Gestational Diabetes Among Women Attending Antenatal Care at General Hospital, Okigwe
CHAPTER ONE
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;
- Determine the pregnant women’s knowledge and awareness of gestational diabetes
- Assess the effects of gestational diabetes on pre-natal complications among pregnant women in General Hospital, Okigwe
- Assess risk factors, behaviours and lifestyle of gestational diabetes among pregnant women in General Hospital, Okigwe
- Determine the strategies for management and prevention of gestational diabetes among pregnant women in General Hospital, Okigwe
CHAPTER TWO
LITERATURE REVIEW
Conceptual Review
The Concept of Gestational Diabetes
Recent data show that gestational diabetes mellitus (GDM) prevalence has increased by 10 – 100% in several race/ethnic groups during the past 20 years. A true increase in the prevalence of GDM, aside from its adverse consequences for infants in the new born period, might also reflect or contribute to the current patterns of increasing diabetes and obesity especially for the offspring. Therefore, the public health aspects of increasing GOM need more attention (Assiamira, 2010).
GDM is the most common metabolic complications associated with pregnancy (wild et al, 2014). GDM occurs in up to 14% of all pregnancies resulting in approximately 200,000 cases annually in the United States. As the occurrence of type 2 Diabetes mellitus has increased over the past few decades, an increase in the incidence of GDM has also been observed. Between 1994 and 2002, the incidence of GDM doubled. The rise in GDM can likely be attributed to improved screening and diagnostic tools, as well as to the climbing rate of obesity in the U.S (Makdad etal, 1991). Excessive caloric intake and sedentary lifestyles are the major causative factors contributing to obesity.
Pregnancy is characterized by major alterations in metabolism and hormonal changes such as progressive insulin resistance that begins near mid pregnancy and continues through the third trimester. Insulin action is enhanced by estrogen and progesterone in the first trimester of pregnancy which leads to lower blood glucose values during this period. Increase fetal placental glucose utilization also contributes to the lower blood glucose values in the third trimester of pregnancy. There is increase basal insulin secretion by the pancreas. In the early pregnancy, fat deposition is enhanced, unlike later in pregnancy when lipolysis is enhanced by human chronic somatomammotropin (H.C.S), formerly called human placental lactogen (HPL) and insulin desensitizing placental hormone contributing to insulin resistance (ACOTT bulletin, 2014 and Kjos et al; 2015). HCS is an insulin antagonist that increases in proportion to placental mass throughout pregnancy (Solomon et al, 2011). It inhibits peripheral uptake of glucose in the mother, but stimulates pancreatic insulin secretion in fetus.
Maternal insulin does not cross the placenta and therefore does not cause hypoglycemia in the fetus. However, maternal hypoglycemia from any cause is of grave danger to the foetus. HCS is a single chain polypeptide hormone similar to growth hormone and prolactin. Serum cortisol is also increased in pregnancy and this contributes to the relative insulin resistance observed in pregnancy. Increased prolactin may also contribute to the insulin resistance in pregnancy, (Medicinenet.com, 2015). According to Thorpe et al (2015), the incidence of impaired glucose intolerance in pregnancy is between 3-10% and varies according to the incidence of diabetes in the generational population. Approximately 7%of all pregnancies (ranging from 1to 14 depending on the population studied and the diagnostic tests employed) have GDM.
CHAPTER THREE
METHODOLOGY
Design
According to Rosenthal and Rosnow (1991), a research design is a blueprint that provides the scientist with a detailed outline or plan for the collection and analysis of data. The study will employ a quantitative descriptive survey design, using a semi-structured questionnaire. Descriptive research involves gathering data that talks about events and then organizes, tabulates, depicts and describes the data collection (Glass & Hopkins, 1984). Quantitative descriptive design is a formal, objective, logical process for obtaining quantifiable information about the world, presented in numerical form and analyzed through the use of statistics that is used to describe the test relationship (Polit & Hungler, 1999). This study used a quantitative descriptive design to gather information about the gestational diabetes among women attending antenatal care at General Hospital, Okigwe.
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