Pregnant Women Knowledge On The Consequence And Risks Factors Of Gestational Diabetes Mellitus And Self Care Measures In Uyo

1.1 Background To The Study

Gestational diabetes mellitus is de?ned as glucose intolerance ?rst identi?ed during pregnancy (Mukerji et al, 2016). While glucose intolerance resolves with delivery 90% of the time, it continues to affect women?s health postpartum (American Diabetes Association, 2017). Diabetes predisposes a woman to obesity, high blood pressure, preeclampsia, unsatisfactory progress of labour, premature rupture of membranes, perineal tearing and shoulder dystocia (Di Bernardo et al, 2017; Prakash et al, 2017). Pregnant women with gestational diabetes are at higher risk of developing type 2 diabetes than pregnant women without gestational diabetes (Herath et al, 2017). There has been a rapid rise in the incidence of diabetes in pregnancy, which has been attributed to the increasing number of women of reproductive age with pre-gestational diabetes and an increase in accurate diagnosis of gestational diabetes (Chukwunyere et al, 2015).

A woman with gestational diabetes in pregnancy is 10.6 times more likely to develop diabetes within 10 years, after controlling for other variables, compared with women without gestational diabetes (Herath et al, 2017). While the overall prevalence of gestational diabetes in women is 12.8%, the prevalence of gestational diabetes increases in direct proportion to the prevalence of type 2 diabetes in a given population, making pregnant women with a pre-existing diagnosis of diabetes at greater risk of developing gestational diabetes (Muche et al, 2019). There are many morbidities associated with gestational diabetes; knowledge of the risks and timely screening of mothers could be beneficial in reducing the complications seen in diabetes in pregnancy (Chukwunyere et al, 2015).

Women with histories of gestational diabetes may not perceive themselves to be at risk for future diabetes. Spirito et al (2018) found that, among 67 women with gestational diabetes, two-thirds did not believe they would develop gestational diabetes during a future pregnancy, and one-?fth did not believe they were at risk for diabetes. In Nigeria, a  study  found  a  prevalence  of  gestational  diabetes  of  4.8%  among 250 pregnant women, which was linked to malnutrition (Ewenighi et al, 2016). Qualitative studies in several high-risk groups such as the Pima Indians and Mexican Americans suggest that these women may believe that gestational diabetes does not pose a problem after delivery (Kim et al, 2017). However, this conclusion cannot be generalised to other populations.

Theoretical models suggest that risk perception may be an important determinant of behavioural change. In the case of diabetes prevention, higher and more accurate perceptions of risk might encourage a healthier lifestyle, including a healthy diet and adequate physical activity. In contrast, underestimating risk might prevent women from making healthy lifestyle changes, and could therefore be a target for behavioural interventions by health professionals, governments, and policy makers.

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; 2018). 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; 2016).

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 (Steve, 2019).

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, 2020).

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, 2020).

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, 2020).

Usually, under your 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, 2020).

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, 2020). 

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, 2015).

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 Akwa-Ibom state 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.

There has been no report exploring the ways in which diabetes risk perception is associated with preventive behaviours in women with histories of gestational diabetes, particularly after accounting for knowledge of diabetes risk factors, perceived personal control, and optimistic bias. Appropriate care of pregnant women throughout pregnancy has a significant contribution on the growth and development of the unborn child and has a crucial role in reducing maternal and neonatal mortality. This study aimed to assess the Knowledge and attitude of gestational diabetes among pregnant women attending Uyo maternal and child centre Akwa-Ibom state.