AN ASSESSMENT OF THE PREVALENCE OF GESTATIONAL DIABETES IN NIGERIA
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CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
Diabetes is a condition when the body’s blood sugar or glucose level is abnormally high. Elevated blood sugar levels during pregnancy are harmful to the body. Gestational diabetes (or Gestational diabetes mellitus GDM) is a disorder in which pregnant women without a history of diabetes have elevated blood glucose (sugar) levels (particularly in the third trimester). This information is sourced from Wikipedia, a free online encyclopedia. Insulin receptor malfunction is the root cause of gestational diabetes. Pregnancy-related factors including the presence of human placental lactogen, which messes with vulnerable insulin receptors, are probably to blame for this. This leads to unnecessarily high blood sugar levels.
Carbohydrate intolerance of varied degrees that initially manifests or is diagnosed during pregnancy is known as gestational diabetes mellitus (GDM) (Tahseen, 2016). It does not rule out the chance that the glucose intolerance existed before conception but was previously overlooked. The definition is applicable regardless of whether insulin is prescribed for therapy or if the illness continues after childbirth (WHO, 2019). All moms experience the development of insulin resistance throughout pregnancy. Cause transient diabetes in roughly 2-4 percent of expectant mothers. It occurs because pregnant women are less able to overcome insulin resistance by producing more insulin (Tahseen, 2015). Depending on the population under study, 3–10% of pregnancies result in gestational diabetes. The condition is typically discovered by screening during pregnancy and has few symptoms. Tests for diagnosis identify blood samples with abnormally high glucose levels (Thomas et al., 2005). Gestational diabetes affects around 7 out of every 100 pregnant women in the United States. When a woman becomes pregnant, she may develop gestational diabetes for the first time. After having your baby, it usually goes away. However, it does raise your chance of developing type 2 diabetes and obesity.
The health of the mother or baby may be harmed by gestational diabetes, and 20 to 50 percent of these women go on to get type 2 diabetes in later life. Between 5.5% and 8.8% of pregnancies result in gestational diabetes (Kenneth, 2006). It is transient and completely curable, but left untreated, it may lead to pregnancy complications such macrosomia (high birth weight), fetal deformities, and greater susceptibility to respiratory syndrome. In this kind of diabetes, the breakdown of red blood cells may lead to hyperbilurubineamia. Severe cases may result in neonatal death, usually from inadequate placental perfusion brought on by vascular damage (Kenneth, 2006).
Despite being a worldwide disorder, diabetes mellitus is more common in wealthy countries, especially in type 2. However, the greatest increase in frequency is expected to occur in Asia and Africa, where most patients are expected to reside by 2030. The increase in emerging countries is in line with the trend of urbanization and lifestyle modifications, the most significant of which is likely a diet affected by the “western-style.” Nevertheless, despite a considerable lot of speculation, some of which is most eloquently presented, our current understanding of the mechanism(s) is restricted (Wild et al., 2004). Without a question, Nigeria has seen a rise in the prevalence of diabetes mellitus throughout the past ten years. Its national prevalence, according to Nyenwa et al. (2003), is 2.2%, and it is still rising.
In 2010, 285 million people worldwide were expected to have diabetes, with type 2 accounting for about 90% of cases. Its frequency is increasing rapidly; by 2030, it is expected to almost triple. Gestational diabetes mellitus has been related to morbidity and death in both mothers and infants. Since treatment is linked to considerable morbidity and death and has a substantial impact on the outcome of pregnancy, early detection is essential (O’Sullivan, 2005). Current guidelines from the American Diabetes Association state that if a risk factor is present, selective screening for gestational diabetes mellitus (GDM) should be conducted. Due to the high prevalence of GDM in a number of ethnic groups, ethnicity is one of the risk factors for routine screening (American Diabetes Association, 2000).
It is believed that the numerous hormonal and non-hormonal changes that take place in the body during pregnancy cause some women to develop an insulin resistance. The hormone insulin, produced by specific cells in the pancreas, enables the body to use glucose as fuel (energy) efficiently. Blood glucose levels rise when the body cannot utilise insulin efficiently or when insulin levels are low.It is typical for late pregnancy to result in some degree of insulin resistance and reduced glucose tolerance. Nonetheless, in certain females, these risk factors may heighten the likelihood of developing gestational diabetes. Among the risk factors are being obese or overweight, Having PCOS; being of African American, African Indian, Asian American, Hispanic, or Pacific Islander American ethnicity; being an older mother, 35 years of age or older; having a baby that weighed more than 9 pounds at birth; having parents or siblings with type 2 diabetes; having a history of gestational diabetes in a previous pregnancy; and so on (American Diabetes Association, 2000).
All expectant moms should receive good parental care, but those who have risk factors for gestational diabetes should receive extra attention. For the sake of the mother’s and the unborn child’s health, diabetes during pregnancy must be appropriately managed (American Diabetes Association, 2000).Generally speaking, gestational diabetes can be effectively managed with a healthy, balanced diet and increased activity, as directed by your healthcare professional. Insulin is occasionally used in addition to other treatments to maintain blood glucose levels as near to normal as feasible. Everyone will benefit from good control and a happy, healthy conclusion (American Diabetes Association, 2000).
When given the right treatment, women with gestational diabetes usually give birth to healthy children. Unfortunately, if you have elevated blood glucose levels, the fetus may grow larger than usual, potentially complicating delivery. Additionally, the newborn is susceptible to hypoglycemia, or low blood sugar, right after birth. Uncontrolled hyperglycemia in neonates can also lead to major complications such as elevated risk of jaundice, increased risk of respiratory distress syndrome, and increased risk of death either before or after delivery. Additionally, there is a higher chance that the infant would grow up to be overweight and get type 2 diabetes. Diabetes in early pregnancy, there is an increased risk of birth defects and miscarriage compared to those mothers without diabetes.
The huge size of the babies born to women with gestational diabetes increases the likelihood that the mother will require a cesarean birth (C-section). The mother’s risk of developing preclampsia, a condition marked by elevated blood pressure and protein in the urine, may be increased by gestational diabetes. According to the American Diabetes Association (2000), women who have gestational diabetes are also more likely to develop type 2 diabetes after giving birth. Therefore, inadequate funding for health care is also the main cause of Nigeria’s health system’s subpar performance. Oil revenues, which are placed into the federation account and distributed among the federal, state, and local governments in accordance with an allocation formula, provide the lion’s share of the country’s resources.
At the moment, local governments allocate money for primary and secondary health care with little oversight from the state, and the federal government is powerless to keep an eye on how those monies are being used (Olakunde, 2012). Antenatal screening plays a critical role in identifying pregnant women who are at an elevated risk of difficulties because medical treatment is scarce in most underdeveloped countries, including Nigeria. The situation is more critical in Nigeria, particularly in Borno and most of the north-eastern states, where resource allocation to the health sector is increasingly being challenged by competing requirements such as those associated with rising insecurity in Nigeria, rising governance costs, poverty, ignorance or illiteracy, cultural and religious beliefs, and, most importantly, corruption.
1.2 STATEMENT OF THE PROBLEM
It is estimated that 5.5-8.8% of pregnancies result in GDM, which is linked to both maternal and child morbidity and mortality. Additionally, it can harm the mother’s or the fetus’s health. The fact that type 2 diabetes and obesity affect 20 to 50 percent of women with GDM in later life is a serious concern.
1.3 RESEARCH OBJECTIVES
The main aim of the project therefore is to access critically the prevalence of gestational diabetes mellitus and its complications among pregnant women in Maiduguri metropolis and its based on public health. Specifically, the objectives of the project are to:
- Determine the effects of GDM on pre-natal complications.
- Discuss the pattern, risk factors, morbidity/mortality, and complications of gestational diabetes.
- To propose strategies for prevention of GDM among pregnant women.
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