PREGNANT WOMEN KNOWLEDGE ON THE CONSEQUENCE AND RISKS FACTORS OF GESTATIONAL DIABETES MELLITUS AND SELF-CARE MEASURES AT THE BUEA REGIONAL HOSPITAL

PAGE EXCERPT

The objective of this study is to assess pregnant women knowledge of the consequence and risks factors of gestational diabetes Mellitus and self-care measures at the Buea Regional Hospital. Risks factors of GDM were age, educational level, history of diabetes, chronic illness and gestational age of the participants.

Abstract

The prevalence of diabetes, especially gestational diabetes mellitus (GDM), is increasing globally. GDM is a disorder with both immediate and long term complications.

The objective of this study is to assess pregnant women knowledge of the consequence and risks factors of gestational diabetes Mellitus and self-care measures at the Buea Regional Hospital.

To achieve the study objectives, a sample size of 50 participants (pregnant women) who visited the Buea Regional Hospital at the time of study for ANC by mean of a structured survey questionnaire. Demographic findings of the participants revealed that the majority of the women are in the age group 21-26years.

Most of whom are married and have attended a secondary level of education. The majority of the respondents were married and Christians by beliefs. Obstetric characteristics of the mothers include, the majority were in their gestational age of 31-36weeks, with 2-4 gravidas. Few of the women have had reported a history of spontaneous abortion and unexplained childbirth, with a high record of macrosomia in the family.

The study findings revealed that there was a high familiarity of respondents’ knowledge with GDM (72.7%). Major sources of information on GDM were (25.0%) from the hospital, (34.09%) from friends, (11.36%) from TV, (13.64%) from other patients, while 15.91%) was social media.

The risks factors of GDM in women were statistically significant for age, educational level, history of chronic illness, history of diabetes, history of macrosomia, and increasing gestational age at p < 0.05. Assessment of knowledge on self-care measures of the women revealed a healthy diet and good exercise reduce the risks of GDM.

Also, health counselling on GDM helps improve the health of the mothers with GDM and reduces the risks of contraction of the diseases.

Thus it was recommended routine healthcare education programs should be organized for antenatal women the topic of GDM should be included as a part and all pregnant women irrespective of clinically risk status should be screened for GDM.

CHAPTER ONE

INTRODUCTION

• Background of the study

The prevalence of diabetes, especially gestational diabetes mellitus (GDM), is increasing globally.

In 2015 alone, it was estimated that 20.9 million women had hyperglycaemia in pregnancy, 85.1% of which were due to GDM (International Diabetes Federation, 2015). The complications arising due to GDM affect both the mother and the baby (Holmes et al., 2010). The true prevalence of GDM is unknown, but it has been estimated in the United States of America to vary from 1% to 14% of pregnancies, depending on the population studied and the diagnostic tests used (Chen et al., 2009).

Maternal hyperglycaemic disorders include type 1 and 2 diabetes mellitus (T1/T2DM) and gestational diabetes mellitus (GDM). T1/ T2DM is a state of glucose intolerance occurring independently of pregnancy, while GDM is characterised by glucose intolerance that begins or is first diagnosed during pregnancy and usually resolves after delivery (Reece, 2010).

GDM complicates approximately 4% of all pregnancies and women with it have an approximate 7-fold risk of developing type-2 diabetes mellitus in the future, as well as their children and subsequent generations(Bellamy et al., 2009).

GDM is associated with an increased risk of maternal metabolic syndrome and T2DM and is now the most frequent form of hyperglycaemic disorder during pregnancy.

This fact should alert the obstetrician to the necessity to pay special attention to this segment of the population, especially in low-income countries. The impact of GDM on maternal and fetal health has been increasingly recognized(Leary et al., 2010).

GDM increases the risk of fetal macrosomia, which is associated with secondary complications like shoulder dystocia, cesarean delivery and birth trauma. There is also a concomitant increase in neonatal complications like hypoglycemia, respiratory distress syndrome, hypocalcemia and hyperbilirubinemia(Ovesen et al., 2015).

Unfortunately, due to insufficient focus on prevention and lack of preconception planning, several challenges about maternal healthcare remain. Lack of access to care and financial issues are some barriers to the utilisation of healthcare(Bhavadharini et al., 2016). In addition, health literacy is also becoming a growing and relevant factor that has been shown to decrease the risk of adverse outcomes in non-pregnant diabetic patients(Cavanaugh, 2011). Improving health literacy helps the individual to comprehend and adopt a healthy lifestyle (Baker, 2006). The challenge, however, is that managing GDM requires women to come to terms with their diagnosis in a short period. Therefore, building health literacy skills and knowledge that is required to understand the importance of screening and managing the condition, within this short window period, is sometimes challenging (Bhavadharini et al., 2016).

It has been reported that the global trend of an increased prevalence of diabetes in African populations and the subsequent increase of diabetes in pregnancy is closely linked to the increase in obesity (Sobngwi et al., 2010).In a study of 11 568 pregnant women in six regions of Cameroon, Sobngwi et al. (2010) reported a 5% to 17% prevalence of GDM (World diabetes foundation, 2019). Another study in Cameroon reported a 6.3% (20/316) prevalence of GDM and that in multivariate analysis older age (≥30 years) remained a significant predictor of GDM (Jao et al., 2013)Munang et al. (2017) reported that in a group of 84 pregnant Cameroonian women, the 75g OGTT was reproducible only in 74.2% cases and that maternal age and BMI were factors associated with non-reproducible results (Munang et al., 2017).

Despite the potential adverse impact GDM may have on pregnancy and its outcome, the prevalence and risk factors (advanced maternal age, body mass index (BMI), history of previous stillbirths, large for gestational age (LGA) and macrosomia, family history of diabetes mellitus, history of congenital malformations, history of GDM and polycystic ovarian syndrome (PCOS) etc.) of this condition have not yet been adequately studied in the Buea Regional Hospital. To our knowledge, no epidemiologic study regarding GDM has been carried out in the Buea Regional Hospital, Cameroon.  

Thus this seeks to seek to assess pregnant women knowledge on the consequences of gestational diabetes mellitus and self-care measures at the Buea Regional Hospital.

1.2 Statement of the problem

Diabetes is a chronic health problem with devastating, yet preventable consequences.  It is characterized by high blood glucose levels resulting from defects in insulin production, insulin action, or both(Aljasem et al., 2001). The problem of GDM has an impact on the health of both the mother and the fetus. It is believed that women with good knowledge of the disease condition will help prevent the occurrence of complications such as stillbirth, macrosomia (too large baby), jaundice, hypoglycemia (low blood sugar), dyspnea (difficulty in breathing) and on the other hand, women with limited knowledge are prone to the consequences of the disease. Sobngwi et al. (2010) reported a 5% to 17% prevalence of GDM in Limbe Cameroon.

This situation was observed during an internship at the Buea Regional Hospital where women do not attend antenatal care at an early stage of pregnancy where the disease could be diagnosed during a routine investigation. Some women do not attend at all and only comes during labour leading to complications such as a perineal tear, prolong labour and some even end up in cesarean section as a result of macrosomia baby and preeclampsia. Meanwhile, the foetus also developed hypoglycemia during early postpartum that could be prevented during ANC. This aroused my interest in investigating pregnant women’s knowledge of the consequences and self-care measures of GDM at the Buea Regional Hospital.

1.3 Objective of the study

1.3.1 Main objective

The main objective of this study is to assess pregnant women knowledge on the consequence and risks factors of gestational diabetes Mellitus and self-care measures at the Buea Regional Hospital.

1.3.2 Specific objective

Specifically, the study seeks to;

1. Determined knowledge of pregnant women on Gestational diabetes mellitus during pregnancy
2. Determined the knowledge of pregnant women on the risks factors and consequences of gestational diabetes mellitus.

• To identify the types of self-care measures practical by pregnant women.

1.4 Research question

1. What is the knowledge of pregnant women on GDM?
2. What is the knowledge of pregnant women on the risks factors and consequences of GDM?
3. What are the self-care measures practices of pregnant women in the prevention of GDM?

1.5 Scope of the study

The scope of this work would be limited to assessing pregnant women knowledge on the consequence and risks factors of gestational diabetes mellitus and their self-care measures. The study would be carried out at the Buea Regional Hospital on pregnant women who comes for ANC.

1.6 Significant of the study

The study would be important for the following stakeholders;

To pregnant women

The study will serve as a means to educate pregnant women on risks involved with gestational diabetes mellitus and measures on how to prevent and handle it during pregnancy.

Health institutions

The research will provide health personnel with the knowledge of pregnant women and associated risks factors of gestational diabetes mellitus. This study will not only bring awareness to expected mothers and clinicians, but also provide information for early intervention to reduce gestational diabetes and its negative impacts among the neonates and their mothers, and subsequently reduce the health care cost associated with the complications of gestational diabetes.

To Research community

The study would provide insight and literature on knowledge and risks factors of diabetes mellitus among pregnant women and some of the measures used for the prevention of gestational diabetes mellitus for future researchers undertaking studies on gestational diabetes mellitus.

1.7 Rationale for the study

Gestational Diabetes Mellitus causes life-threatening complications to the mother and the child. Prevalent progression of GDM leads to type 2 diabetes in future. GDM is a preventable disease so to avoid complications it becomes necessary to identify the risk indicators at the earliest. This would help the mother to take a preventive step for herself and the child as well. Pregnancy with complications has to be identified and timely action to be taken for safer deliveries by skilled personnel. Saving the two lives are truly a noble deed. The researcher must make the public realize the importance of GDM. The research will let people know the prevalence, risk factors, preventive measures of the disease. It is very necessary to motivate people regarding GDM.

There are very few studies conducted in Cameroon concerning GDM so people are not aware of the disease. They lack total knowledge about this disease. The person who knows also does not know very well. There is no proper data about its aetiology, prevalence, risk factors, and preventive measures on this disease. Due to a lack of information for the providers they also could not generate the exact information for the target population. The right information on GDM has to be given to all pregnant mothers. As already told the studies done in Cameroon were few it is the right of the Cameroonian citizen to get to know the disease in the best possible way.

1.8 Definition of study

Gestational diabetes mellitus

GDM is defined as glucose intolerance that is first identified during pregnancy (ADA 2012). This means that pregnant women with GDM had no diabetes before pregnancy according to the definition.

Macrosomia

A newborn with an excessive birth weight-typically defined as morethan4.0 kg at birth which, classically occurs in infants of diabetic mothers (Segen’s Medical Dictionary, 2012).