Document Type : Original Article
Authors
- . Vanessa Ravel
- . Venkatachalam Jayaseelan
- . Sasirekha Rengaraj
- . Subitha Lakshminarayanan
- . Sivaranjini Kannusamy
- . Balaji Susindhran
Department of Obstetrics and Gynaeocolgy, JIPMER, Puducherry, India
Abstract
BACKGROUND: Globally, one in ten pregnant women have diabetes; out of which, 90% contribute
to gestational diabetes mellitus (GDM). Medical Nutrition Therapy (MNT) is the cornerstone for GDM
treatment yet adherence to MNT among the masses is not adequately monitored as part of the routine
antenatal services. The study aimed to estimate the proportion of adherence to MNT and determine
the factors related toadherence among antenatal women with GDM. This study also explores the
facilitators, barriers, and possible suggestions for improving adherence.
MATERIALS AND METHODS: This facility‑based sequential explanatory mixed‑method study was
conducted among 341 antenatal women with GDM at, Puducherry. The study was conducted in 2021.
Dietary adherence was evaluated using Perceived Dietary Adherence Questionnaire and based on
the scores obtained they were selected for in‑depth interviews to explore the facilitators and barriers.
Collected data wereanalysed by Chi‑square test using STATA version 16.
RESULTS: Out of 341 participants, the proportion of participants adherent to MNT was 135 (39.6%)
with 95% CI of 34%–44%.Thepredictors for poor adherence were unemployment (PR: 0.65; 95%CI:
0.48–0.88) and good adherence was antenatal women in the 2nd trimester (PR: 1.541; 95%CI:
1.18–2.025).Barrierstonon‑adherence were financial crisis, lack of awareness ofthe need for MNT,
and joint family pressure.
CONCLUSIONS: About two‑thirds of antenatal women with GDM are non-adherent to MNT.
Unemployment and period of gestation were found to be theirdeterminants. Appropriate action has
to be implemented for improving the adherence rate.
Keywords
and Operational Guidelines. Maternal Health Division, MOHFW,
Government of India, 1–100.2018. Available from: https://nhm.
gov.in/New_Updates_2018/NHM_Components/RMNCH_
MH_Guidelines/Gestational‑Diabetes‑Mellitus.pdf.
2. Guariguata L, Linnenkamp U, Beagley J, Whiting DR, Cho NH.
Global estimates of the prevalence of hyperglycaemia in
pregnancy. Diabetes Res Clin Pract 2014;103:176‑85.
3. Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD,
Ohlrogge AW, et al. IDF Diabetes Atlas: Global estimates of
diabetes prevalence for 2017 and projections for 2045. Diabetes
Res Clin Pract 2018;138:271‑81.
4. Kampmann U, Madsen LR, Skajaa GO, Iversen DS, Moeller N,
Ovesen P. Gestational diabetes: A clinical update. World J
Diabetes 2015;6:1065‑72.
5. Brawerman GM, Dolinsky VW. Therapies for gestational diabetes
and their implications for maternal and offspring health: Evidence
from human and animal studies. Pharmacol Res 2018;130:52‑73.
6. Metzger BE, Coustan DR, Trimble ER. Hyperglycemia and
adverse pregnancy outcomes. Clin Chem 2019;65:937‑8.
7. Li Z, Cheng Y, Wang D, Chen H, Chen H, Ming WK, et al.
Incidence rate of type 2 diabetes mellitus after gestational diabetes
mellitus: A systematic review and meta‑analysis of 170,139
women. J Diabetes Res 2020;2020:3076463.
8. Marchetti D, Carrozzino D, Fraticelli F, Fulcheri M, Vitacolonna E.
Quality of life in women with gestational diabetes mellitus:
A systematic review. J Diabetes Res 2017;2017:7058082.
9. Vounzoulaki E, Khunti K, Abner SC, Tan BK, Davies MJ,
Gillies CL. Progression to type 2 diabetes in women with a
known history of gestational diabetes: Systematic review and
meta‑analysis. BMJ 2020;369:m1361.
10. Retnakaran R, Shah BR. Glucose screening in pregnancy and
future risk of cardiovascular disease in women: A retrospective,
population‑based cohort study. Lancet Diabetes Endocrinol
2019;7:378–84.
11. O’Malley EG, Reynolds CME, O’Kelly R, Killalea A, Sheehan SR,
Turner MJ. A prospective evaluation of point‑of‑care
measurements of maternal glucose for the diagnosis of gestational
diabetes mellitus. Clin Chem 2020;66:316‑23.
12. Nicolosi BF, Souza RT, Mayrink J, Feitosa FE, Rocha Filho EA,
Leite DF, et al. Incidence and risk factors for hyperglycemia in
pregnancy among nulliparous women: A Brazilian multicenter
cohort study. PLoS One 2020;15:e0232664.
13. Msollo SS, Martin HD, Mwanri AW, Petrucka P. Prevalence
of hyperglycemia in pregnancy and influence of body fat on
development of hyperglycemia in pregnancy among pregnant
women in urban areas of Arusha region, Tanzania. BMC
Pregnancy Childbirth 2019;19:315.
14. Yuen L, Saeedi P, Riaz M, Karuranga S, Divakar H, Levitt N, et al.
Projections of theprevalenceof hyperglycaemia in pregnancy
in 2019 and beyond: Results from the International Diabetes
Federation Diabetes Atlas, 9th edition. DiabetesRes Clin Pract
2019;157:107841.
15. Nayak PK, Mitra S, Sahoo JP, Daniel M, Mathew A, Padma A.
Feto‑maternal outcomes in women with and without gestational
diabetes mellitus according to the International Association of
Diabetes and Pregnancy Study Groups (IADPSG) diagnostic
criteria. Diabetes MetabSyndr 2013;7:206–9.
16. Lee KW, Ching SM, Ramachandran V, Yee A, Hoo FK, Chia YC,
et al. Prevalence and risk factors of gestational diabetes mellitus
in Asia: A systematic review and meta‑analysis. BMC Pregnancy
Childbirth 2018;18:494.
17. Lim SY, Yoo HJ, Kim AL, Oh JA, Kim HS, Choi YH, et al.
Nutritional Intake of Pregnant Women with Gestational Diabetes
or Type 2 Diabetes Mellitus. Clin Nutr Res 2013;2:81‑90.
18. Mukona D, Munjanja SP, Zvinavashe M, Stray‑Pederson B.
Adherence to anti‑diabetic therapy in women with diabetes in
pregnancy. J Diabetes Complicat 2017;1:6‑10.
19. Asaad G, Sadegian M, Lau R, Xu Y, Soria‑Contreras DC, Bell RC,et al. The reliability and validity of the perceived dietary adherence
questionnaire for people with type 2 diabetes. Nutrients
2015;7:5484–96.
20. Ayele AA, Emiru YK, Tiruneh SA, Ayele BA, Gebremariam AD,
Tegegn HG. Level of adherence to dietary recommendations and
barriers among type 2 diabetic patients: A cross‑sectional study
in an Ethiopian hospital. Clin Diabetes Endocrinol 2018;4:21.
21. Gadgil MD, Ehrlich SF, Zhu Y, Brown SD, Hedderson MM,
Crites Y, et al. Dietary quality and glycemic control among women
with gestational diabetes mellitus. J Womens Health (Larchmt)
2019;28:178‑84.
22. Mukona D, Munjanja SP, Zvinavashe M, Stray‑Pederson B.
Barriers of adherence and possible solutions to nonadherence
to antidiabetic therapy in women with diabetes in pregnancy:
Patient’s perspective. J Diabetes Res2017;2017:3578075.
23. Hirst JE, Tran TS, Do MA, Rowena F, Morris JM, Jeffery HE.
Women with gestational diabetes in Vietnam: A qualitative study
to determine attitudes and health behaviours. BMC Pregnancy
Childbirth 2012;12:81.
24. Mekonnen CK, Ferede YM, Abate HK. Determinants of dietary
adherence among type 2 diabetes patients aimed covid‑19 at
the university of gondar comprehensive specialized hospital.
Diabetes Metab Syndr Obes 2021;14:917‑27
25. Mohebbi B, Tafaghodi B, Sadeghi R, Tol A, Yekanenejad MS.
Factors predicting nutritional knowledge, illness perceptions,
and dietary adherence among hypertensive middle‑aged women:
Application of transtheoretical model. J Edu Health Promot
2021;10:212.
)