GESTATIONAL DIABETES AMONG WOMEN ATTENDING ANTENATAL CARE AT GENERAL HOSPITAL, OKIGWE

ABSTRACT

This study was carried out on gestational diabetes among women attending antenatal care at General Hospital, Okigwe. The target population comprised of pregnant women who are attending antenatal care in General Hospital, Okigwe in Rivers State, who were also be involved as participants in the data collection process for analysis. The sampling technique used was the random sampling technique as this was suitable for the study of this nature with a case study. The sample size was determined using the Taro Yamane’s formula. The sample size was calculated to be 200. The researcher utilized a self-structured questionnaire with closed-ended questions to collect data used for analysis in the study. The results were presented in tables. The Statistical Package for Social Sciences (SPSS version 20.0) was used for all analyses. The result of the study showed that the respondents had a good knowledge and awareness of gestational diabetes. The study also showed that knowing blood sugar level and keeping it under control, eating a healthy diet as outlined by the healthcare provider, getting regular, moderate physical activity, maintaining a healthy weight gain, and taking insulin and/or other medications as prescribed by the caregiver are all the accepted strategies for managing gestational diabetes. The study recommended that nurses should engage in in-service training in their respective wards to improve their knowledge and practices on gestational diabetes management.

CHAPTER ONE

INTRODUCTION

1.1 Background to the study

Diabetes is a disease in which the blood glucose of the body or the blood sugar level is too high. When you are pregnant, high blood sugar is not good for the body. According to Tahseen (2015), Gestational diabetes is a condition in which women without previously diagnosed diabetes exhibit high blood glucose (sugar) levels during pregnancy (especially during their third trimester). Gestational diabetes is caused when insulin receptors do not function properly. This is likely due to pregnancy related factors such as presence of human placental lactogen that interferes with susceptible insulin receptors. This in turn causes inappropriately elevated sugar levels.

Gestational Diabetes Mellitus (GDM) is carbohydrate intolerance of varying seventy with onset or first recognition during pregnancy (custom, 2011). It does not exclude the possibility that the glucose intolerance may antedate pregnancy but has been previously unrecognized. The definition applies irrespective of whether or not insulin is used for treatment or th condition persist after pregnancy (WHO, 2011). Resistance to insulin develops in all mothers during pregnancy. In about two to four percent pregnant women, result in temporary diabetes. It happens because pregnant women have less ability to produce extra insulin to overcome insulin resistance (Tahseen, 2015).

Gestational diabetes affects 3–10% of pregnancies, depending on the population studied, gestational diabetes generally has few symptoms and it is commonly diagnosed by screening during pregnancy. Diagnostic tests detect inappropriately high levels of glucose in blood samples (Thomas et al; 2015). About 7 out of every 100 pregnant women in the united State gets gestational diabetes. Gestational diabetes is diabetes is diabetes that happens for the first time when a woman is pregnant. Most of the time, it goes away after you have your baby. But it does increase your risk of obesity and type 2 diabetes.

Gestational diabetes may damage the health of the fetus or mother and about 20 to 50% of women with gestational diabetes develop type 2 diabetes later in life. Gestational diabetes occurs in about 5.5 – 8.8% of all pregnancies (Kenneth, 2016). It is temporary and fully treatable, but if untreated, may cause problem with pregnancy such as macrosomia, (height birth weight), fetal malformations, increased caused respiratory syndrome. Hyperbilirubinemia may result from red blood cell destruction in this type of diabetes. In severe cases perinatal death may occur, most commonly as a result of poor placental perfusion due to vascular impairment (Kenneth, 2016).

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; 2014). 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; 2013).

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 (O’sullivan, 2015).

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, 2000). 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, 2000). 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, 2010).

1.2 Statement of problem

Usually, under a 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, 2010). 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, 2010). 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, 2012). 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 states and most of the areas 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. Furthermore, Gestational Diabetes 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 50%of women with Gestational Diabetes develop type 2 diabetes and obesity later in life. It is against this backdrop that this study is carried out to evaluate the gestational diabetes among women attending antenatal care at General Hospital, Okigwe

1.3 Objectives of the study

The general objective of this study is to assess the gestational diabetes among women attending antenatal care at General Hospital, Okigwe. Specifically, the study seeks to;

1. Determine the pregnant women’s knowledge and awareness of gestational diabetes

2. Assess risk factors, behaviours and lifestyle of gestational diabetes among pregnant women in General Hospital, Okigwe

3. Determine the strategies for management and prevention of gestational diabetes among pregnant women in General Hospital, Okigwe

1.4 Research questions

The following questions were formulated based on the research problem and objectives;

1. What are the pregnant women’s knowledge and awareness of gestational diabetes?

2. What are the risk factors, behaviours and lifestyle of gestational diabetes among pregnant women in General Hospital, Okigwe?

3. What are the strategies for management and prevention of gestational diabetes among pregnant women in General Hospital, Okigwe?

1.5 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 (Crowther et al; 2015). In addition ~50% of women with GDM are expected to develop type 2 diabetes within 5years of index pregnancy (Kim et al; 2012). Recent clinical trials have shown that health behaviours such as diet and physical activities prevent or delay onset of diabetes (Tuomilehto et al; 2011, Knowler et al; 2012). Such behaviours interventions have been shown to be cost effective at a higher level than a pharmacological intervention (Hernan et al; 2013). 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.

This study would also serve as a point of reference and information based on the results that would be derived from the analysis and interpretation for policy implication by major stakeholders and health authorities. It is desirable to have information on management of gestational diabetes among pregnant women to help bridge any identified gaps and enable them better understand the benefits of compliance and adherence to healthy risk-free beaiour. Also, this study will contribute to the existing body of literature and serve as a reference for future research in related fields.

1.6 Scope of study

This study is delimited to the gestational diabetes among women attending antenatal care at General Hospital, Okigwe. The variables considered in the study include the pregnant women’s knowledge and awareness of gestational diabetes, the effects of gestational diabetes on pre-natal complications among pregnant women, risk factors, behaviours and lifestyle of gestational diabetes among pregnant women, and the strategies for management and prevention of gestational diabetes among pregnant women.

1.7 Operational definition of terms

Gestational Diabetes: also known as Gestational diabetes mellitus (GDM) is a condition in which a woman without diabetes develops high blood sugar levels during pregnancy. Babies born to mothers with poorly treated gestational diabetes are at increased risk of being too large, having low blood sugar after birth, and jaundice. Long term, children are at higher risk of being overweight and developing type 2 diabetes.

Pregnancy: also known as gestation is the time during which one or more offspring develops inside a woman. Pregnancy may be confirmed with a pregnancy test and is typically divided into three trimesters.