http://doi.org/10.33698/NRF0329-Kiran Kumari, Himanshu Vyas, Pratibha Singh, Deviga T
ABSTRACT
Introduction: Gestational diabetes mellitus has become one of the very common perinatal complications. It is a disorder of carbohydrate metabolism diagnosed during pregnancy. Objective: To evaluate the knowledge and lifestyle modication regarding gestational diabetes mellitus among antenatal mothers. Methodology: A Cross-sectional design was used and the study was conducted in the antenatal OPD of a tertiary care teaching hospital of Western Rajasthan. The study included 140 antenatal mothers diagnosed with gestational diabetes mellitus and seeking antenatal care at antenatal OPD by purposive sampling technique. Knowledge was assessed using structured knowledge questionnaire and lifestyle modication by a structured Rating scale. Data were analysed using descriptive and inferential statistics and P<0.05 was considered to be statistically signicant. Results: Majority of the mothers in this study had fair knowledge (83.6%) followed by 10.7% having poor and 5.7% with good knowledge. Majority of mothers (97.1%) developed good level of lifestyle modication after being diagnosed with gestational diabetes and 2.9% had fair level of lifestyle modication. A very weak correlation was found between the knowledge and lifestyle modication (r=0.085). Only level of education was found to be signicantly associated with knowledge regarding gestational diabetes (p = <0.01). Conclusion: Since the prevalence of gestational diabetes is increasing, there should be good knowledge and awareness regarding gestational diabetes among antenatal mothers. Health care providers should create awareness and improve knowledge of the mothers regarding gestational diabetes and its possible long term complications.
Key words: Antenatal mothers; Gestational diabetes mellitus; Knowledge; Lifestyle modication
Address for correspondence:
Mr. Himanshu Vyas, Associate Professor,
College of Nursing, AIIMS, Jodhpur, Email: himanshunsg@gmail.com,
Mob: 8003991309
Introduction:
As incidence of diabetes continues to grow and progressively affects the individuals of all ages including young adults and children, women of reproductive age. Antenatal women are at increased risk of developing diabetes during pregnancy. Gestational diabetes mellitus (GDM) has become one of the very common perinatal complications which has adverse effect both on mother as well as fetus. Gestational diabetes mellitus is a disorder of carbohydrate metabolism diagnosed during pregnancy that affects women’s health not only during pregnancy but also after delivery of baby. Gestational diabetes affects up to 14 % of all the pregnancies. As per the facts, both obesity and DM are now worldwide epidemics and, the prevalence of GDM is continuously increasing. 1
All the pregnant women should be tested for glucose tolerance before or early in pregnancy so that overt diabetes can be ruled out and also repeated in 2nd and 3rd trimesters for detection of gestational diabetes. Classical risk factors for Gestational diabetes include maternal age over 25 years, previous macrosomic baby, previous unexplained IUFD (intrauterine fetal death), previous pregnancy with Gestational diabetes, family history of type 2 diabetes or Gestational diabetes, obesity and fasting blood glucose above 140mg/dl or random blood glucose above 200 mg/dl2.
The diagnosis of Gestational diabetes is necessary for mother and fetus during pregnancy. They are the ideal group to be targeted for lifestyle modications and pharmacologic intervention in order to delay or postpone the onset of overt diabetes3. Women diagnosed with GDM should understand about their disease so that they can do daily care for themselves and reduce their risk of developing diabetes in future as well as decrease the risk of harm to the growing fetus. But, if there is lack of knowledge regarding severity of this disease, the antenatal women may be poorly or not adherent in self-management of the disease. So, health care providers need to give more focus on providing clear and accurate information to enhance maternal knowledge regarding gestational diabetes, its risks and complications, screening and management.
Women with GDM require a thorough education that focus not only on immediate care but also on long term health implications . Thus , implementing interventional strategies to women with GDM aimed at controlling glycaemic status and increase knowledge about managing with GDM has implications for maternal and neonatal morbidity and mortality by reduction in feto-maternal complications4.
There are studies which show that if there is insufcient knowledge about the disease, it may lead to poor perception of medical information5 . This leads to minimal compliance to management plan and ultimately unfavourable pregnancy outcome. Hence, appropriate knowledge with reference to disease is highly related to prevent the complications of disease by proper management of disease, which permits people to live better with their diseased condition. The knowledge about gestational diabetes among women will translate into adoption of a healthy lifestyle, better health-seeking behaviour, better self- care and thus prevention and early diagnosis of the disease. So, this study aims to assess the knowledge and lifestyle modication regarding gestational diabetes among antenatal mothers.
Material and Methods
A total of 140 Antenatal mothers more than 20 weeks of gestation diagnosed with gestational diabetes were recruited in the study after taking informed written consent. Mothers with other co-morbidities with gestational diabetes like pregnancy induced hypertension, cardiovascular illnesses, renal diseases or any other systemic illness were excluded from the study. The study was approved by Institute Ethics Committee. Participation was voluntary and they were explained about the purpose of the study. Informed written consent was taken from the subjects and they were assured of condentiality with autonomy to withdraw self from the study at any time of data collection.
Data was collected through face to face interview method with the help of pretested structured tools. The socio-demographic details were collected using socio- demographic data sheet which was designed to collect information on background such as age, education status, occupation, parity etc. Knowledge questionnaire was used to collect knowledge of women regarding gestational diabetes which consisted of 25 MCQ’s related to basic knowledge of Gestational diabetes, diagnosis and risk factors, diet and food values, physical activity, antepartum and postpartum care, treatment and management, effect on baby and mother. The knowledge level was categorized as Good (Score >75%), Fair (Score 36-75%), Poor (Score <50%). A 19-item rating scale was used to assess the lifestyle modication regarding Gestational diabetes among antenatal mothers. It includes 4 domains such as Dietary habits, Organized exercise, Following daily routine, Monitoring and treatment. Each item was assessed on a scale of 3 points i.e. Always (Score 3), Sometimes (Score 2), and Never (Score 1). Total possible score is 57 and minimum possible score is 19. Level of lifestyle modication were categorized as Poor Level (Score 1-19), Fair level (20-38), Good level (38-57). The self – structured knowledge questionnaire and rating scale were found to be valid and reliable with score of internal consistency more than 0.7.
The collected data was entered in Microsoft excel and data was compiled and analysed using SPSS 16.0 (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). Descriptive statistics such as mean, standard deviation, and range values were computed for quantitative variables. Inferential s t a t i s t i cs were applied (Chi–square, Fisher’s Exact test and correlation coefcient) to determine the association of knowledge levels and level of lifestyle modication regarding gestational diabetes with selected demographic variables and the correlation between Knowledge score and lifestyle modication score among mothers, respectively. A probability level P < 0.05 was considered to be s t a t i s t i cally s i gni cant for a l l associations.
Results
Socio-demographic and clinical profile : A total of 140 antenatal mothers participated in the study. Table 1 and 2 shows the demographic and clinical prole of the study participants. The most common age group was 21-30 years consisting of 94 (67.1 %) antenatal mothers. 119 (85.0 %) antenatal mothers belong to Hindu religion. Among 140 participants, 90 (64.3%) antenatal mothers were graduated, and 6 (4.3%) had no formal education. Majority of antenatal mothers (84.3%) were home maker and 28% of the antenatal mothers had family income between the range of Rs. 10,000 to 20,000/month.
As per clinical prole of the participants 42.9% antenatal mothers had family history of diabetes and 2.1% had history of gestational diabetes in previous pregnancy. Out of total participants, 50.7% women were diagnosed with gestational diabetes in 26-31 week of gestation. 55% got information regarding gestational diabetes from health care providers and 37.9 % had normal BMI. Majority of antenatal mothers 123 (87.9%) had 2 hrs Post Prandial Blood Glucose between 141-200mg/dl at the time of diagnosis.
|
Table 1: Sociodemographic profile of participants
Table 2: Clinical profile of participants
(N = 140)
(N = 140)
| Demographic Variables | f |
| Age (in years)
<20 years |
8(5.7) |
| 21-30 years | 94(67.1) |
| 31-35 years | 28(20.0) |
| >35 years | 10(7.1) |
| Religion
Hindu |
119(85.0) |
| Muslim | 21(15.0) |
| Educational status
No formal education |
6( 4.3) |
| Primary | 9( 6.4) |
| Secondary | 13( 9.3) |
| Higher secondary | 22(15.7) |
| Graduate and above | 90(64.3) |
| Occupation
Employed |
17(12.1) |
| Self-employed | 5( 3.6) |
| Home-maker | 118(84.3) |
| Education status of husband
Illiterate |
5( 3.6) |
| Primary | 3( 2.1) |
| Secondary | 4( 2.9) |
| Higher secondary | 28(20.0) |
| Graduation and above | 100(71.4) |
| Family income per month
Less than Rs. 10000/- |
12( 8.6) |
| 10,000 to 20,000 | 40(28.6) |
| 20,000 to 30,000 | 32(22.9) |
| 30,000 to 50,000 | 29(20.7) |
| 50,000 to 80,000 | 18(12.9) |
| Above 80,000/- | 9 (6.4) |
Knowledge regarding Gestational diabetes
Figure 1 depicts the level of knowledge among antenatal mothers regarding gestational diabetes. Most of the antenatal mothers ( 83 . 6 %) were having fair knowledge regarding gestational diabetes, followed by 5.7 % of women having good level of knowledge and 10.7% had poor
knowledge about gestational diabetes. Fig 1: Level of Knowledge among antenatal
mothers regarding gestational diabetes
Table 3: Item wise analysis of knowledge regarding gestational diabetes
N=140
| Sr.
No. |
Statements | Correct response f (%) |
| 1. | Gestational diabetes is a condition of variable degree of glucose intolerance in pregnancy | 38 (27.14) |
| 2. | Gestational diabetes gets diagnosed during pregnancy | 36 (25.71) |
| 3. | Gestation diabetes mothers are increased risk of developing diabetes in later life | 87 (62.14) |
| 4. | Inadequate insulin may be the cause for the gestational diabetes | 63 (45.00) |
| 5. | One of the effect gestational diabetes on growing fetus is macrosomia (large baby) | 63 (45.00) |
| 6. | Gestational diabetes is used to diagnosed by oral glucose tolerance test (OGTT) | 64 (45.71) |
| 7. | Obesity is the risk factor for developing gestational diabetes | 55 (39.29) |
| 8. | Family history of gestational diabetes increase the risk in gestation diabetes in present pregnancy | 54 (38.57) |
| 9. | The risk factors of gestational diabetes includes obesity, high maternal age and family history | 81 (57.85) |
| 10. | Diabetic diet includes low carbohydrate, low fat and high bre diet | 83 (59.28) |
| 11. | Food items contain bre are rice, white bread, fruits and vegetables, etc | 57 (40.71) |
| 12. | Exercise manage the blood sugar level in the body | 39 (27.85) |
| 13. | Exercise is recommended for three alternative days in a week during pregnancy | 83 (59.28) |
| 14. | Daily fetal activity assessment by fetal movement during pregnancy | 76 (54.28) |
| 15. | Purpose of monitoring fetal activity is to assess the fetal well being | 53 (37.85) |
| 16. | Normal value of oral glucose tolerance test after 2 hours is <140mg/dl | 93 (66.43) |
| 17. | It is important to control blood sugar in gestational diabetes, to keep mother and fetus safe during pregnancy | 37 (26.43) |
| 18. | Self blood glucose testing is the best method to test blood sugar level at home | 96 (68.57) |
| 19. | Insulin and life style modication are the treatment for gestational diabetes | 88 (62.86) |
| 20. | The recommended route for taking insulin injection is subcutaneous | 83( 59.29) |
| 21. | Eating sugar or jaggery help to manage hypoglycaemic symptoms | 66 ( 47.14) |
| 22. | Sweating is one of the symptom of hypoglycaemia | 54 (38.57) |
| 23. | Warm and dry skin are the symptoms of hyperglycaemia | 92 (65.71) |
| 24. | Increased thirst and weight gain are sign/symptoms of gestational diabetes | 78 (55.71) |
| 25. | Breast feeding the baby Immediately after delivery is important to prevention of hypoglycaemia in newborn | 90 (64.29) |
Table 3 depicts the items of knowledge questionnaire with frequency percentage of correct response. Most of the women have given correct response about gestational diabetes, its causes, risk factors and symptoms. Item number 16 (Normal value of oral GTT test),18 (Self blood testing as method of glucose testing at home) and 23 (Warm and dry skin are the symptoms of hyperglycemia) were the items correctly answered by majority of participants ( > 9 0 % ) w h e r e a s i t e m n u m b e r 1 (Gestational diabetes is a condition of variable degree of glucose intolerance in pregnancy),12 (Exercise manage the blood sugar level in the body) and 17 (It is important to control blood sugar in gestational diabetes, to keep mother and fetus safe during pregnancy) were answered incorrectly by majority of participants (>60%).
Level of lifestyle modification regarding Gestational diabetes
Figure 2, depicts the level of lifestyle modication among antenatal mothers related to gestational diabetes. Majority of antenatal mothers (97.1%) had good level of lifestyle modication while only 2.9% of women had fair level of l i festyle modication after being diagnosed with gestational diabetes.
Table 4 depicts the items of life style rating scale with frequency percentage of compliance. Majority of the women compliant to lifestyle modication like taking medications regularly (95%), taking small and frequent meals (81%), limiting fat and carbs from diet(75%), following r e g u l a r m e a l p l a n a n d d o i n g exercises(50%). Regarding doing regular exercise 44% women accepted that they are not regular with exercise and they do it sometimes while 30 % of women did not do any type of exercise.
Association of knowledge level and level of lifestyle modification with socio- demographic variables and correlation between knowledge level and level of lifestyle modification: Knowledge levels of the participants were found to have s ignicant association with only educational status of the participants (chi square value 34.96; p value: (<0.01). There was no signicant association found between levels of lifestyle modication with other socio-demographic variables. A very weak positive correlation (r = 0.085) between knowledge score and level of lifestyle modication regarding gestational diabetes was found.
Table 4: Lifestyle modification practiced by the participants after diagnosed with gestational diabetes N=140
|
List of items |
After diagnosed with gestational
diabetes |
||
| Always f(%) | Sometimes f(%) | Never f(%) | |
| 1. Take small and frequent meals | 114 (81) | 24 (17) | 2 (2) |
| 2. Include fruits and vegetables in your diet | 119 (85) | 21 (15) | 0 (0) |
| 3. Careful about how much food you
consuming in a day or in a meal |
102 (73) | 30 (21) | 8 (6) |
| 4. Include fiber rich foods in your diet | 100 (71.42) | 39 (27.85) | 1 (0.71) |
| 5. Keep your diet low in fats | 105 (75) | 27 (19.28) | 8 (5.71) |
| 6. Keep your diet low in carbohydrates | 108 (77.14) | 26 (18.57) | 6 (4.28) |
| 7. Avoid consumption of sweets and soft
drinks |
111 (79.28) | 26 (18.57) | 3 (2.14) |
| 8. Avoid/limit junk food or packaged food in
your diet |
105 (75) | 27 (19.28) | 8 (5.71) |
| 9. Take part in light or moderate activities such as normal household work, walking, jogging etc for at least 10-15 minutes
regularly. |
75 ( 53.57) | 42 (30) | 23 (16.43) |
| 10. Follow a regular meal plan at same time for each day | 59 (42.14) | 41(29.28) | 40 (28.57) |
| 11. Take snacks at bedtime each day | 74 (52.86) | 33 (23.57) | 33 (23.57) |
| 12. Doing exercise regularly | 49 ( 35) | 61(43.57) | 30 (21.43) |
| 13. Maintaining food diary to improve
glycemic control |
89 ( 63.57) | 25 ( 17.85) | 26 (18.57) |
| 14. Monitor your blood sugar properly and
regularly |
93 ( 66.43) | 24 (17.14) | 23 ( 16.43) |
| 15. Take medication on time regularly | 133 ( 95) | 5 (3.57) | 2 ( 1.43) |
Discussion
Gestational diabetes is a pregnancy induced metabolic disorder that refers to glucose intolerance of variable severity with onset of rst recognition during pregnancy. Gestational diabetes if not treated or managed on time may lead to serious immediate as well as long term complications to both mother and newborn. These complications can be prevented by appropriate knowledge regarding gestational diabetes along with its proper diagnosis and management with lifestyle modication.
The present study was conducted to identify the level of knowledge and level of lifestyle modication regarding gestational diabetes among antenatal mothers diagnosed with gestational diabetes. In this study majority of the antenatal women with gestational diabetes were in age group of 21-30 years. Similarly, the study conducted by Bhalge UU et al.6, Sujindra et al.7, Shriram et al.8, Lakshmi D et al.9 and Zeba et al.10, where majority of the women with gestational diabetes under study were in the age group of 20-30 years.
It has been seen that health care providers were the most quoted source of information for most of the women. Similarly, a study family history of diabetes in the present study. These results were consistent with the literature where studies showing that majority of the women were having family history of diabetes.9,10,13-15
Body Mass Index (BMI) is a measure of body fat based on height and weight and it intended to quantify tissue mass. BMI is widely used as a general indicator of whether a person has a healthy body weight for their height. Obesity or can say, overweight has been an important risk factor for development of GDM. Several studies have reported that obesity at the beginning of pregnancy may predispose women to GDM. In the present study, nearly 1/3rd of women were having BMI between 25- 29 which is consistent with the study done by Shridevi et al.15, where most of the women were having BMI above 25.
Findings of present study showed that 2.9% antenatal mothers under study had history of GDM in their previous pregnancy. Similarly, conducted by Lucy Anne P et al11, showed that Wimaljeewala16 reported of 4.7%, whereas half of women get source of information from Jayatinath17 and Zeba et al.10 reported that health care providers. Contrary to these results, Bhalge UU6, and researchers in their study reported of having different source of information (28.50%). Also a study done by Zeba et al1 0 , reported that source of information for most of antenatal women were neighbours (47%) and families (42.9%). Further, the present study indicated that most of the antenatal women under study were literate and done their graduation. Whereas, the study conducted by Dhyani et al.12, most (67%) of the antenatal women were having only primary education.
Considering the risk factors for GDM, family history of diabetes mellitus has been identied as one of the important one. Nearly half of the participants (42.9%) were having most of the women had history of GDM in previous pregnancy.
Mean knowledge score among antenatal mothers in the present study was 12.8±3.29 that means majority of mothers in this study had average score of knowledge. These results were collaborating with the ndings of the other research studies, which found mean knowledge score of 6 . 51 ± 3 . 41 and 10.01±3.63, respectively. 11,17 Knowledge is an important indicator of health literacy.18 There were some researches indicating that knowledge is an important factor for understanding of disease. If there is inadequate knowledge about the disease, it may results in poor understanding of medical information and poor adherence to treatment strategies that nally leads to poor pregnancy outcome. The present study results revealed that most of the women, 83.6% had fair level of knowledge about GDM. These results too much extent agree with the results of a study conducted by Shriram et al.8 and Dhyani et= practices. As the present study ndings revealed that most of the women had fair knowledge and almost, majority of them had adopted good level of lifestyle modication. If lifestyle intervention done early in the pregnancy, it may reduce the risks of al.11 where majority of the subjects were Gestational diabetes and prevent excessive having average of fair level of knowledge. The ndings of present study indicated that only 5.7% women were having good knowledge and 10.7% have poor knowledge. Consistent results have been reported in the studies conducted by Lakshmi D et al.9, gestational weight gain. A very weak positive correlation (r = 0.085) had been reported between knowledge score and level of lifestyle modication in the present study.
Several limitations should be considered, the results may not be generalized to larger wimaljeewala 1 6 , where 1 / 3 r d of the population because of varied geographical participants were having poor or inadequate knowledge (35.2% & 35.3% respectively). The current study results show that Knowledge levels of the participants were found to have signicant association with education level only. This result to a much extent agree with the literature where educational status of the antenatal mothers has been signicantly associated with locations and mixed inhabitants. Also the information collected from the sample is by self-report. So there might be the chances of recall bias and less validity.
Conclusion
Since the prevalence of gestational diabetes is increasing, mothers should have good knowledge and awareness regarding knowledge level.9.10.11,17,19 Different results gestational diabetes. The present study documented by a study conducted by Shriram et al.8, found that Age, education, and parity were not signicantly associated with the level of knowledge of women about GDM. This study does not show signicant association of knowledge with any other indicator. There are some studies reported that antenatal women who were employed showed signicant association with knowledge whereas some studies reported s ignicant association of age with knowledge.12,19
In the present study, most of the participants (97.1%) were aware about what should be the lifestyle modication they should adopt with reference to their disease. Knowledge and understanding of medical information is the major determinant for adoption of lifestyle concluded that most of the antenatal mothers with GDM had average level of knowledge and lifestyle modication regarding gestational diabetes. There is a need of education of antenatal mothers regarding gestational diabetes during their antenatal visits.
Appropriate knowledge with reference to disease may prevent the complications of disease by proper management and treatment. Also, the knowledge about gestational diabetes among women will translate into adoption of a healthy lifestyle, better health- seeking behaviour, better self-care and thus prevention and early diagnosis of the disease. Therefore, health care providers should create awareness and improve the knowledge of mothers regarding gestational diabetes and its possible complications. There should be promotion of regular screening of gestational diabetes among all pregnant mothers and health awareness program should be conducted among health care providers as well as pregnant women for better utilization of health services.
Conflict of Interest
The Author(s) declared no potential conict of interest with respect to the research, authorship, and/or publication of this article.
Financial Support and Sponsorship
The Author( s) received no nancial assistance for the study.
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