Knowledge, Attitude and Practice Study on Antenatal Women with Gestational Diabetes Mellitus

Gestational diabetes is type of diabetes that can develop during pregnancy in women who have had no history of diabetes in the past. GDM is generally observed in women during the second or third trimester of their pregnancy, it is known to be a subtype of Diabetes Mellitus that is known as the development or the recognition of glucose intolerance during pregnancy. The risk of developing type 2 diabetes mellitus is greater in mothers with GDM compared to the general population. This was a prospective observational study carried out in the Department of gynecology in ESI MC & PGIMSR, Rajajinagar, Bengaluru. A total of 100 samples were collected, of which 85 were selected for the study. Subjects for the study were identified by the investigator during ward rounds based on the inclusion and exclusion criteria. Relevant data collected were recorded on the Self-designed data collection form. All recorded data were entered using Microsoft excel software for determining the statistical significance. The results it was found that most of the antenatal women are of age group 26-30 years, home maker, secondary school, Primi gravida, diagnosed in 3 rd trimester, with no family history of gestational diabetes mellitus, low-income status and urban population. The knowledge, attitude and practice about gestational diabetes mellitus was assed. In the present study, we have concluded that good knowledge about the disease among the subjects also had good attitude and practice towards the disease. Improving the knowledge regarding the disease resulted in better health outcome among pregnant women.


INTRODUCTION
Gestational diabetes mellitus (GDM) is a condition that may occur in the second half of pregnancy when blood glucose control is more difficult to achieve, leading to hyperglycemia (abnormally high concentration of glucose in the blood) that may affect the woman and her baby.The World Health Organization (WHO) defines GDM as "Carbohydrate intolerance resulting in hyperglycemia or any degree of glucose intolerance with onset or first recognition during pregnancy usually from 24 weeks' gestation onwards" and resolves following the birth of the baby. [1]Diabetes complicates between 1

MATERIALS AND METHODS
This was a prospective observational study carried out over a period of 6 months in the Department of Gynecology ESI MC & PGIMSR, Rajajinagar, Bengaluru.Subjects for the study were identified by the investigator during ward rounds based on the inclusion and exclusion criteria.A total of 100 samples were collected, of which 85 were selected for the study.Relevant data collected were recorded on the Self-designed data collection form.The data thus obtained was entered into a Microsoft Excel sheet and analyzed appropriately.The study was approved in accordance with the guidelines issued by ICMR the Institutional Ethics Committee has issued ethical clearance to carry on the work.
Inclusion Criteria: a) Pregnant women b) willing to participate was approached by the investigator.c) Women diagnosed with diabetes mellitus during pregnancy.d) Pregnant women above the age of 18 years.
Exclusion Criteria: a) Women with past history of diabetes mellitus.b) Women who are not willing to Participate in the study.• Email: editor@ijfmr.com

Statistical Analysis:
All recorded data were entered and analyzed using MS Excel.Descriptive statistics were computed for quantitative variables.Frequencies and percentages were calculated for categorical values.Column charts, pie-charts, bar graphs were applied to find the nature of data distribution.

RESULTS & DISCUSSION
The study was conducted in the day care ward of the Gynecology department of ESI MC & PGIMSR, Rajajinagar, Bengaluru.A total of 100 samples were collected.Of these, 15 samples were dropped out due to insufficient data, so the overall sample size was 85.

Distribution Of Subjects According to Age
Out of 85 subjects responded, 1(1.20%) was of age </=20 Question K3 was to assess the knowledge regarding the information about any history of gestational diabetes mellitus during previous pregnancy.Out of 85 pregnant women, 44 were primi which was excluded since the question is not applicable.Hence among 41 respondents (35 were in secondary gravida and 6 were in tertiary gravida), among which 6 (15%) were having history of GDM during their previous pregnancy and 35 (85%) were not having history of GDM during previous pregnancy).The graphical representation as shown in figure11 indicates that study population's knowledge regarding the history of gestational diabetes mellitus.Question K11 was about the respondent's knowledge regarding the responsibility of diabetic care.Out of 85 respondents, 85(100%) responded yes.Here yes is for possible correct answers like pregnant women, family, doctor and all of the above are responsible for the diabetic care during GDM.0(0%) responded no, indicating none are responsible for diabetic care during GDM.The graphical representation as shown in figure19 indicates that the knowledge of respondents regarding the responsibility of diabetic care.

ASSESSMENT OF ATTITUDE TOWARDS GESTATIONAL DIABETES MELLITUS (GDM):
The attitude of the respondents towards the gestational diabetes mellitus (GDM) was assessed by using self-designed questionnaire.
Question A1: Gestational diabetes causes complications in pregnancy.) agreed that all pregnancies should be screened routinely for gestational diabetes mellitus (GDM) and 8 (9.42%) disagreed that all pregnancies should be screened routinely for gestational diabetes mellitus (GDM).The table representation shown above specifies the attitude of pregnancy women towards importance of screening all pregnancies routinely for gestational diabetes mellitus (GDM).

RESPONSES
Question A4: Should one eat more fresh fruits and vegetables during pregnancy.) agreed about concept of eating for two (more food for the baby's growth) always correct and 4 (4.70%)disagreed about concept of eating for two (more food for the baby's growth) always correct.The table representation shown above specifies the attitude of pregnancy women about concept of eating for two (more food for the baby's growth) always correct.

ASSESSMENT OF PRACTICE TOWARDS GESTATIONAL DIABETES MELLITUS
The practice of the subjects towards the gestational diabetes mellitus was assessed by using self-designed questionnaire. ) subjects responded yes had a practice of visiting hospital for fasting and post meal blood sugar testing and 1 (1.17%)Subjects responded no didn't having a practice of visiting hospital for fasting and post meal blood sugar testing.The table representation from above figure indicates about practice of pregnant women about visiting hospital for fasting and post meal blood sugar testing.Here the possible correct answers are like Once every week, once every two weeks, once a month as single answer yes and don't know was considered as no.

Question P1:
Question P7: What practice will you follow to control if you are diagnosed with gestational diabetes mellitus?RESPONSES NUMBER OF PATIENTS PERCENTAGE YES 85 100% NO 0 0% Out of 85 subjects, 85 (100%) subjects responded yes had a good practice to control gestational diabetes mellitus (GDM) and 0 (0%) subjects responded no didn't having a practice to control gestational diabetes mellitus (GDM).The table representation from above figure indicates a practice in pregnant women about management regarding gestational diabetes mellitus (GDM).Here the possible correct answers are like Balanced diet, Regular antenatal check-up, Moderate exercise, Medication, All of above as single answer yes and don't know was considered as no.
Question P8: Do you eat more vegetables than meat in order to control blood glucose.

DISCUSSION
An observational study was performed in the outpatient OBG department of ESIC hospital, Rajajinagar in Bengaluru district by enrolling 85 study subjects conducted for a period of 6 months.Out of 85 subjects included in the study, 45.90% of subjects were of the age group 26-30, 31.80% of subjects were of the age group 21-25, 21.20% of subjects were of age group 31-35, 1.20% of subjects were of age group </=20 and 0% of subjects were of age group >35.Out of 85 subjects included in the study, 67.10% of subjects were home makers, 15.30% of subjects were professionals, 10.60% of subjects were laborers, 3.50% of subjects were farmers and 3.50% of subjects were health care workers.Out of 85 subjects included in the study, 36.50% of subjects were secondary school, 30.60% of subjects were higher secondary school, 24.70% of subjects were graduate, 5.90% of subjects were just literate, 1.20% of subjects were illiterate and 1.20% of subjects were post graduate.Out of 85 subjects included in the study, 72.60% of subjects were urban and 27.40% of subjects were rural.Out of 85 subjects included in the study, 51.80% of subjects were Primi gravida, 43.50% of subjects were secondary gravida, 4.70% of subjects were tertiary gravida and 0% of subjects were multi gravida.Out of 85 subjects included in the study, 64.70% of subjects were 3 rd trimester, 18.80% of subjects were 2 nd trimester, 16.50% of subjects were 1 st trimester.In this study the assessment of knowledge regarding is as follows: Out of 85 subjects included in the study, Question K1 was related to the respondent's knowledge about the diabetes.To this question out of 85 respondents, 95% responded were aware of the diabetes.Question K2 was related to the respondent's knowledge about the gestational diabetes mellitus (GDM).To this question out of 85 respondents, 55.29% responded were aware of gestational diabetes mellitus.Question K3 was to assess the knowledge regarding the information about any history of gestational diabetes mellitus during previous pregnancy.Out of 85 pregnant women, among which 15% were having history of GDM during their previous pregnancy.Question K4 was to assess the knowledge regarding risk factors of GDM.Out of 85 respondents, 67.70% responded yes about the risk factors of GDM.Question K5 was related to the respondent's knowledge regarding the special dietary care needed during pregnancy.To this question out of 84 respondents, 64.70% responded yes for the need of special dietary care during pregnancy.Question K6 was related to respondent's knowledge regarding the common problem of new born of a GDM mother.Out of 85 respondents, 42.35% responded yes about the common problem of a GDM.Question K7 was related to the respondent's knowledge regarding the diagnosis of GDM.To this question out of 85 respondents, 88% responded yes about the knowledge regarding the diagnosis of GDM.Question K8 was to assess respondent's knowledge regarding the use of insulin in controlling blood sugar.Out of 85 respondents, 51% responded yes about the knowledge regarding the use of insulin in controlling blood sugar.Question K9 was related to the respondent's knowledge regarding the how many hours fasting is required before testing fasting blood sugar.Out of 85 respondents, 83.53% responded yes regarding correct knowledge about fasting hours before testing blood glucose.Question K10 was to assess the respondent's knowledge regarding the OGTT (oral glucose tolerance test).To this question out of 85 respondents, 68.24% responded yes were knowledgeable regarding the OGTT.Question K11 was about the respondent's knowledge regarding the responsibility of diabetic care.Out of 85 respondents, 100% responded yes.In this study the assessment of Attitude regarding is as follows: Out of 85 subjects included in the study, Out of 85 subjects, 48.24% agreed that gestational diabetes mellitus caused complications during pregnancy.Out of 85 subjects,75.30%agreed that early diagnosis is crucial for preventing complications during pregnancy.Out of 85 subjects, 90.58% agreed that all pregnancies should be screened routinely for gestational diabetes mellitus (GDM).Out of 85 subjects, 88.24% agreed that one should eat more fruits and vegetables during pregnancy.Out of 85 subjects, 95.30% agreed about concept of eating for two (more food for the baby's growth) always correct.In this study the assessment of Practice regarding is as follows: Out of 85 subjects included in the study, Out of 85 subjects, 91.76% subjects responded yes had a practice of eat three or more meals every day.Out of 85 subjects, 90.58% subjects responded yes had a control from eating junk foods.Out of 85 subjects, 92.94% subjects responded yes had followed a weight check-up during pregnancy.
Out of 85 subjects, 98.83% subjects responded yes had a practice of visiting doctor during pregnancy.Out of 85 subjects, 97.65% subjects responded yes had a practice of screening for blood sugar during sugar.Out of 85 subjects, 98.83% subjects responded yes had a practice of visiting hospital for fasting and post meal blood sugar testing.Out of 85 subjects, 100% subjects responded yes had a good practice to control gestational diabetes mellitus (GDM).Out of 85 subjects, 91.76% subjects responded yes had a practice of consuming more vegetables than meat.

CONCLUSION:
Gestational diabetes mellitus is a condition in pregnancy which can cause foetal and maternal complications.After delivery the new born may have life threatening metabolic complications and later in life may suffer from obesity, glucose intolerance and Diabetes in early adulthood.The mother might also be at the risk of developing type-2 diabetes mellitus.So, the knowledge among the antenatal women will result in disease prevention and early detection.In this study about the status of knowledge, attitude and practices towards GDM was revealed knowledge was insufficient among the participants.This might have an adverse effect on maternal and foetal wellbeing.Education of antenatal women supporting the welfare of baby and the mother should be provided at all levels of Reproductive Health Program.There is a need to improve the antenatal patient's knowledge on GDM.If knowledge about GDM increases among pregnant women they may be motivated to have an attitudinal change resulting in better practices like compliance for management protocols including dietary modifications, not defaulting on medications and getting regular follow-up.This may result in improved pregnancy outcomes.In this study, it was found that significant factors like being male, having higher income, high socio-economic levels, following diabetic diet, maintaining physical activity on a regular basis, good knowledge about the disease and having stronger beliefs about medicines and their use were highly adherent to anti-diabetic medications indicating high medication adherence levels.Subjects with high levels of medication adherence had a good glycemic control.Subjects having good knowledge about the disease had better medication adherence and was associated with better glycemic control.Beliefs about medicines was suboptimal, with subjects having stronger beliefs towards use of medicine were comparatively highly adherent to medicines than those who had negative beliefs about medicines.Subjects' knowledge and beliefs about medicine are crucial factors that are significantly associated with medication adherence.By improving and educating patients knowledge regarding the disease and medications may have a good impact on medication compliance and management of the disease.Counselling the subjects regarding the importance of self-care behavior, following a diabetic diet and being physical active in addition to medication compliance ensuring a strategic diabetic management and therapeutic outcome.
related to the respondent's knowledge regarding the diagnosis of GDM.To this question out of 85 respondents, 75 (88%) responded yes about the knowledge regarding the diagnosis of GDM and 10 (12%) responded no about the knowledge regarding the diagnosis of GDM.The graphical representation as shown in figure15 indicates the knowledge regarding the diagnosis of GDM.Here the possible diagnosis like Urine test, Blood test after glucose ingestion (OGTT), Fasting blood sugar test / Sugar test after meals (FBS/PPBS) were considered as single answer yes and don't know was considered as no. to assess the respondent's knowledge regarding the OGTT (oral glucose tolerance test).To this question out of 85 respondents, 58(68.24%)responded yes were knowledgeable regarding the OGTT and 27(31.76%)responded no were not knowledgeable regarding the OGTT.The table representation as shown in indicates the knowledge of respondent's regarding the OGTT.
Question K4 was to assess the knowledge regarding risk factors of GDM.Out of 85 respondents, 57 (67.70%) responded yes about the risk factors of GDM and 28 (32.94%)respondedno about the risk factors of GDM.The graphical representation as shown in figure12 indicates the knowledge regarding the risk factors of GDM.Here the possible risk factors like Older maternal age, Family history of Diabetes mellitus, History of GDM in previous pregnancy, delivery of baby with big size, Obesity were considered as single answer yes and don't know was considered as no.Question K5: Do you think special dietary care is needed during your pregnancy?Question K5 was related to the respondent's knowledge regarding the special dietary care needed during pregnancy.To this question out of 84 respondents, 55 (64.70%) responded yes for the need of special dietary care during pregnancy and 30 (35.30%) responded no for the need of special dietary care during pregnancy.The graphical representation as shown in figure13 indicates that knowledge regarding the knowledge about special dietary care needed during pregnancy were considered as single answer yes and don't know was considered as no.Question K6 was related to respondent's knowledge regarding the common problem of new born of a GDM mother.Out of 85 respondents, 36 (42.35%) responded yes about the common problem of a GDM and 49 (57.65%)respondedno about the common problem of a GDM mother.The graphical representation as shown in figure14 indicates knowledge of respondents regarding the common problem of new born of a GDM mother.Here the possible common problem like Big baby, Birth trauma, Respiratory distress syndrome, Preterm delivery, Congenital anomalies were considered as single answer yes and don't know was considered as no.Question K8 was to assess the respondent's knowledge regarding the use of insulin in controlling blood sugar.Out of 85 respondents, 43 (51%) responded yes about the knowledge regarding the use of insulin in controlling blood sugar and 42 (49%) responded no about the knowledge regarding the use of insulin in controlling blood sugar.The table representation as shown in the knowledge regarding the use of insulin in controlling blood sugar.indicates the knowledge regarding the how many hours fasting is required before testing fasting blood sugar.Here the possible correct answers are like 6 hours before test, 12 hours before test, 8 hours before test, 16 hours before test.wereconsidered as single answer yes and don't know was considered as no.Question K10: Do you know about OGTT test?
Out of 85 subjects, 41 (48.24%) agreed that gestational diabetes mellitus caused complications during pregnancy and 44 (51.76%) disagreed that gestational diabetes mellitus caused complications during pregnancy.The table representation shown above specifies the attitude of pregnancy women towards gestational diabetes mellitus caused complications during pregnancy.Out of 85 subjects, 64 (75.30%) agreed that early diagnosis is crucial for preventing complications during pregnancy and 21(24.70%)disagreed that early diagnosis is crucial for preventing complications during pregnancy.The table representation shown above specifies the attitude of pregnancy complications towards importance of early diagnosis for preventing complications during pregnancy.All pregnancies should be screened routinely for GDM.
Out of 85 subjects, 75 (88.24%)agreed that one should eat more fruits and vegetables during pregnancy and 10 (11.76%) disagreed that one should eat more fruits and vegetables during pregnancy.The table representation shown above specifies the attitude of pregnancy women about eating more fruits and vegetables during pregnancy.Is concept of eating for two (more food for the baby's growth) always correct.
Do you eat three or more meals every day.24%) subjects responded no had a practice of eat three or more meals every day.The table representation from above figure indicates about practice of having balanced meals in a day.Out of 85 subjects, 77 (90.58%) subjects responded yes had a control from eating junk foods and 8 (9.42%) subjects responded no didn't had a control from eating junk foods.The table representation from above figure indicates about practice of having a control from eating junk foods.Out of 85 subjects, 79 (92.94%) subjects responded yes had followed a weight check-up during pregnancy and 6 (7.06%) subjects responded no didn't followed a weight check-up during pregnancy.The table representation from above figure indicates practice of body weight check-up during pregnancy.Out of 85 subjects, 84 (98.83%) subjects responded yes had a practice of visiting doctor during pregnancy and 1 (1.17%) subjects responded no didn't having a practice of visiting doctor during pregnancy..The table representation from above figure indicates about practice of visiting doctor during pregnancy.Out of 85 subjects, 83 (97.65%) subjects responded yes had a practice of screening for blood sugar during sugar and 2 (2.35%) subjects responded no didn't having a practice of screening for blood sugar during sugar.The table representation from above figure indicates about practice of pregnant women about screening for blood sugar during sugar.How often do you visit hospital for fasting and post meal blood sugar testing.
Out of 85 subjects, 78 (91.76%) subjects responded yes had a practice of consuming more vegetables than meat and 7 (8.24%)subjects responded no didn't having a practice of consuming more vegetables than meat.The table representation from above figure indicates practice of consuming of vegetables and meat during pregnancy.