spirito et al (2018) found that, among 67 women with gestational diabetes, two-thirds did not believe they would develop gestational diabetes during a future pregnancy, and one-fifth did not believe they were at risk for diabetes. In Nigeria, a study found a prevalence of gestational diabetes of 4.8% among 250 pregnant women, which was linked to malnutrition (Ewenighi et al, 2016). Qualitative studies in several high-risk groups such as the Pima Indians and Mexican Americans suggest that these women may believe that gestational diabetes does not pose a problem after delivery (Kim et al, 2017). However, this conclusion cannot be generalised to other populations.

Theoretical models suggest that risk perception may be an important determinant of behavioural change. In the case of diabetes prevention, higher and more accurate perceptions of risk might encourage a healthier lifestyle, including a healthy diet and adequate physical activity. In contrast, underestimating risk might prevent women from making healthy lifestyle changes, and could therefore be a target for behavioural interventions by health professionals, governments, and policy makers.

Diabetes mellitus occurs throughout the world, but it is more common (especially type 2) in the more developed countries. The greatest increase in prevalence is however expected to occur in Asia and Africa, where most patients will probably be found in 2030. The increase in the incidence in developing countries follows the trend of urbanization and life style changes, perhaps most importantly a “western-style” diet. But there is little understanding of the mechanism(s) at present, though there is much speculation, some of it most compellingly present (Wild et al; 2018). Diabetes mellitus has no doubt been on the increase in prevalence for the past 10years in Nigeria. The National prevalence puts it at about 2.2% and this continues to increase (Nyenwa et al; 2016).

Globally, as of 2010, an estimated 285 million people had diabetes, with type 2 making up to about 90% of the cases. Its incidence is increasing rapidly, and by 2030, this number is estimated to almost double.

Gestational diabetes mellitus is associated with both morbidity and mortality in both mother and child. Since it is much in common condition and associated with significant morbidity and mortality, its early detection is very important as treatment greatly affects pregnancy outcome (Steve, 2019).

Recent American Diabetes Association guidelines recommend selective screening for gestational diabetes mellitus (GDM) based on the presence of the risk factor. Because there is high incidence of GDM among certain ethnic groups, ethnicity is included as one of the risk factor during routine screening (American Diabetes Association, 2020).

Gestational diabetes is thought to arise because the many changes, hormonal and otherwise, that occur in the body during pregnancy lead some women to become resistant to insulin. Insulin is a hormone made by specialized cells in the pancreas that allows the body to effectively use glucose for fuel (energy). When levels of insulin are low or the body cannot effectively use insulin, blood glucose levels rise.

Some degree of insulin resistance and impaired glucose tolerance is normal in late pregnancy. However, in some women this risk factors that can increase your risk of getting gestational diabetes. Risk factors include: Being overweight or obese, Having a history of gestational diabetes in a previous pregnancy, having had a baby with high birth weight (over 9 pounds), having parent or sibling with type 2 diabetes, having polycystic ovary syndrome (PCOS), being of African American, African Indian, Asian American, Hispanic or pacific Islander American ethnicity, If you are an older mom, age 35 or over etc (American Diabetes Association, 2020).

Good parental care is important for all pregnant mothers, but especially important for women who carry risk factors gestational diabetes. Diabetes during pregnancy needs to be properly controlled to ensure the well-being of both the mother and the baby (American Diabetes Association, 2020).

Usually, under your healthcare provider’s guidance, a healthy balanced diet and more exercise can go a long way towards controlling gestational diabetes. Occasionally, insulin will also be used to use to keep blood glucose levels as close to normal as possible. Good control will ensure a happy healthy outcome for all (American Diabetes Association, 2020).

Women with gestational diabetes who receive proper care typically go on to deliver healthy babies. However, if you have high blood glucose levels, the elevation in the blood glucose can cause the fetus to be larger than normal, possible making delivery more complicated. The baby is also at risk for having low blood glucose (hypoglycemia) immediately after birth. Other serious complication of poorly controlled diabetes in the new born can include an increased risk of jaundice, an increase risk for respiration distress syndrome and a higher chance of dying before or following birth. The baby is also at a greater risk of becoming overweight and developing type 2 diabetes later in life. Diabetes in early pregnancy, there is an increased risk of birth defects and miscarriage compared to those mothers without diabetes.

Women with gestational diabetes have a higher chance of needing a cesarean birth (C-section) due to the large sizes of their babies. Gestational diabetes may increase the risk of preclampsia in the mother, a condition characterized by high blood pressure and protein in urine. Women with gestational diabetes are also at increased risk of having type 2 diabetes after pregnancy (American Diabetes Association, 2020).

The poor performance of Nigeria’s health system can therefore also be primarily attributed to poor financial resourcing of health services. The bulk of the nation’s resources come from oil revenues, which are deposited into the federation account and shared among federal, state and local governments according to an allocation formula. The federal government is currently unable to monitor the expenditure of funds allocated for secondary and primary health services, while local governments allocate funds with little influence from state as observers (Olakunde, 2015).

In most settings of developing counties including Nigeria, there is limited access to medical care and the need to identify women whose pregnancy is at increased risk of complications is an important part of antenatal screening.
The situation is more critical in Nigeria, especially in Akwa-Ibom state where the resource allocation to the health sector is increasingly being challenged by other competing requirement such as those associated with rising insecurity in Nigeria, rising cost of governance, poverty, ignorance or illiteracy, cultural and religious beliefs and the most of all, corruption.

There has been no report exploring the ways in which diabetes risk perception is associated with preventive behaviours in women with histories of gestational diabetes, particularly after accounting for knowledge of diabetes risk factors, perceived personal control, and optimistic bias. Appropriate care of pregnant women throughout pregnancy has a significant contribution on the growth and development of the unborn child and has a crucial role in reducing maternal and neonatal mortality. This study aimed to assess the Knowledge and attitude of gestational diabetes among pregnant women attending Uyo maternal and child centre Akwa-Ibom state.


1.2 Statement of the Problem

GDM is estimated to occur in about 5.5-8.8% of all pregnancies, associated with both morbidity and mortality in both mother and child. It may also damage the health of the fetus or the mother. Another major concern is that about 20 to 50of women with GDM develop type 2 diabetes and obesity later in life.

The association between risk perception and behaviour has been inconsistent, with some studies demonstrating an association between risk perception and preventive behaviours but others not finding such an association (Ferrer and Klein, 2015). One explanation for these inconsistencies is that the links between behaviour and risk perception are poorly specified (Alberti and Zimmet, 1998). Another explanation is that other factors that may affect risk perception are not adequately accounted for in the analysis. These factors include knowledge of diabetes risk factors, the degree to which a woman believes that risk is modified by her actions (perceived personal control) and one’s assessment of their risk compared with others like them (optimistic bias) (Metzger et al, 2016).

There has been no report exploring the ways in which diabetes risk perception is associated with preventive behaviours in women with histories of gestational diabetes, particularly after accounting for knowledge of diabetes risk factors, perceived personal control, and optimistic bias. Appropriate care of pregnant women throughout pregnancy has a significant contribution on the growth and development of the unborn child and has a crucial role in reducing maternal and neonatal mortality. This study aimed to assess the Knowledge and attitude of gestational diabetes among pregnant women attending Uyo maternal and child centre Akwa-Ibom state, which will contribute to planning effective preventive interventions of diabetes in pregnancy.


1.3 Objective of the Study

The main objective of the study is to assess the pregnant women knowledge on the consequence and risks factors of gestational diabetes mellitus and self care measures in uyo, Akwa-Ibom state. Specifically, the study aims to

  1. Determine the effects of GDM on pre-natal complications.
  2. Discuss the pattern, risk factors, morbidity/mortality, and complications of gestational diabetes.
  3. To propose strategies for prevention of GDM among pregnant women.
  4. The study will also facilitate further study from where this project paused for academic excellence.

1.4 Research Questions

  1. Does GDM affect pre-natal complications?
  2. Does GDM affect the morbidity and mortality rate of pregnant women and their babies?
  3. Are there strategies for the prevention GDM among pregnant women?

1.5 Research Hypothesis

The hypothesis of this study is that Gestational Diabetes Mellitus is given as:

  • Ho: GDM does not significantly impact on pre-natal complications
  • Hi: GDM significantly impact on pre-natal complications.

1.6 Significance of the Study

The health system is faced with an increase in Gestational diabetes mellitus. Therefore, pregnancy complication will require increased resource to manage appropriate glycemic control during pregnancy and reduce adverse prenatal outcomes (Obasi et al; 2017). In addition ~50% of women with GDM are expected to develop type 2 diabetes within 5years of index pregnancy (Patrick et al; 2020). Recent clinical trials have shown that health behaviours such as diet and physical activities prevent or delay onset of diabetes (Tuomilehto et al; 2021, knowler et al; 2018). Such behaviours interventions have been shown to be cost effective at a higher level than a pharmacological intervention (Hernan et al; 2019). Therefore, clinicians will increasingly have to primate plasma glucose testing and improved health behaviours at post-partum visits of women who had GDM to prevent development of diabetes and recurrent GDM. Also, some physicians may not recognize that women with GDM are at risk of diabetes.


1.7 Delimitation of the Study

This study on the pregnant women knowledge on the consequence and risks factors of gestational diabetes mellitus and self care measures in uyo, Akwa-Ibom state. The delimitations of this study significantly narrow the scope of the research. Some of these delimitations include:

  1. Participation in this study is voluntary.
  2. The population is restricted to pregnant women in Uyo, Akwa-Ibom state.
  3. The sample is limited to pregnant women with gestational diabetes mellitus.
  4. Only few hospitals (antenatal clinics) are involved in the study out of many clinics in Uyo metropolis.
  5. Religious and cultural belief affects women participation in the study.

1.8 Limitation of the Study

This research work is specifically on the Knowledge and attitude of gestational diabetes among pregnant women attending Uyo maternal and child centre Akwa-Ibom state. In the limitation on research work of this magnitude or nature can be carried out without limitation. Hence, during the course, certain constraints were encountered.

Cost:

The cost of thorough research is not what can be afforded by a student. The prices of materials needed for this work has gone up and transport fee has also gone up.

Time:

The time was one of the limitations in the process of carrying out this research work.

Scarcity of Literature:

The research encountered some problems in collection of literature especially on the bank History and operations. This are hindered the smooth running of this work.


1.9 Operational Defination of Terms

Gestational Diabetes Mellitus:

Gestational diabetes mellitus is defined by the world health organization as being “any degree of glucose intolerance with onset or first recognition during pregnancy” and should therefore include glucose readings that fall within diagnostic ranges for diabetes.

Prevalence:

Refers to the total number of cases of a disease in the given statistical population at a given time. According to Wikipedia free encyclopedia, in epidemiology, it is the proportion found to have a condition (typically a disease or risk factor). It arrived by comparing the number of people found to have a condition with the total number of people studied. Usually expressed as a fraction, percentage or as a number of cases per 100,000 people.

Risk Factors:

This refers to something that increases a person’s chances of developing a disease eg. Cigarette smoking is a risk factor for lung cancer, and obesity is a risk factor for heart disease.

Glucose Tolerance (Impaired):

Is a situation whereby blood glucose is raised beyond normal range but not high to cause diabetes. It is a risk factor for diabetes.

Insulin Resistance:

Is a condition in which the body produces insulin but does not use it effectively.

Morbidity:

The incidence of a disease and the rate of a population affected. Or the quality of being unhealthful, morbid.

Mortality:

This is the condition of being susceptible to death or the death rate of a population.

Prenatal Care:

Refers to the care given to pregnant woman before birth. Also known as antenatal care.

Perinatal Outcomes:

These are outcomes pertaining to the time around birth.


1.10 Organization of the Study

This research work is organized in five chapters, for easy understanding, as follows.

  • Chapter one is concern with the introduction, which consist of the (overview, of the study), historical background, statement of problem, objectives of the study, research hypotheses, significance of the study, scope and limitation of the study, definition of terms and historical background of the study.
  • Chapter two highlights the theoretical framework on which the study is based, thus the review of related literature.
  • Chapter three deals on the research design and methodology adopted in the study.
  • Chapter four concentrate on the data collection and analysis and presentation of finding.
  • Chapter five gives summary, conclusion, and recommendations made of the study.

Chapter Five


Summary, Conclusion and Recommendation

5.1 Summary

Gestational diabetes poses serious fetal complications and decreases maternal quality of life. The risk that GDM poses is both mother and child. It causes abnormal growth and chemical imbalances in the child after birth. It also results in hypoglycemia after birth in addition to being larger than normal. Other risks include increased risk of jaundice, respiratory distress syndrome etc. counseling before and during pregnancy is required in order to prevent complications that arises due to GDM which increases maternal and child morbidity and mortality. This study is centered towards reducing the complications that are being caused as a result of gestational diabetes and reducing the rate of maternal and child mortality which has become an issue of great concern in the health sector.


5.2 Conclusion

It was shown in the result of this study that the prevalence of GDM is 11.2%. Also, it has been concluded that this due to the eating habits and behavior /life style adopted by most women before and during pregnancy. A considerable number of women in this study do not eat well(balanced diet) and do not exercise well. Others not exercise at all, therefore increasing their risk of GDM considerably. It has been established that the presence of risk factors exposes one GDM more than its absence. It has also been established in the results of this study that a lot of risk factors exist among a number of women which included having GDM in previous pregnancies, having had miscarriages, still births , glucosuria, having being delivered of large/ small babies, history of diabetes in first degree relative, being obesed etc.


5.3 Recommendations

Some of the recommendations of this study include:

Prenatal counseling:

This requires that all women (at child bearing age ) who are expecting to be pregnant receives proper counseling from medical experts on how to go through the gestational period successfully with no or minimal complications. This will go a long way in improving maternal and child health as pregnant women go through this period with little orientation or completely ignorant of this vital information.

Ante Natal Care:

Although it is a common practice in most parts of the world, women should still be encouraged to go for ante natal care during pregnancy especially in rural areas. This should also be done early so that some complications can be avoided.

Exercise / Body Workouts:

Most pregnancies comes with a lot of inconviniences which might make a woman very lazy and unwilling to undergo any stress especially exercises. But exercises are very important and recommended to women who are pregnant to help them prevent some diseases and assist them during delivery. Exercise goes a long way in preventing and controlling gestational diabetes. At least 30 minutes walk, thrice a week is the recommendation for every pregnant woman with or without gestational diabetes mellitus.

Balanced Diet:

Aside exercises, pregnant women are advised to always eat balanced diet to help them remain health and help the baby to be healthy as well. GDM is also controlled by consumption of balanced, I encourage pregnant women (especially in the northern part of the country where a large percentage of meals are carbohydrates) to eat more balanced diet and a lot of fruits.


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