Abstract

 Gestational diabetes mellitus is a chronic health problem with devastating, yet preventable consequences on pregnant women. It is characterized by high blood glucose levels resulting from defects in insulin production.

This study was aimed at  assessing  pregnant women knowledge and preventive measures on Gestational Diabetes at the  Mount Mary Hospital Buea ,Cameroon.  A  cross- sectional descriptive hospital base design was used and data was collected using a pre – tested semi structured questionnaire addressed to 70 continently  sampled pregnant women attending antenatal clinic at Mount Mary Hospital. Data was analyzed using Microsoft Excel 2013 and presented on tables and figures in frequencies and percentages.

The findings revealed that , there were significant gaps in their understanding of it causes, risk and management. Only 46 (65.7%) correctly identified GDM as à pregnancy specific condition, and 38(52.8%) understood that it involves insulin resistance rather than insulin deficiency. Preventive measures such as regular exercise 30 (42.9%) and à balance diet 41(58.6%) were not consistently practiced. The study concludes that there is a need for enhanced health education and targeted interventions to improve pregnant women’s knowledge and preventive practices regarding GDM.

Recommendations included integrating GDM education into routine antenatal care, organizing community awareness programs, and improving access to nutritious foods and physical activity opportunities for pregnant women.

CHAPTER ONE

INTRODUCTION

1.1 Background of study

The prevalence of diabetes, especially gestational diabetes mellitus (GDM), is increasing globally. In 2015 alone, it was estimated that 20.9 million women had hyperglycemia in pregnancy, 85.1% of which were due to GDM (International Diabetes Federation, 2015). The complications arising due to GDM affect both the mother and the baby (Holmes et al., 2010). The true prevalence of GDM is unknown, but it has been estimated in the United States of America to varying from 1% to 14% of pregnancies, depending on the population studied and the diagnostic tests used (Chen et al., 2009).

Maternal hyperglycemic disorders include type 1 and 2 diabetes mellitus (T1/T2DM) and gestational diabetes mellitus (GDM). T1/ T2DM is a state of glucose intolerance occurring independently of pregnancy, while GDM is characterized by glucose intolerance that begins or is first diagnosed during pregnancy and usually resolves after delivery (Reece, 2010). GDM complicates approximately 4% of all pregnancies and women with it have an approximate 7-fold risk of developing type-2 diabetes mellitus in the future, as well as their children and subsequent generations (Bellamy et al., 2009). GDM has been shown to be associated with an increased risk of maternal metabolic syndrome and T2DM and is now the most frequent form of hyperglycemic disorders during pregnancy. This fact should alert the obstetrician to the necessity to pay special attention to this segment of the population, especially in low-income countries. The impact of GDM on maternal and fetal health has been increasingly recognized (Leary et al., 2010). GDM increases the risk of fetal macrosomia which is associated with secondary complications like shoulder dystocia, cesarean delivery and birth trauma. There is also a concomitant increase in neonatal complications like hypoglycemia, respiratory distress syndrome, hypocalcemia and hyperbilirubinemia (Ovesen et al., 2015).

Unfortunately, due to insufficient focus on prevention and lack of preconception planning, several challenges pertaining to maternal healthcare still remain. Lack of access to care and financial issues are some barriers to the utilization of healthcare (Bhavadharini et al., 2016). In addition, health literacy is also becoming a growing and relevant factor that has been shown to decrease the risk of adverse outcomes in non-pregnant diabetic patients (Cavanaugh, 2011).  Improving health literacy helps the individual to comprehend and adopt a healthy lifestyle (Baker, 2006). The challenge, however, is that managing GDM requires women to come to terms with their diagnosis in a short period of time. Therefore, building health literacy skills and knowledge that is required to understand the importance of screening and managing the condition, within this short window period, is sometimes challenging (Bhavadharini et al., 2016).

It has been reported that the global trend of an increased prevalence of diabetes in African populations and the subsequent increase of diabetes in pregnancy is closely linked to the increase in obesity (Sobngwi et al., 2010). In a study of 11 568 pregnant women in six regions of Cameroon, Sobngwi et al. (2010) reported a 5% to 17% prevalence of GDM (World diabetes foundation, 2019). Another study in Cameroon reported a 6.3% (20/316) prevalence of GDM and that in multivariate analysis older age (≥30 years) remained a significant predictor of GDM (Jao et al., 2013) Munang et al. (2017) reported that in a group of 84 pregnant Cameroonian women, the 75g OGTT was reproducible only in 74.2% cases and that maternal age and BMI were factors associated with non-reproducible results (Munang et al., 2017).

Despite the potential adverse impact GDM may have on pregnancy and its outcome, the prevalence and risk factors (advanced maternal age, body mass index (BMI), history of previous stillbirths, large for gestational age (LGA) and macrosomia, family history of diabetes mellitus, history of congenital malformations, past history of GDM and polycystic ovarian syndrome (PCOS) etc.) of this condition have not yet been adequately studied at Mount  Mary Hospital. To our knowledge, no epidemiologic study regarding GDM has been carried out at Mount Mary Hospital, Cameroon. Thus, this study sought to assess pregnant women knowledge on the consequences of gestational diabetes mellitus and preventive practices at the Mount Mary Hospital.

1.2 Statement of the problem

Diabetes is a chronic health problem with devastating, yet preventable consequences.  It is characterized by high blood glucose levels resulting from defects in insulin production, insulin action, or both (Aljasem et al., 2001). The problem of GDM has an impact on the health of both the mother and the fetus. It is believed that women with good knowledge on the disease condition will help prevent the occurrence of complications such as stillbirth, macrosomia (too large baby), jaundice, hypoglycemia (low blood sugar), dyspnea (difficulty in breathing) and on the other hand, women with limited knowledge are prone to the consequences of the disease. Sobngwi et al. (2010) reported a 5% to 17% prevalence of GDM in Limbe Cameroon.

This situation was observed during an internship at the Buea Regional Hospital where most of the women do not attend antenatal care at an early stage of pregnancy where the disease could be diagnosed during a routine investigation. Some women do not attend at all and only comes during labour leading to complications such as a perineal tear, prolong labour and some even end up in cesarean section as a result of macrosomia baby and preeclampsia. Meanwhile, the foetus also developed hypoglycemia during early postpartum that could be prevented during ANC. This aroused my interest in investigating pregnant women’s knowledge of the consequences and preventive measures of GDM at Mount Mary Hospital

1.3 Rationale

Due to the impact of gestational diabetes on the health of both the mother and the fetus and the fact that these consequences could be prevented, it is necessary to carry out studies as such with the aim of increasing awareness which will intend lead to prevention and an overall decrease in prevalence and mortality rate.

1.4 Research Questions

1. What knowledge do pregnant women have on gestational diabetes mellitus?
2. What preventive measures do pregnant women carry out to fight against gestational diabetes mellitus?

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