CHAPTER ONE

INTRODUCTION

1. BACKGROUND OF THE STUDY

Gestational, Diabetes, WHO, New criteria Gestational diabetes mellitus (GDM) is, defined as any degree of glucose intolerance with onset or first recognition during pregnancy Metzger BE (1998).

The definition applies whether insulin or only diet modification is used for treatment and whether or not the condition persists after pregnancy. It does not exclude the possibility that unrecognized glucose intolerance may have antedated or begun concomitantly with the pregnancy.

Gestational Diabetes Mellitus is classified as type 4 DM Spong CY (1998). The diagnosis of gestational diabetes according to the new guideline by the world health organization (WHO) in 2013 is based on any one of the following values: Fasting plasma glucose - 5.1-6.9mmol/l (92- 125mg/dl); 1hour post 75g oral glucose load > 10.0mmol/l (180mg/dl); 2 hours post 75g oral glucose load8.5-11.0mmol/l (153-199mg/dl) (American Diabetes Association, Gestational Diabetes Mellitus, Diabetes. Diabetes Care)(2003).

The diagnosis of gestational diabetes according to the new guideline by the world health organization (WHO) in 2013 is based on any one of the following values: Fasting plasma glucose - 5.1-6.9mmol/l (92- 125mg/dl); 1hour post 75g oral glucose load > 10.0mmol/l (180mg/dl); 2hours post 75g oral glucose load8.5-11.0mmol/l (153-199mg/dl) American Diabetes Association, Gestational Diabetes Mellitus, Diabetes. Diabetes Care (2003).

The diagnosis of gestational diabetes according to the new guideline by the world health organization (WHO) in 2013 is based on any one of the following values: Fasting plasma glucose - 5.1-6.9mmol/l (92- 125mg/dl); 1hour post 75g oral glucose load > 10.0mmol/l (180mg/dl); 2hours post 75g oral glucose load8.5-11.0mmol/l (153-199mg/dl) Martínez-Frías (2005).

Gestational diabetes mellitus is defined as glucose intolerance of variable degree with onset or first recognition during pregnancy which as a concept existed since 1946 Metzger BE (1998). This definition acknowledges the possibility that patient may have previously undiagnosed DM or may have developed D.M coincidentally with pregnancy. Gestational diabetes usually resolves after delivery and whether symptoms subside after pregnancy is also irrelevant to the diagnosis. American Diabetes Association. Gestational Diabetes Mellitus. Diabetes Care. (2004).

The precise mechanisms underlying gestational diabetes remain unknown. The hallmark of GDM is increased insulin resistance. Pregnancy hormones and other factors are thought to interfere with the action of insulin as it binds to the insulin receptor.

Insulin resistance is a normal phenomenon emerging in the second trimester of pregnancy, which progresses thereafter to levels seen in non-pregnant patients with type 2 diabetes. It is unclear why some patients are unable to balance insulin needs and develop GDM, however a number of explanations have been given, similar to those in type 2 diabetes, autoimmunity, single gene mutations, obesity, and other mechanisms Buchanan TA (2005).

About 40-60% of women with GDM exhibit no symptoms for this reason many advocate to screen all women. But some women may demonstrate increased thirst, increased urination, fatigue, nausea and vomiting, bladder infection, yeast infections and blurred vision Buchanan TA (2005).

1. STATEMENT OF THE PROBLEM

Gestational diabetes poses a risk to mother and child. This risk is largely related to high blood glucose levels and its consequences. Risk factors for developing gestational diabetes include; previous diagnosis of gestational diabetes or prediabetes, impaired glucose tolerance, or impaired fasting glycaemia, family history revealing a first degree relative with type 2 diabetes, maternal age, overweight and previous pregnancy which resulted in a child with a high birth weight 7.

Polycystic ovarian syndrome is also a risk factor, although relevant evidence remains controversial. Finally, several researches has been carried out on Gestational Diabetes Mellitus in a Nigerian Antenatal Population but not even a single research has been carried out the effect of gestational diabetes on pregnant women in Enugu state.

1. AIM AND OBJECTIVES OF THE STUDY

The main aim and objectives of the study is to examine the effect of gestational diabetes on pregnant women. Other specific objectives of the study include;

1. to determine the causative factors of gestational diabetes amongst pregnant women.
2. to determine the extent to which gestational diabetes affects pregnant women in Enugu state.
3. to determine the effect of gestational diabetes on pregnant women in Enugu state.
4. to proffer possible solutions to the problems.
   1. RESEARCH QUESTIONS

1. What are the causative factors of gestational diabetes amongst pregnant women?
2. What is the extent to which gestational diabetes affects pregnant women in Enugu state?
3. What is the effect of gestational diabetes on pregnant women in Enugu state?
4. What are the possible solutions to the problems?
   1. RESEARCH HYPOTHESIS

Ho:  Gestational diabetes has no significant effect on pregnant women.

Hi:   Gestational diabetes has no significant effect on pregnant women.

1. SIGNIFICANCE OF THE STUDY

The study on the effect of gestational diabetes on pregnant women will be of immense benefit to pregnant women in Enugu state in the sense that it will educate them on precautionary measures as how to avoid gestational diabetes and also for those ones that are hereditary, healthcare providers can manage them till it’s time for delivery.

The study will educate pregnant women with diabetes to seek medical attention as soon as they are pregnant for close monitoring and observation. Finally, the study will contribute to the body of existing literature and knowledge to this field of study and basis for further research.

1. SCOPE OF THE STUDY

The study on the effect of gestational diabetes on pregnant women is limited to Enugu state.

1. LIMITATION OF THE STUDY

Time Constraints: One the challenges experienced by the researcher is the issue of time; the research will simultaneously engage in departmental activities like seminars and attendance to lectures. But the researcher was able to meet up with the deadline for the submission of the project.

Financial Constraints: Every research work needs funding; however lack of adequate funds might affect the speed of the researcher in getting materials for completion of the project.

1.9   DEFINITION OF TERMS

Effect:     A change which is a result or consequence of an action or other cause.

Gestational:    Gestation is the period of time between conception and birth. During this time, the baby grows and develops inside the mother's womb. Gestational age is the common term used during pregnancy to describe how far along the pregnancy is.

Diabetes:         Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.

Pregnant:                Having a child or other offspring developing in the body; with child or young, as a woman or female mammal.