INTRODUCTION:

Pregnancy is associated with profound changes in the fat and carbohydrate metabolism. Glucose metabolism is characterized by a lower fasting plasma and elevated post-prandial values in the early weeks. In later weeks carbohydrate metabolism is stressed by the rising levels of human chorionic somatotropin (hCS), prolactin, cortisol, and glucagons. These hormones cause decreased glucose tolerance and insulin resistance.

A small pregnant population cannot withstand the physiological stresses accompanying pregnancy which result in abnormal glucose tolerance which causes Gestational diabetes mellitus.

Many of the obstetric and gynaecological problems arise from gestational diabetes mellitus. Both maternal and fetal complications are included. Maternal complications are obesity which cause resistance to insulin which will results in diabetes after gestational diabetes mellitus, fasting hyperglycaemia (>105mg/dl), increased frequency of maternal hypertensive disorders, increases the need for caesarean delivery, increased risk for the development of type 2 diabetes in women after pregnancy. Foetal complications are intrauterine fetal death during the last 4-8 weeks of gestation due to maternal hyperglycaemia, increased risk of fetal macrosomia, neonatal jaundice, polycythemia in the neonate, hypocalcaemia in the neonate, and fetal growth disorders. Offspring of obese women with gestational diabetes mellitus are at increased risk of obesity, glucose intolerance, and diabetes in late adolescence and young adulthood.

Women with gestational diabetes mellitus are an ideal group for the primary prevention of diabetes as they are at increased risk of future diabetes, predominantly type II diabetes, as are their children. The timely action taken in screening all pregnant women for glucose tolerance, achieving euglycemia in them and ensuring adequate nutrition may prevent in all possibility, India becoming the diabetes capital of the world.

NEED FOR THE STUDY:

The prevalence of diabetes is increasing globally and India is no exception. The “fetal origin of disease” hypothesis proposes that gestational programming may cortically influence adult health and disease.

The complications of gestational diabetes can be reduced by good glycaemic control, through home blood glucose monitoring, dietary modification, exercise, insulin regimen and prevention of maternal and foetal complications of gestational diabetes. A lack of knowledge on gestational diabetes results in exalting cost of GDM both for the country and the family. It is necessary to impart knowledge regarding gestational diabetes mellitus (GDM), and its treatment mainly administration of insulin and dietary pattern to be followed. It can reduce the incidence of developing maternal and fetal complications.

OBJECTIVES:

1. To formulate structured teaching program.

2. To assess the pre-test and post-test knowledge regarding gestational diabetes mellitus among antenatal women at Dr. B.R.A.M hospital, Raipur, C.G.

3. To assess the effectiveness of structured teaching program on knowledge regarding gestational diabetes mellitus among antenatal women at Dr. B.R.A.M hospital, Raipur, C.G.

4. To find out the association between pre-test knowledge score regarding gestational diabetes mellitus with selected socio-demographic variables.

HYPOTHESES:

H₁: The mean post-test knowledge scores of the antenatal women regarding gestational diabetes mellitus will be significantly higher than the mean pre-test knowledge scoresat 0.05 level of significance.

H₂: There will be significant association between pre-test knowledge scores of antenatal women regarding gestational diabetes mellitus with the selected socio demographic variables at 0.05 level of significance.

CONCEPTUAL FRAMEWORK:

Model attempts to represent reality with a minimum use of words. Visual or symbolic representation of theory or conceptual frame work often help to express abstract, ideas in a more readily understandable or precise form than the original conceptualization. The conceptual model in this study is based on Neuman’s system model (1982). It provides guidance for development utilisation and evaluation of structured teaching program. The conceptual frame work consist of three phases- input, output and process.

METHODOLOGY:

RESEARCH APPROACH:

One group pre-test post-test approach.

RESEARCH DESIGN:

Pre-experimental, one group pre-test –post test research design

POPULATION:

Target population:

In present study the target population included were antenatal women.

Accessible population:

The population selected for this study was antenatal women admitted in Dr. Bhimrao Ambedkar memorial Hospital, Raipur (C.G.)

Setting of The Study:

The setting for the present study was antenatal wards of Dr. Bhimrao Ambedkar Memorial Hospital, Raipur (C.G.)

Sample:

The sample of the study comprised of 60 antenatal women of Dr. Bhimrao Ambedkar memorial Hospital, Raipur (C.G.)

Sampling Technique:

Non probability Purposive sampling technique was used to select 60 samples.

Sample Size

Total 60 antenatal women were taken for this study.

VARIABLES:

According to Polit And Hungler, variable is an attribute of a person or an object that varies, that it takes an different values. Two type of variable are identified in the study. They are dependent variable and independent variables.

Dependent variable:

Dependent variable was– knowledge of antenatal women regarding Gestational diabetes mellitus.

Independent variable:

Independent variable in this study was structured teaching programme on gestational diabetes mellitus among antenatal women.

SAMPLING CRITERIA:

Inclusion criteria:

· Antenatal women who are admitted in Dr. BhimRao Ambedkar Memorial Hospital, Raipur, C.G.

Exclusion criteria:

· Antenatal women not present at the time of data collection.

· Antenatal women who are not willing to participate.

Description of The Tools:

The self-structured questionnaires were organised in two sections

Fig. 1.1 Description of tools.

Criterion Measures:

The question prepared for assessment of knowledge on Gestational diabetes mellitus. The score categorized as:

· Very good- 21 to 30 (70-100%)

· Good - 11to20 (36.66-66.66%)

· Average – 1 to10 (33.33%)

Method of Data Collection:

Table.1.1 Analysis of pre-test and post-test knowledge score:

The data collection was done for 4 weeks period. After obtaining informed and willing from the study participants the study was conducted at the Dr. Bhimrao Ambedkar memorial Hospital, Raipur (C.G.) total of 60 samples data were collected.

Data Analysis and Interpretation:

Descriptive statistics such as frequency, percentage, mean and standard deviation was used to assess the knowledge of antenatal women and effectiveness of structured teaching program regarding gestational diabetes mellitus.

Analysis of pre and post-test knowledge score using mean, mean percentage and standard deviation.

Planned teaching programme	Total knowledge score (out of 1800)	Mean	Mean %	SD
Pre-test	488	8.12	49.16	±2
Post-test	1042	17.38	71.7	±2.32

Revels that knowledge regarding gestational diabetes mellitus, structured teaching programme pre-test total knowledge score was 488(1800), mean was 8.12, mean percent was 49.16 and SD was 2 where as in post-test total knowledge score 1042(1800), mean was 17.38, mean percentage was 71.7 and SD was 2.32.

Knowledge	Pre-test				Post –test
	Frequency	Percentage	Frequency	Percentage
Good	0	00	05	8.33%
Averag	07	11.67%	55	91.67%
Need for improve-ment	53	88.33%	0	0%

Analysis of pre-test and post test knowledge score of planned teaching programme according to criteria.

Table and Figure 2.1:

Represent that in structured teaching programme 07(11.67%) were having average knowledgeand 53(88.33%) were in need for improvement in pre-test and in post-test majority 55(91.67%) were having average knowledge, 5(8.33%) were having good knowledge.

Effectiveness of pre-test and post-test knowledge score of planned teaching programme.

Planned teaching programme

Mean ±SD

df.

Paired ‘t’ value

Table value

Pre test

8.12±2

9.54

2.02

Post-test

17.38±2.32

Represent that there was significant difference between the pre-test and post-test knowledge score of structured teaching programme as calculated value 9.54; (df.59) was greater than table value 2.02 at 0.05level of significance.

Hence, structured teaching programme on knowledge regarding gestational diabetes mellitus was effective to improve the knowledge of antenatal women on gestational diabetes mellitus.

MAJOR FINDINGS OF STUDY:

The data was collected, analysed and interpreted in term of objectives. Descriptive and inferential statistics were utilized for the data analysis. The level of significance set for testing the hypothesis was, 0.05 using ‘t’ test. The major findings of the study were presented under the following

Description of subjects according to socio-demographic variables in frequency and percentage:

1. Most of the antenatal women 36(60%) in maternity wards belonged to age group of 20-25 years.

2. Majority of antenatal women 46(76.67%) in maternity wards belonged to Hindu Religion.

3. Maximum number 45(75%) antenatal women in maternity wards were studied up to Table: 3.1 Showing value of mean, SD. degree of freedom and paired t-test. primary school.

4. Majority of antenatal women 38(63.33%) in maternity wards are House wife.

5. Majority of antenatal women 43(71.67%) in maternity wards have monthly income 5, 000-10, 000.

6. Maximum number of antenatal women 33(55%) are belongs to Nuclear Family.

7. Majority of antenatal women 46(76.67%) in maternity wards have one child.

8. Majority of antenatal women 43(71.67%) in maternity ward Don’t know about Family history of Diabetes.

Analysis of data using mean, mean% and standard deviation:

Revels that knowledge regarding deep vein thrombosis, planned teaching programme pre-test total knowledge score was 487(1800), mean was 8.12, mean percent was 27.06 and SD is 2 where as in post-test total knowledge score were 1043(1800), mean was 17.38, mean percent was 57.93 and SD was 2.32.

Criteria wise analysis of knowledge scores between pre-test and post-test in frequency and percentage:

The study findings revelled that in pre- test score of the antenatal women had knowledge score 7(11.67%) were average and 53(83.33%) were poor. In post-test 5(8.33%) were good and 55 (91.67%) were average.

t-Test to assess the effectiveness of structured teaching programme on knowledge regarding gestational diabetes mellitus among antenatal women in Dr. Bhimrao Ambedkar Memorial Hospital, Raipur, C.G.:

Represent that there was highly significant difference between the pre-test and post-test knowledge score of structured teaching programme as calculated value 9.54 (df.59) was greater than table value 2.02 at 0.05level of significance.

Chi-square analysis for association between pre- test knowledge score of antenatal women with selected socio-demographic variables.

Revels that:

1. Findings related to age: The present study revealed that the calculated value of chi square is 7.82, which is less than the tabulated value at 0.05 level of significance; there was no significant association between pre-test level of knowledge and age of antenatal women.

2. Findings related to religion: The present study revealed that the calculated value of chi-square is 2.13, which is less than the tabulated value at 0.05 level of significance; there was no significant association between pre-test level of knowledge and religion of antenatal women.

3. Findings related to Educational qualification: The present study revealed that the calculated value of chi-square is 4.2, which is less than the tabulated value at 0.05 level of significance; there was no significant association between pre-test level of knowledge and educational qualification of antenatal women.

4. Findings related to Occupation: The present study revealed that the calculated value of chi-square is 6.4, which is less than the tabulated value at 0.05 level of significance, there was no significant association between pre-test level of knowledge and occupation of antenatal women.

5. Findings related to Monthly income: The present study revealed that the calculated value of chi-square is 5.41, which is less than the tabulated value at 0.05 level of significance, there was no significant association between pre-test level of knowledge and monthly income of antenatal women.

6. Findings related to Type of family: The present study revealed that the calculated value of chi-square is 6.27, which is less than the tabulated value at 0.05 level of significance, there was no significant association between pre-test level of knowledge and type of family of antenatal women.

7. Findings related to No. of living children: The present study revealed that the calculated value of chi-square is 7.82, which is less than the tabulated value at 0.05 level of significance, there was no significant association between pre-test level of knowledge and no. of living children of antenatal women.

8. Findings related to family history of diabetes: The present study revealed that the calculated value of chi-square is 7.82, which is greater than the tabulated value at 0.05 level of significance, there was no significant association between pre-test level of knowledge and family history of diabetes.

Findings reveals that there is significant association between the pre-test knowledge levels of the antenatal women in maternity wards with selected socio demographic variables.

Hence hypothesis H2 is accepted.

CONCLUSION:

Gestational diabetes is the commonest type encountered. (50-80% of all pregnant diabetes) Majority of them are at 20-30 years. Gestational diabetes usually develops during the second or third trimester. There are no standard methods for screening, diagnosing and treating this condition which leads to serious maternal and fetal complications. The primary prevention is more important as this effort in likely to reverse or halt the epidemic of disease. Women with gestational diabetes mellitus are an ideal group for the primary prevention of diabetes as they are at increased risk of future diabetes, predominantly type II diabetes, as are their children. The timely action taken in screening all pregnant women for glucose tolerance, achieving euglycemia in them and ensuring adequate nutrition may prevent in all possibility, India becoming the diabetes capital of the world. Gestational Diabetes Mellitus (GDM) complicates approximately 4% of all pregnancies. Since it is preventable in majority of cases, it is appreciable for the women especially in the reproductive age between 19 to 45 years to be aware about Gestational Diabetes mellitus risk factors, early detection, complications and prevention. Thus the investigator took up the interest in the study to assess the knowledge on prevention of Gestational Diabetes mellitus among women of reproductive age.

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Received on 06.01.2021 Modified on 13.02.2021

Int. J. of Advances in Nur. Management. 2021; 9(2):190-194.

DOI: 10.5958/2454-2652.2021.00043.3