Prevalence Of Gestational Diabetes Among Pregnant Women Attending Antenatal Care

1.1 Background Of The Study

Diabetes mellitus is the commonest metabolic /endocrine disorder in pregnancy and is associated with increased maternal and perinatal morbidity and mortality especially when inadequately controlled 6,7,8. Other metabolic/endocrine disorders include thyroid conditions (Graves? disease and hypothyroidism), adrenal disorders (Cushing?s syndrome and Conn?s syndrome) and hyperparathyroidism. Diabetes mellitus in pregnancy which is either pre-gestational or gestational, is a heterogeneous group of condition with a common metabolic characteristic of hyperglycaemia 9,10.

Gestational diabetes mellitus is glucose intolerance of variable severity, with onset or first recognition during pregnancy. This includes women with previously undiagnosed diabetes at one end of the spectrum and those with mild disturbances of glucose intolerance resulting from the metabolic changes late in pregnancy at the other end.

9,10,11,12. GDM includes impaired glucose tolerance (IGT) and overt diabetes mellitus. IGT is defined as 2-hour plasma glucose value of between ?7.8mmol/l - 11.1mmol/l based on the 75g oral glucose tolerance test (OGTT). However, it is overt diabetes if the 2-hour value is >11.1mmol/l 10. According to the WHO, GDM can also be diagnosed using the fasting blood glucose (FBG) when it is ?7.0mmol/l. This definition requires the fasting or 2-hour value of 75g OGTT to be met 10.

Uncontrolled pre-gestational or gestational diabetes mellitus is associated with adverse pregnancy outcomes including increased rate of miscarriages, congenital malformations, stillbirths, fetal macrosomia and neonatal morbidity and mortality 1,7,13,14,15. Reports suggest that the perinatal morbidity and mortality can be reduced to levels similar to that of non-diabetic women if properly managed 4,10. With the rising tide of obesity, the background prevalence of diabetes mellitus in pregnancy is increasing 10.

There are considerable debates regarding the relevance of detecting GDM especially the impaired glucose tolerance as against diabetes of first onset or recognition in pregnancy, the most effective test for screening, when in pregnancy should screening be undertaken and to whom it should be applied. What has been agreed is that more severe forms of gestational glucose intolerance are linked to adverse fetal, neonatal and maternal outcomes 7,11,12,13,15. Also vigorous management of women with previously undiagnosed diabetes in pregnancy is not in doubt 11.

It is however important to detect gestational diabetes mellitus because: 10,11,12,16,17,18. •

Pregnancies complicated by GDM are at increased risk of fetal macrosomia, intra- uterine fetal death, neonatal metabolic abnormalities (hypoglycaemia, hypocalcaemia, polycythaemia and hyperbilirubinaemia) and birth trauma.

•Maternal complications of GDM include increased incidence of operative and manipulative deliveries (from growth disorders) and hypertensive disorders.

•Gestational diabetic women intensively managed can achieve near normal rates of macrosomia and neonatal hypoglycaemia.

•GDM predicts the development of diabetes later in life.

Knowing that the management of GDM can lead to the achievement of near normal pregnancy outcome, a study of the prevalence and risk factors in our antenatal population will assist in policy formulation regarding the inclusion or otherwise of routine screening and diagnosis of GDM in such women. This will enable the scale-up of care for these patients and the overall aim is to increase the chances of achieving a better maternal and perinatal outcome in the care of such patients with GDM.

1.2 Statement Of The Problem

In Nigeria, like most other developing countries, women are rarely screened for gestational diabetes mellitus. Peradventure were they are screened for urinalysis as part of antenatal care, majority who tested positive to glucose in their urine are not referred for either fasting or random glucose confirmatory tests. For those few that were screened and diagnosed for GDM, they have few options for management of the disease. This observed poor management of GDM is not peculiar to GDM alone, but to diabetes mellitus management in general which has been reported to be poor in Nigeria.10-11

Therefore, this retrospective study was designed to access the prevalence of gestational diabetes among pregnant women attending antenatal care using JUTH, Jos as a case study.

1.3 Objectives Of The Study

The study generally focus on prevalence of gestational diabetes among pregnant women attending antenatal care. The study will specifically assess the objectives below; 

1. To determine the prevalence of GDM among pregnant women attending antenatal care in JUTH, Jos

2. To determine the pattern of glucose tolerance among the antenatal population in JUTH, Jos.

3. To determine the risk factors for GDM among pregnant women in JUTH, Jos.

1.4 Research Questions

The study will be guided by the following questions;

i. What is the prevalence of GDM among pregnant women attending antenatal care in JUTH, Jos.

ii. What is the pattern of glucose tolerance among the antenatal population in JUTH, Jos.

iii. What are the risk factors for GDM among pregnant women in JUTH, Jos.

1.5 Research Hypothesis

Ho: The prevalence of GDM among pregnant women attending antenatal care

 in JUTH, Jos is low.

Ha: The prevalence of GDM among pregnant women attending antenatal care.

in JUTH, Jos is high.

1.6 Significance Of The Study 

It is important to find out for these reasons the prevalence and risk factors for GDM in our antenatal population and this will highlight the magnitude of the condition in our centre. There has been no previous study of GDM in Jos University Teaching Hospital.

The results from the study will assist in strengthening intervention plans and policy with respect to the development of a local protocol for screening and diagnosis of GDM especially among pregnant women with known risk factors.

1.7 Scope Of The Study

This study on the prevalence of gestational diabetes among pregnant women attending antenatal care. The study will be delimited to Jos University Teaching Hospital.

1.8 Limitations Of The Study

This was a hospital-based study and may not be a reflection of the true situation in the general community largely due to referral bias. Also few of the women recruited did not participate in the study, giving an attretion rate of 4.5% and plasma insulin response levels were not assayed.

1.9 Definition Of Term

Pregnancy: Pregnancy is the term used to describe the period in which a fetus develops inside a woman's womb or uterus.

1.10 Organization of the Study

The study is categorized into five chapters. The first chapter presents the background of the study, statement of the problem, objective of the study, research questions and hypothesis, the significance of the study, scope/limitations of the study, and definition of terms. The chapter two covers the  review of literature with emphasis on conceptual framework, theoretical framework, and empirical review. Likewise, the chapter three which is the research methodology, specifically covers the research design, population of the study,  sample size determination,  sample size, and selection technique and procedure, research instrument and administration, method of data collection, method of data analysis, validity and reliability of the study, and ethical consideration. The second to last chapter being the chapter four presents the data presentation and analysis, while the last chapter(chapter five) contains the summary, conclusion and recommendation.