الفهرس 
Acknowledgement
Prevention of GDMOnly 14 pages are availabe for public view
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Abstract
Summary
Gestational diabetes mellitus (GDM) is a major public health problem, affecting about one in every six pregnancies globally. The field of GDM diagnosis continues to be marred by controversy, and a need to develop consensus has often been highlighted (Goyal et al., 2020). Globally 20.9 million pregnancies are associated with hyperglycemia; among those GDM affects 17.8 million pregnancies. In developed countries the prevalence of GDM ranges from 1-28% and in Africa it affects up to 13.9% of pregnant women (Mdoe, 2018).
The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide. Meta-analysis concluded that the pooled prevalence of GDM in Africa was 13.6%, with the highest prevalence in Central Africa (20.4%) and the lowest in Northern Africa (7.6%), estimated by using the current International Association of the Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria ( Grunnet et al., 2020) The rate of gestational diabetes among pregnant women in Egypt affects between 2-14% of all pregnancies. Pregnancy induces progressive changes in maternal carbohydrate metabolic process (El-Nagar et al., 2019).
This study aimed to determine the hospital-based rate of GDM and its risk factors at Woman’s Health Hospital, Assiut University. Assess the effect of lifestyle counseling among women with gestational diabetes on fetal and maternal outcomes at Woman’s Health Hospital, Assiut University.
A quasi-experimental research (pre- post test) design was carried out in this study; the study was conducted at the ANC clinics of Assiut city which serves the west sector. This sector included: Kolta MCH, Hay Gharb MCH, Elarbaeen MCH and woman’s Health Hospital, Assiut University 365 cases had GDM. Were included in the present study
Two tools were used in this study; the first one was a structured interviewing questionnaire sheet. It included personal data, obstetrical and risk factor, knowledge of women’s about GDM, exercise and dietary interventions and information about the effect of GDM on pregnancy outcome. The second tool was following up sheet to assess information about the effect of GDM on pregnancy outcome and newborn.
An official approval letter was obtained from director of Women’s Health Hospital to conduct this study, directorate of health and oral consent was taken from women’s participated in the study.
Pilot study was conducted before starting data collection on 10 %(n= 40)women during the first two weeks of data collection to test the clarity ,applicability of the questions and time needed for each interview . It is included in the sample size.
The investigator interviewed the woman face to face; each interview took 30 minutes with each woman to collect the questionnaire data.
The study results revealed the following
The study showed that the prevalence of gestational diabetes among the study sample was 3.4%.
The mean age of recruited women was 30.77 ± 5.11 ( 19.0-42.0 ) years in studied women, more than one third (37.3%) of the them less than 30 years, while more than one third (31.5%) of women had secondary school, and it was observed that the three quarters (75%)of women were house wive’s . As regards to residence, more than half (58.1%) of the sample were living in urban areas.
The study shown that, less than half (47.9%) of studied pregnant mothers birth weight >3.5 KG and less than two thirds (62.2%) full term, while neonatal birth weight and neonatal blood glucose mean ±SD (90.17 ± 28.56 and 3.46 ± 0.78 respectively. And the vast majority of sample (96.7%) had no admission to intensive care unit.
The study shows that Apgar score of the neonatal at 1st minute represents that 80.3% of the children were active and more than half of them (69.0% and 55.9%) respectively prompt response to stimulation and had pink appearance.
The study shows that, effect of gestational diabetes on mother slightly three fifths (60.3%) weight gain fouled by preeclampsia (21.6%) the more than three quarters (78.9%) Caesarean also table shows that, no complication intra operative and Post-operative (68.8%%, 67.7%) respectively.
Represented that risk factors where the common was Presence of Multiparous in 203 (55.6%) women followed by history of GDM during pregnancy in166 (45.5%).
There is a statistically significant difference between Pre-test & Post-test knowledge and personal data with pregnant mothers (p. = 0.000).
There is a statistical significant difference between Apgar score and risk factors, overweight/obese & history of GDM during Pregnancy (p. = 0.000 & 0.000) respectively.
There is a statistical significant difference between Pre-test and Post-test knowledge level (p. = 0.000).
There is a statistical significant difference between score of mothers’ knowledge about GDM and personal data before and after receiving program at (P. value <0.000*).
There is a statistical significant difference between between of knowledge before and after education score and outcome data after receiving program at (P. value < 0.007).
Conclusion
The prevalence of GDM was 3.4% among the pregnant women’s attending Ante- Natal Care (ANC) clinics which served the west sector of Assiut city. Based on results of the current study can be concluded that there was statistical significant difference between Pre-test & Post-test on maternal and fetal out come.The major risk factors of GDM were multiparous and family history of DM. Knowledge about GDM is poor amongst pregnant women especially in rural areas. Health education plays an important role in increasing the awareness of pregnant women regarding GDM risk and its proper management in order to reduce its burden both for the mother. Physical activities during pregnancy are associated with a significantly lower risk of developing GDM.
Recommendations
1. Planning and developing antenatal health educational classes for all women to increase their awareness about the importance of early, proper screening and effective GDM management to improve their pregnancy outcomes.
2. A manual booklet containing basic needed information about GDM and its related complications should be provided to all pregnant women with GDM at MCH centers.
3. Public orientation through mass media should be directed toward women at risk of GDM to prevent and /or reduce its related maternal and neonatal complications
4. Farther research can be done to investigate the effectiveness of health education program on maternal and fetal out came.
5. Booklet about GDM should be available in MCH centers in Arabic language to incres awarnessof nurses.