|Year : 2018 | Volume
| Issue : 1 | Page : 51-55
Awareness of gestational diabetes mellitus among pregnant women attending a tertiary health center
Vineeta Dhyani1, Niranjana S Mahantashetti2, MS Ganachari1, Sanjay Kambar3, Vikrant Ghatnatti4
1 Department of Pharmacy Practice, KLE University College of Pharmacy, Belagavi, Karnataka, India
2 Department of Paediatrics, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
3 Department of Community Medicine, Jawaharlal Nehru Medical College, Diabetes Centre, KLE's Dr. Prabhakar Kore Hospital and MRC, Belagavi, Karnataka, India
4 Department of Endocrinology, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
|Date of Web Publication||17-Jan-2018|
Mrs. Vineeta Dhyani
Department of Pharmacy Practice, KLE University's College of Pharmacy, Nehru Nagar, Belagavi - 590 010, Karnataka
Source of Support: None, Conflict of Interest: None
BACKGROUND AND OBJECTIVES: Awareness of gestational diabetes mellitus (GDM) among pregnant women is poor. However, increasing awareness may help in diagnosis and prevention of maternal and fetal complications. Hence, this study was aimed at evaluating the knowledge in diagnosed GDM pregnant women.
METHODOLOGY: This cross-sectional study was conducted from October 2014 to March 2017. A total of 500 registered pregnant women diagnosed to have GDM residing within 5 km of the study area aged more than 18 years who were willing to participate in the study were enrolled in the study. The participants were provided with the questionnaire which was designed to assess their knowledge about GDM.
RESULTS: The age of the women ranged from 22 to 44 years with mean age as 27.53 ± 2.42 years and median age as 27 years. The most common age group was 26–30 years which comprised 67.6% of the women. Maximum women had primary education (61%) and were Hindus (54.8%). Most of the women were working (54.8%), resided in slum areas (43.2%), and had body mass index (BMI) between 19.8 and 26 kg/m2 (67%). The mean BMI level was 28.07 ± 4.11 kg/m2. The mean blood sugar levels at diagnosis ranged between 88 and 300 mg/dL and the mean blood sugar level was 201.36 ± 38.67 mg/dL and the median blood sugar level was 190 mg/dL. Majority of the women, that is, 57.6% of the women, had an average knowledge about GDM while 21.8% of the women had good knowledge, 1.6% had excellent, and 19% had poor knowledge. The mean knowledge score was 6.51 ± 3.41. The mean percentage of the knowledge was 36.14% ± 18.94%. Statistically significant association was noted between knowledge about GDM with maternal age and educational status, religion, and occupation (P < 0.050), but the GDM knowledge was independent of that found between place of residence (P = 0.715) and family history of DM (P = 0.661).
CONCLUSION: There is poor knowledge about GDM in the study area. Hence, there is need to create awareness of this condition through counseling and use of mass media.
Keywords: Antenatal care, gestational diabetes mellitus, knowledge, pregestational diabetes mellitus
|How to cite this article:|
Dhyani V, Mahantashetti NS, Ganachari M S, Kambar S, Ghatnatti V. Awareness of gestational diabetes mellitus among pregnant women attending a tertiary health center. Indian J Health Sci Biomed Res 2018;11:51-5
|How to cite this URL:|
Dhyani V, Mahantashetti NS, Ganachari M S, Kambar S, Ghatnatti V. Awareness of gestational diabetes mellitus among pregnant women attending a tertiary health center. Indian J Health Sci Biomed Res [serial online] 2018 [cited 2019 Aug 24];11:51-5. Available from: http://www.ijournalhs.org/text.asp?2018/11/1/51/223420
| Introduction|| |
India ranked second globally for the number of adults with diabetes mellitus (DM) while China being the first. Gestational DM (GDM) is one of the subtypes of diabetes, characterized by glucose intolerance first detected during pregnancy. The prevalence of pre-GDM (PGDM) and GDM varies with ethnicity. The South Asian race is at a higher predisposition for both type 2 DM and GDM., A recent community-based study in South India reported 17.8% of the women residing in urban area with GDM, 13.8% women residing in semi-urban, and 9.9% women residing in rural areas using 2 h 75 g postglucose value ≥140 mg/dL.,Diabetes complicates up to 20% of all pregnancies worldwide, including PGDM and GDM. PGDM is at risk of preeclampsia in the antepartum period whereas the infants born to the mother with GDM may be at risk for macrosomia, hypoglycemia, jaundice, respiratory distress syndrome, polycythemia, and hypocalcemia. Furthermore, GDM is attributable to increased risk of cardiovascular outcomes, stillbirth, early childhood obesity, and adverse maternal outcomes, such as increased rates of preeclampsia and cesarean and operative births. Based on recent literature, it is suggested that gestational diabetes and fetal macrosomia are independent risk factors for shoulder dystocia.
Data suggest that educational strategies on GDM need to be encouraged and implemented, especially for young, fertile women of all ethnicities. Early counseling of families has been recommended by the Fifth International Workshop-Conference on GDM to avoid excessive material and fetal weight gain. Educational programs have been recommended that emphasize reduced fat and energy intake, regular physical activity, and regular clinic visits.
This study was conducted to evaluate the awareness of GDM among pregnant women attending a tertiary care center of North Karnataka.
| Methodology|| |
This cross-sectional study was conducted under the Department of Pharmacy Practice, Jawaharlal Nehru Medical College, KLE University, Belagavi, Karnataka, from October 2014 to May 2017. The sample size of the study was calculated by the inverse random sampling formula to reject the null hypothesis. An attrition rate of 15% was considered. Those registered pregnant women diagnosed to have GDM residing within 5 km of study area aged more than 18 years, and those who were willing to participate in the study were recruited for the study. Pregnant women with endocrinal complications and renal complications, pregnancy complications, prior type 2 DM, multiple gestations, and having significant difficulties to cooperate were excluded from the study. Before the commencement, the study was approved by the institutional ethics committee; this study was also registered with Indian CTRI-CTRI/2017/01/007622. Pregnant women with ≥24 weeks of gestation diagnosed to have GDM based on DIPSI criteria and were screened for eligibility. Those who were eligible were briefed about the nature of the study and the intervention, procedure involved in the study along with their family members. Those who were willing to participate and provide written informed consent were enrolled.
The selected participants were interviewed to obtain the demographic data such as age, religion, education, occupation, place of residence socioeconomic status, history of DM, family history, current treatment, medical history, personal history, and dietary habits. These findings were recorded in a predesign and pretested pro forma.
Further, the participants were provided with the questionnaire in local language which was designed to assess the knowledge regarding the GDM. The questionnaire comprised 18 questions and emphasized about dietary habits, exercise program, random blood sugar monitoring, treatment, insulin intake, medications, adverse drug reactions, complication in mother as well as fetus, and birth outcomes. The assessment was done by a research scholar based on the responses obtained from the questions. The interpretation of knowledge was done based on the scores obtained, that is, those who answered correctly were interpreted as having adequate knowledge and were graded with a score of 1 for each question. Finally, the sum of total points was calculated and these total scores were converted into percentage and the grading was done as having excellent knowledge if the percentage was ≥75, good knowledge if the percentage was between 51 and 75, average knowledge if the percentage was between 26% and 50%, and poor knowledge if the percentage was ≤25%.
The data were entered into a Microsoft Excel spreadsheet and were analyzed using SPSS statistical software version 20.0. The categorical data were expressed as rates and ratios, and Fisher's exact test and Chi-square test were used for calculating percentages and comparison. Continuous data were expressed as mean ± standard deviation and the independent sample t-test was used for the calculation of comparison. P ≤ 0.05 as 95% confidence interval was termed as statistically significant.
| Results|| |
During the study, a total of 500 women provided written consent to participate in the study and filled the questionnaire. The age of the women ranged from 22 to 44 years with mean age as 27.53 ± 2.42 years and median age as 27 years. The most common age group was 26–30 years comprised 67.6% of the women [Graph 1]. Maximum women had primary education (61%) and were Hindus (54.8%). Most of the women were working (54.8%) and resided in slum areas (43.2%) [Table 1]. Most of the women had body mass index (BMI) between 19.8 and 26.00 kg/m2( 67%) [Graph 2]. The mean BMI level was 28.07 ± 4.11 kg/m2 with median levels being 27.41 kg/m2. The minimum BMI recorded was 17.80 kg/m2 and maximum BMI was as high as 42.98 kg/m2. The mean blood sugar levels at diagnosis ranged between 88 and 300 mg/dL, the mean blood sugar level was 201.36 ± 38.67 mg/dL, and median blood sugar level was 190 mg/dL.
Majority of the women, that is, 57.6% of women, had average knowledge about the GDM while 21.8% of the women had good knowledge, 1.6% had excellent, and 19% had poor knowledge [Graph 3]. Most of the women answered accurately for the question numbers 1–14 (46.8% of the women each), that is, effect of exercise on GDM (60%). Maximum women answered wrong for the question number15 (27%) [Table 2], that is, a woman with gestational diabetes should take moderate exercise such as walking, exercise more than a woman who do not have gestational diabetes, rest more than a woman who do not have gestational diabetes [Table 2]. The mean knowledge score was 6.51 ± 3.41 and median score was 6 with range null being minimum and 17 being maximum. The mean percentage of the knowledge was 36.14% ± 18.94% and median knowledge percentage was 33.33%. None of the women answered all the questions correctly. Further 16 (3.2%) women could not answer even one question correctly [Table 2]. Maximum women had knowledge about the condition of gestational diabetes, its treatment, causes, blood sugar levels, and dietary intake (46.8%). However, the participants were unaware about what should be the lifestyle modification with regard to the daily exercise and effect of GDM on newborn weight.
|Table 2: Distribution of study population according to the Knowledge about GDM|
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Statistically significant association was noted between knowledge about GDM with age and educational status, religion, and occupation (P< 0.050). However, no association was found between place of residence (P = 0.715) and family history of DM (P = 0.661) with GDM knowledge. Significantly higher number of participants aged between 36 and 40 years had excellent knowledge about GDM (71.43%) compared to 20.95% of the women aged 20–25 years who had poor knowledge and to 59.05% of the women aged 20–25 years who had average knowledge [Table 3]. According to the age, awareness of disease also increases in pregnant women with GDM.
| Discussion|| |
The present study highlights poor knowledge in the study area about GDM and a small proportion of women with (21.8%) good knowledge. The knowledge levels of GDM observed in the present study were very much in agreement with a similar study by Shriraam et al. in Chennai who reported that 17.5% women had good knowledge, 56.7% had fair knowledge, and 25.8% of women were observed to have inadequate knowledge about GDM. The median knowledge score was observed to be 7. However, the proceeding study use different sets of questionnaire which comprised 12 questions, every correct response was given a score of 1 and each women's score was calculated out of 12. A score of 0–4 was considered as poor knowledge, 5–8 as fair, and 9–12 as good knowledge of GDM, while in the present study, the questionnaire comprised 18 questions. In the present study, 46.8% of the women had awareness of GDM consistent with a study by Shriraam et al. in Chennai where 85% of the participants had awareness of GDM compared to 46.8% in our study.
A similar study by Shriraam et al. in Chennai showed that majority of population of women was known to the condition of GDM and DM. Awareness of GDM diagnosis time, diet, and exercise as a treatment option for GDM and of the probability of untreated GDM posing a risk to the unborn child was also high among the study women. The knowledge about the risk factors for GDM and the course of GDM and that the women diagnosed with GDM are at an increased risk for future type 2 diabetes was low. However, in our study, participants knew the condition of gestational diabetes, its treatment, causes, blood sugar levels, and dietary intake (46.8%). However, the participants were unaware of what should be the lifestyle modification with regard to daily exercise and effect of GDM on newborn weight. This difference can be explained by the different civilizations of the study area, that is, most of the women in the study from Chennai involved literate participants and in this study considerable subset of participants had poor educational status with (1.6%) of women having primary education to slum area (43.2%) where health-seeking behavior, awareness of health is lacking.
In this study, positive association was noted between knowledge about GDM with age, educational status, occupation, and religion. This finding was consistent with a similar study by Shriraam et al. in Chennai, but the authors reported a positive association of knowledge with only age and educational status. However, the association between GDM knowledge with occupation and religion needs further evaluation as only small subset of women belonged to Christianity.
| Conclusion|| |
The present study highlights poor knowledge about the GDM in the study area. There is a need to create awareness of this condition through regular screening, using mass media. Furthermore, there is a need for educating the health-care workers and doctors as both have an important role in creating awareness among antenatal women.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]