الفهرس 
PregnancyOnly 14 pages are availabe for public view
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Abstract
Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of different organs especially the eyes, kidneys, nerves, heart, and blood vessels (Metzger BE et al, 2010)
During pregnancy, maternal complications of diabetes mellitus include abortion, preterm labour, pre-eclampsia, polyhydramnios, infection, obstructed labour and caesarean section while Fetal complications include intrauterine fetal growth retardation, intrauterine fetal death, macrosomia, congenital malformation and neonatal jaundice. (Doyle 2004)
Quality of life is the degree to which one enjoys life and the possibilities it holds for him/her. Quality of life must take into consideration one’s current problems, disease symptoms and the ability to adapt disease effect on life (Mohangoo, et al 2007).
The aim of this study was to evaluate the effect of protocol of care on improving the quality of life for diabetic pregnant women through assessing quality of life for pregnant women to determine their needs, then design protocol of care according to these needs to improve women quality of life and apply protocol of care according to quality of life dimensions. Hence, evaluating the effect of protocol of care on women quality of life was the aim of the current study.
Design: The current study was quasi-experimental design (intervention study) and it was carried out at Benha University Hospital, inpatient and antenatal outpatient clinic.
Sample: The sample was purposive type. The study sample size was 100 pregnant women and that represented 30% of the total number of diabetic pregnant women.
Setting: attended to the outpatient clinic in year 2011/2012 (300 women).The sample was divided equally into two groups: one was the control group and the other was the study group.
Inclusion criteria: Women during reproductive age, pregnant at first trimester with diabetes mellitus before pregnancy and no other medical or obstetrical complications existed except diabetes.
Data collection was performed through:
1-Structured interview questionnaire schedule
Included:
A-Socio-demographic data
B-Assessment of medical and obstetrical history
C-Assessment of knowledge about diabetes manifestation and complications
D-Assessment of women health: (nutrition - insulin injection – practicing exercise)
2- Observation sheet:
included:
A-Assessment of blood glucose level
B-Assessment of HBA1c test
C-Observation of weight gain
3 - Quality of life assessment sheet
Included:
assessment of basic factors, physical activity, stress management, social interactions, nutrition and general health.
Instruction booklet
Included:
diet, exercise, sites of insulin injection and general advice.
A pilot study: was carried out on 10 women (10% of sample) for diabetic pregnant women. It was done to evaluate the applicability and clarity of the tools, assessment of feasibility of fieldwork and detection of any possible obstacles that might face the researcher and interfere with data collection.. The sample of women in the pilot study was not included in the main study sample.
The results: Before applying the protocol, results showed that there was no significant difference between control and study group regarding knowledge and quality of life indices for all dimensions. After applying the protocol, there was highly significant difference between the two groups.
Highly significant correlations had been detected between women.
Quality of life and total knowledge score, blood glucose level, HBA1c which decreased from 72% to 36% , practicing physical exercise which improved from 30% to 62% and improved weight gain .These results indicated that The majority of diabetic pregnant women improved in knowledge, practices and all quality of life dimensions after applying the protocol .
Conclusion: Diabetic pregnant women showed a major deficiency and lack of knowledge about diabetes with pregnancy and this was associated with poor quality of life before applying the protocol of care with a significant improvement after applying it.
Applying the protocol of care for diabetic pregnant women regarding quality of life affected positively on the control of blood glucose level, and control of weight gain which meant that the hypothesis of the study was positively achieved. Also, quality of life for diabetic pregnant women improved after intervention.
Recommendations:
- Developing Program based on improving knowledge, practice, attitude and correction of wrong beliefs for diabetic pregnant women through health teaching, awareness program which should be part of health care personnel responsibilities.
-Integrating health education & counseling with support diabetic pregnant women and their families to decrease diabetes mellitus complication and improve labor outcome.