PREVALENCE OF NON INSULIN DEPENDENT DIABETES MELITUS (NIDDM) AMONG PREGNANT WOMEN

1.1 Introduction

Diabetes mellitus (DM) is a metabolic disorder of multiple etiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both (WHO, 2011). In pregnancy, DM can either predate the pregnancy (pre-gestational) or be discovered first during the pregnancy (gestational). The classification of diabetes mellitus in pregnancy has elaborates catecholamines, which may impair plasma glucose control therefore, adequate analgesia is required during labour or cesarean section for good glycaemic control (Gillmer et al., 2003). Insulin requirement falls by half within 24 hours of been revised and its optimal management should involve multi-disciplinary inputs.

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitations of the Study and Definition of technical terms.

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1.2 Background of Study

Diabetes mellitus is a common medical disorder in pregnancy. It contributes particularly to perinatal morbidity / mortality, and maternal morbidity. This review aims at improving maternal and neonatal health care especially in Sub-Saharan Africa by improving the knowledge of health practitioners on current evidences in the classification and management of diabetes mellitus in pregnancy.

Non insulin management of GDM was very recently reviewed by Magon and Seshiah with a lot of potentials for OGLA (Magon et al., 2011). In 1994, placental testing demonstrated that glibenclamide (glyburide), a second-generation sulfonylurea, did not cross the placenta (UN, 2011). No randomized controlled trial has focused on the use of OGLA during organogenesis in the first trimester (Kelly et al., 2005), however, when glibenclamide is used for DM in the second and third trimesters (beginning at 11 weeks' gestation), their outcomes were similar to those randomized to insulin treatment, and there was no risk to mother or fetus (Langer, 2002). In line with the above evidences, a survey of American obstetricians indicated that 13% of them began treatment of GDM with glyburide when diet and exercise fail (Gabbe et al., 2004).

During labour or cesarean section, euglycaemia is beginning to accumulate about the effectiveness and safety of metformin in pregnancy (Rowan et al., 2008). It has been observed that non-diabetic women with polycystic ovary syndrome treated preconceptually and throughout pregnancy with metformin had a lower incidence of maintained with infusion dextrose and sliding scale of GDM and produced healthy, normal infants (Glueck et al., 2002; Glueck et al., 2002).

Prevalence of Diabetes Mellitus in Pregnancy Worldwide prevalence of diabetes in pregnancy is 3 7 per 1000 pregnancies (Gillmer et al., 2003; Gillmer et al., 1999; Reece et al., 1998). In Nigeria, prevalence of DM in pregnancy varies but are generally less than 3 per 1000 deliveries; (Oladokun et al., 2003; Diejoma et al., 1982) however, a recent report from Ibadan, Nigeria suggested that the prevalence might be on the increase (13.9%) and the diagnosis in first trimester was common (17.4%) (Kuti et al, 2011). The upward trend in prevalence may not be unconnected to the current global pandemic of obesity and diabetes even among women of childbearing age (Lawrence et al., 2008).

The pattern of insulin requirements in pregnancy varies between women with type 1 and type 2 diabetes, suggesting a differential effect of pregnancy-mediated insulin resistance. Women with type 2 diabetes require a much greater increase in insulin dose from the start to the end of each trimester, and insulin requirements do not decrease in early and late pregnancy as is the case in women with type 1 diabetes (Padmanabhan et al., 2016; García-Patterson et al., 2010). The changes in insulin sensitivity through pregnancy are believed to be caused partly by hormones from the placenta and partly by other obesity- and pregnancy-related factors that are not fully understood.

Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the Prevalence of Non Insulin Dependent Diabetes Melitus (NIDDM) among Pregnant Women Attending Antenatal Care (ANC) at General Hospital.

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1.3 Statement of Problems

Investigation revealed that public health problem and threat to maternal and child health in Africa. No prior review has been conducted in Africa using the updated GDM diagnostic criteria. Among women with diabetes, use of non-insulin antidiabetics early in pregnancy was not associated with greater risks of foetal losses or major malformations than insulin.

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1.4 Aim and Objectives of Study

The aim of the study is to examine the Prevalence of Non Insulin among Pregnant Women Attending Antenatal Care (ANC) at General Hospital in Lagos State In achieving this aim, the following specific objectives were laid out as follows:

1. To evaluate the association between use of non-insulin antidiabetics and the risk of miscarriages among Pregnant Women.
2. To investigate the factors militating the use of non insulin among pregnant women attending the antenatal care (ANC) clinic in the study area.
3. To determine the prevalence of non-insulin and its risk factors among Pregnant Women Attending Antenatal Care (ANC) at General Hospital.
4. To suggest an effective program for the control and monitoring of non-insulin among pregnant women in the study area.

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1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• Are there factors militating the use of non insulin among pregnant women attending the antenatal care (ANC) clinic in the study area?
• What is the association between use of non-insulin antidiabetics and the risk of miscarriages among Pregnant Women?
• What is the prevalence of non-insulin and its risk factors among Pregnant Women Attending Antenatal Care (ANC) at General Hospital?
• Are there effective program for the control and monitoring of the use non-insulin among pregnant women in the study area?

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1.6 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

Hypothesis One

• H0: There are no significant factors militating the use of non insulin among pregnant women attending the antenatal care (ANC) clinic at General Hospital
• H1: There are significant factors militating the use of non insulin among pregnant women attending the antenatal care (ANC) clinic at General Hospital

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1.7 Significance of Study

The study will be of immense importance to evaluate Prevalence of Non Insulin Dependent Diabetes Melitus (NIDDM) among Pregnant Women considering the above barriers in provision of antenatal care services to this population in Nigeria. Close monitoring of drug use during pregnancy is of paramount importance towards protecting the pregnant woman and the unborn foetus.

This study will be of immense benefit to other researchers who intend to know more on this study and can also be used by non-researchers to build more on their research work. This study contributes to knowledge and could serve as a guide for other study.

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1.8 Scope of Study

The study focuses on the Prevalence of Non Insulin Dependent Diabetes Melitus (NIDDM) among Pregnant Women Attending Antenatal Care (ANC) at General Hospital in Lagos State.

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1.9 Limitations of the Study

During the course of this study, many things militated against its completion, some of which are:

1. Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Research material: availability of research material is a major setback to the scope of the study.
3. Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
4. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

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1.10 Operational Definition of Terms

Diabetes mellitus (DM): Diabetes mellitus is a metabolic disorder of multiple etiologies characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism.

Attitude: The way one behaves towards somebody or something that shows how you think or feel.

Knowledge: To have information about something because you have experience or because you have learned it or be told.