Effectiveness of Nursing care of antenatal mothers with Gestational diabetes mellitus

 

Ms. Lakshmi. K

Professor, MES College of Nursing, Palachode (po), Kolathur Via, Perinthalmanna, Kerala- 679338

 

ABSTRACT:

 

 

INTRODUCTION:

Pregnancy is special. Let’s make it safe, (WHO)

Gestational diabetes mellitus (GDM) is defined as carbohydrate tolerance with onset or first recognition during the present pregnancy. It is usually present in late in the second and third trimester. Risk factors to develop GDM include family history of diabetes mellitus, having previous birth of an overweight baby of 4 kg or more, unexplained perinatal loss, persistent glycosuria, a age over 30 years, obesity, presence of polyhydramnios, recurrent vaginal candidiasis in present pregnancy¹.

 

The prevalence of gestational diabetes mellitus has tremendously increasing in the past few years, especially in the developing countries like india². The Indian women have 11 times more risk of developing GDM as compared to women in other parts of the world³. The prevalence of GDM in India varies in different regions with a reported prevalence of 3. 0% in Kashmir⁴, 9.5% in western India⁵, 6. 2% in Mysore and 22% in Tamilnadu⁶. The 1997 WHO estimates the prevalence of diabetes in adults showed an expected total rise of > 120% from 135 million in 1995 to 300 million in 2025⁷. It occurs more often in the worldwide than in the past, probably because of increasing rates of overweight and obesity (ACOG 2013). It accounts for 200,000 cases per year; it complicates approximately 7% of all pregnancies (ADA 2013)⁸, whereas its total incidence is estimated up to 17.8%⁹. Women who have had GDM have at least a seven-fold increased risk of developing type 2 diabetes mellitus in the future¹⁰. Moreover, the presence of a hyperglycaemic intrauterine environment due to GDM is associated with the development of type 2 diabetes in the offspring¹¹. According to WHO, IADPSG, DIPSI diagnostic criteria of GDM with oral glucose tolerance test are

 

Criteria	Method	Fasting (mg/dl)	1 hour (mg/dl)	2hour (mg/dl)
WHO 1999	Fasting OGTT with 75g glucose	-	-	Greater or equal to 140
IADPSG	Fasting OGTT with 75g glucose	Greater than or equal to 92	Greater than or equal to 180	Greater than or equal to 153
DIPSI	Non fasting OGTT with 75g glucose	-	-	Greater or equal to 140

 

The complications raises to the mother and foetus are polyhydramnios, birth trauma, increased perinatal loss is associated with fasting hyperglycaemia, preterm labour, preeclampsia, macrosomia, shoulder dystocia, congenital malformation etc.¹. To prevent this complications, nursing management focuses on the education regarding diet, exercise, self monitoring of blood glucose, pharmacology management , foetal surveillance of twice weekly - NST test, daily foetal movement count etc⁸.

 

STATEMENT OF THE PROBLEM:

Effectiveness of nursing care of antenatal mothers with gestational diabetes mellitus.

 

OBJECTIVES:

1.   To assess the health status of antenatal mothers with Gestational diabetes mellitus.

2.   To evaluate the effectiveness of nursing care on antenatal mothers with Gestational diabetes mellitus.

3.   To correlate the Selected demographic variables with effectiveness of nursing care of antenatal mothers with Gestational diabetes mellitus

 

ASSUMPTION:

Assessment of the mother’s condition enables the nurse to gain thorough knowledge about Gestational diabetes mellitus. Individualized quality nursing care will improve the wellbeing of the mother and foetus.

 

LIMITATIONS OF THE STUDY:

The study was limited to a) Period of 6 weeks b) The sample of 30 pregnant mothers. c) The mothers who were in age group of 18 years – above 29 years.

 

MATERIAL AND METHODS:

Research approach:

Quantitative approach

 

Research design:

Non experimental evaluative case study design.

 

Setting of study: 

The study was conducted in antenatal ward at Melmaruvathur Adhiparasakthi institute of medical science and research, Kancheepuram District.

 

Population:

The population of the study comprises of the antenatal mothers with Gestational diabetes mellitus who were admitted in antenatal ward at Melmaruvathur Adhiparasakthi institute of medical science and research, Kancheepuram district during the time of data collection.

 

Sample:

Antenatal mothers admitted in antenatal ward with GDM.

 

Sample Size:

The total number of sample was 30 pregnant mothers with Gestational diabetes mellitus

 

Sampling techniques:

Non probability purposive Sampling techniques was used.

 

CRITERIA FOR SAMPLE SELECTION:

Inclusive Criteria:

1    Mothers who have diagnosed with Gestational diabetes mellitus.

2    Mothers who understand Tamil and English.

3    Mothers who were both primigravida and multigravida.

4    Mothers who were willing to participate in the study.

5    Mother who were admitted at Melmaruvathur Adhiparasakthi institute of Medical science and Research.

 

Exclusive Criteria:

1    Mothers who are admitted in the Antenatal ward with pre gestational diabetes mellitus.

2    Mothers who were with other complicating metabolic disorders.

3    Mothers who were not willing to participate in the study.

 

DESCRIPTION OF THE TOOL:

Section-A:

This section consist of information about demographic variables such as age in years, educational status, occupation, family income, dietary pattern, gestational age, order of pregnancy, family history of diabetes mellitus, source of information.

 

Section-B:

Observational Checklist and ongoing assessment tool for the assessment of mothers with gestational diabetes mellitus. In this section an observational checklist was used to monitor the general condition of the mother with gestational diabetes mellitus. It includes details such as vital parameters, blood glucose monitoring, and assessment of clinical manifestation, foetal movement, Foetal heart rate, and treatment of Gestational diabetes mellitus.

 

Section-C:

In this part focused on nursing cares which are provided to mother with gestational diabetes mellitus. This part consisting of total number of nursing intervention such as dietary management, administering insulin therapy, monitoring foetal heart rate, maintaining kick chart, education regarding exercise, dietary habits.

 

RELIABILITY AND VALIDITY:

The tool was prepared with the guidance by the experts on the basis of objectives, which were assessed and evaluated, accepted by research committee. Content validity of this instrument was obtained from nursing experts. Reliability and practicability of tool was tested through the pilot study and used for main study.

 

DATA COLLECTION PROCEDURE:

The data were collected from antenatal mothers with gestational diabetes mellitus, who were co-operative and receptive. Assessment was done with the help of prepared tool. Nursing intervention was carried out from 8.00 am to 5.00 pm on all days during the study period, on 7^th day the care was evaluated with ongoing assessment tool.

 

REPORT OF PILOT STUDY:

Pilot study was conducted to find out the effectiveness of nursing care on antenatal mothers with gestational diabetes mellitus during the period of 2 weeks in Melmaruvathur institute of medical science and research, with the assessment tool which was evaluated by experts of the research committee and content validity was obtained from the experts. The sample taken for pilot study was excluded for main study. During the study ten samples were selected by using convenient sampling method. The data was analyzed by using paired t test. The result of the study was Calculated value is 5.46 and tabulated value is 4.60. Calculated value is greater than tabulated value. Therefore significant effect in nursing care of antenatal mothers with gestational diabetes mellitus.

 

Section A:

Table - 1 Distribution of demographic variables of mothers with gestational diabetes mellitus N = 30

S. No.	Demographic Data	No	Percentage (%)
1.	Age in years a) 18-24 years b) 23-31 years c) 32- 38 years d) Above 39 years	0 7 14 9	30.0 46.7 24.3 0
2.	Educational Status a) Illiterate b) School education c) College education	14 11 5	46.6 37.0 16.7
3.	Occupation a) Home maker b) Skilled worker c) Unskilled worker	13 14 3	43.3 47.0 10.0
4.	Family income per month a) Rs 1000/-2000/ b) Rs.2,001/- to Rs.3,000/- c) Above Rs 3001/	5 7   18	16.6 23.3   60.0
5.	Dietary pattern a) Vegetarian b)Non vegetarian	-- --	-- --
6.	Order of pregnancy a) Primigravida b) Multigravida c) Grand multigravida	16 16 -	53.3 53.3 -
7.	Gestational age a) Up to 12 weeks b) 13-28 weeks c) 29-42 weeks	- 9 21	- 30.0 70.0
8.	Family history of diabetes mellitus a) Yes b) No	13 17	43.3 57.0
9.	Source of health information a)  Mass media b) Health personnel c)  Neighbours and friends	15 12 3	50.0 40.0 10.0

 

Table 1 revealed that among 30 samples, 14 (46.7%) were belongs to the age group of 25 - 31 years, 14 (46.7%) were illiterate, 13 (43.45%) were home maker, 18 (60.0%) were belongs to monthly income of RS. 3001 and above, 17 (56.6%) were non vegetarian, 17 (56.6%) were primigravida, 15 (50.0%) were belongs to the gestational age of 29 to 42 weeks, 17 (56.7%) were family history of diabetes mellitus, 15 (50.0) were obtained information through mass media.

 

section B:

Table – 2 comparisons between assessment and evaluation scores of effectiveness of nursing care of antenatal mothers with gestational diabetes mellitus.                                                      n =30

S. No	HEALTH STATUS	Assessment		Evaluation
		N	%	N	%
1.	Poor glycemic control	17	56.6%`	-	-
2.	moderate glycemic control	13	43.3%	4	13.3%
3.	Good glycemic control	-	-	26	86.6%

Table 2 shows that comparison between assessment and evaluation scores of effectiveness of nursing care on antenatal mothers with gestational diabetes mellitus. This table reveals that frequency and percentage distribution of nursing care of antenatal mothers with gestational diabetes mellitus. During assessment phase 17(56.6%) of mothers were in poor glycemic control, 13(43.3%) Mothers in moderate glycemic control. During evaluation phase 4 (13.3%) of mothers were in moderate glycemic control, 26(86.6%) were in Excellent glycemic control.

 

Section - C:

Table -3 Comparison between mean and standard deviation of assessment and evaluation of antenatal mothers with gestational diabetes mellitus

S. No	Health Status	MEAN	S.D
1.	Assessment	30.3	3.06
2.	Evaluation	16.06	2.44

 

Table 3 shows comparison between mean and standard deviation of assessment and evaluation of antenatal mothers with GDM. This table shows that during the pre test mean was 30.0 with the standard deviation of 3.06 and on post test the mean was 16.06 with the standard deviation of 2.44.

 

Section - D:

Table - 4. Mean and Standard deviation of improvement score of antenatal mothers with GDM                                                      N =30

S. No	Health Status	MEAN	S.D	Sign Value
1.	Improvement score	16.06	2.44	4

 

Table 4 shows the mean and standard deviation of improvement score for effectiveness of nursing care on antenatal mother with GDM. The table also reveals the assessment of health status is nothing but the value of mean, standard deviation and sign value of improvement score. The improvement score of mean value is 16.06 and standard deviation is 2.44 and the sign value is 4. The sign value was compared with tabulated value at P<0.01. So it is concluded that the nursing care on antenatal mother with GDM is effective. So there is a significant relation between nursing care on antenatal mother with GDM.

 

Section: E Table - 5 correlation between demographic variables and the evaluation score of health status of mothers with GDM N=30

S.N	Demographic variables	Assessment				Evaluation				r
		Severe > 75%		Moderate 51-74%		Moderate 51-74%		Mild > 75%
		N	%	N	%	N	%	N	%
I	Age in years a) 18-24 years b) 23-31 years c) 32- 38 years d) Above 39 years	5 8 4 0	16.6 26.6 13.3 0	4 6 3 0	13.3 20.0 10.0 0	2 1 1 0	3.3 3.3 6.6 0	8 13 5 0	26.6 43.3 16.6 0	0.75*
2	Occupation a) Home maker b) Skilled worker c) Unskilled worker	7 1 9	23.3 3.3 30.0	6 4 3	20 13.4 10	2 1 1	6.7 3.3 3.3	11 4 11	36.7 13.3 36.7	0.45*
3	Family income per month a) Rs 1000/-2000/ b) Rs.2,001/-toRs.3,000/-   c) above Rs 3001/	3 5 9	10 16.7 30.0	2 2 9	6.7 6.7 30	2 1 1	6.7 3.3 3.3	3 6 17	10 20 56.7	0.92*
4	Dietary pattern a) Vegetarian b) Non vegetarian	8 9	26.6 30	5 8	16.6 26.6	2 2	6.7 6.7	11 15	36.7 50	0.82*
5	gestational age a) up to 12 weeks b)13-28 weeks c) 29-42 weeks	3 7 7	10 23.3 23.3	2 3 8	6.7 10 26.7	1 2 1	3.3 6.7 3.3	4 8 14	13.3 26.7 46.7	0.63*
6	Family history of diabetes mellitus a)Yes b) No	8 9	26.6 30	5 8	16.7 26.7	2 2	6.7 6.7	11 15	36.7 50	0.82*

 

On correlating the evaluation score with the selected demographic variables, there is significant correlation in age in years, occupation, family income, dietary pattern, gestational age and family history of diabetes mellitus

 

RESULTS AND DISCUSSION:

First objective was to assess the health status of antenatal mothers with gestational diabetes mellitus:

Conceptual frame work was used for this study is modified Lydia Hall’s core, care, care theory was applied to do the intervention and carryout the observation. In pre assessment the total observed score was 30. 3 after nursing care on antenatal mother with gestational diabetes mellitus the score was 16.06. The finding after analyses reveals that the significant difference among antenatal mother with gestational diabetes mellitus.

 

The second objective was to evaluate the effect of nursing care on antenatal mother with gestational diabetes mellitus:

The blood Glucose level was assessed before the treatment and the blood Glucose level was observed during and after treatment of antenatal mother with gestational diabetes mellitus. This was rated and assessed by use of assessment tool. Comparison of assessment mean level of 30.3 and evaluation mean 16.06 shows the improvement mean was 16.06 with standard deviation of 2.44. The Sign test value was 4, proved the significant difference in blood Glucose level by nursing care of antenatal mothers with gestational diabetes mellitus The finding of the study reveals statically significant difference through nursing care on antenatal mothers with gestational diabetes mellitus.

 

The third objective was to correlate the selective demographic variable with the effectiveness of nursing care on antenatal mother with gestational diabetes mellitus:

On correlating the evaluation score with the selected demographic variables, there is significant correlation in age in years, occupation, family income, dietary pattern, gestational age and family history of diabetes mellitus.

 

CONCLUSION:

This study reveals that effective nursing care of antenatal mothers with gestational diabetes mellitus helps to maintain the blood glucose level within normal limit and also prevent the maternal and foetal complications. So it is necessary for the nurses to render effective nursing care to gestational diabetes mellitus mothers to avoid complications.

 

LIST OF SYMBOLS:

GDM – Gestational Diabetes Mellitus, WHO – World Health Organisation, IADPSG – International Association of Diabetes and Pregnancy Study Groups., DIPSI- Diabetes in Pregnancy Study Group in India, OGTT – Oral Glucose Tolerance Test.

 

ACKNOWLEDGEMENT:

I express my sincere thanks to almighty god, for his blessings and guidance, which enabled me to complete my study successfully.

 

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Received on 12.02.2020          Modified on 16.03.2020

Accepted on 18.04.2020   ©AandV Publications All right reserved