INTRODUCTION:

Today‘s woman is one who wears many hats and is very expert at multi-tasking, at home and at work. And in this race to strike a balance, many often tend to ignore their own health and personal well-being. The growing fetus depends entirely on its mother's healthy body for all needs.

Consequently, pregnant women must take steps to remain as healthy and well nourished, should take into account the many health care and lifestyle considerations as they possibly can. Pregnancy is a diabetogenic condition characterized by insulin resistance with a compensatory increase in beta cell response and hyperinsulinemia.¹ The placental secretion of hormones progesterone, cortisol, placental lactogen, prolactin, and growth hormone is a major contributor to the insulin resistance, which likely plays a role in ensuring that the fetus has an adequate supply of glucose.²

Exercise increases insulin sensitivity of muscle glucose transport and also enhances insulin action in extra muscular tissues.³ The three most important endocrine responses to exercise include a decrease in plasma insulin, an increase in sympathetic nervous activity causing changes in insulin counter regulatory hormones, and hormones affecting sodium and water balance.⁴

Planned physical activity of 30 min/day is recommended for all pregnant individuals excluding normal daily activities. Advising gestational diabetes mellitus patients to walk for at least 10 min after each meal accomplishes this goal. Regular aerobic exercise with proper warm-up and cool-down has been shown to lower fasting and postprandial glucose concentrations in several studies of previously sedentary individuals with gestational diabetes mellitus⁵. All women without medical or obstetric contraindications should be encouraged to start or continue a program of moderate exercise as part of their treatment for gestational diabetes mellitus.⁶Regular moderate-intensity exercise performed over the second-third trimesters of pregnancy can be used to attenuate important gestational diabetes mellitus-related adverse outcomes.⁷

The prevalence of GDM in India was 16.55% in the urban area and the frequency varied from 12% to 21% in different parts of the country.⁸A low prevalence of gestational diabetes mellitus was observed in Kashmir 4.4% and a high prevalence of 16.55% in the southern part of India.⁹ Gestational diabetes mellitus is a severe and neglected threat to maternal and child health. Indian Diabetic Federation estimates that 16.8% of live births were affected by some form of hyperglycemia in pregnancy in 2013, and 6 million in India alone, of which 90% are due to gestational diabetes mellitus.¹⁰

India has the second largest number of people with diabetes in the world. Not surprisingly therefore, the prevalence of gestational diabetes mellitus in India is also alarmingly high. Indian women are more likely to develop gestational diabetes mellitus compared to Caucasian women.¹¹ Estimates on the prevalence for gestational diabetes mellitus in India vary greatly; from low figures in the northern region of Jammu, to higher figures reported in the southern state of Tamil Nadu. In North Chennai, Tamil Nadu 891 pregnant women were screened and prevalence rate of gestational diabetes mellitus was found to be 16.2% , in south Chennai, among 1002 pregnant women, prevalence rate was 15% and in Erode out of 562 pregnant women, the prevalence rate was found to be 18.8%. In Ludhiana, Punjab, 220 pregnant women were screened and prevalence rate of gestational diabetes mellitus was17.5% and in Bangalore, Karnataka out of 49 pregnant women prevalence rate was 12% .¹²

Screening for gestational diabetes mellitus was done in different parts of Kerala. In Trivandrum, 750 pregnant women were screened and prevalence rate of gestational diabetes mellitus was found to be 15% and in Alwaye, out of 200 pregnant women, the prevalence rate was as high as 21%.¹²These widely ranging statistics may reflect a true variation in gestational diabetes mellitus prevalence throughout the subcontinent, but may also be partially accounted for by discrepancies in protocols for screening and diagnosis, and access to care or changes in risk factors in different geographic regions.¹¹ As more people in this country switch from heavy exercise routines, to health promoting activity programs, walking is emerging as a viable daily endeavor. Pregnant women who have been diagnosed with gestational diabetes mellitus may find that a simple walking program can keep their blood sugar levels under control, keep their body fat levels from increasing dramatically, and enhance their overall health.

Statement of the Problem:

Evaluate the Effect of Post Prandial Exercise on Blood Sugar Level of Antenatal Mothers with Gestational Diabetes Mellitus at Women and Children‘s Hospital Alappuzha.

Objectives of the Study:

a. Assess the fasting blood sugar and post prandial blood sugar level in antenatal mothers on the 1st and 6th day of post prandial exercise.

b. Evaluate the effect of post prandial exercise on fasting blood sugar level and post prandial blood sugar level among antenatal mothers with gestational diabetes mellitus.

c. Compare the level of fasting blood sugar and post prandial blood sugar among antenatal mothers with gestational diabetes mellitus on diet control group and insulin group.

d. Find out the association between pre test of fasting blood sugar and post prandial blood sugar among antenatal mothers with selected variables

Hypothesis:

H1- There is a significance difference in the blood sugar levels before and after the post prandial exercise among antenatal mothers with gestational diabetes mellitus as measured by glucometer.

H2- There is a significance difference in the blood sugar levels before and after the post prandial exercise among antenatal mothers with gestational diabetes mellitus who were on diet control and insulin as measured by glucometer

Theoretical Frame work:

The present study aimed at evaluating the effectiveness of post prandial exercise on blood sugar level of antenatal mothers with gestational diabetes mellitus. The theoretical framework of the present study is based on General System Theory with input, throughput, output and feedback. This model was first introduced by Ludwig Von Bertalanffy in 1968.

MATERIAL AND METHODS:

Research Approach:

The research approach selected for this study was quantitative approach.

Research Design:

The research design selected for this study was one group pretest post test design. The design showed as follows.

O1 X O2

O1- Assessing the level of fasting blood sugar and post prandial blood sugar before administration of post prandial exercise among antenatal mothers with gestational diabetes mellitus.

X - Administration of post prandial exercise to all antenatal mothers with gestational diabetes mellitus.

O2 - Assessing the level of fasting blood sugar and post prandial blood sugar on 6th day after administration of post prandial exercise among antenatal mothers with gestational diabetes mellitus.

Variables:

Three types of variables were identified in this study. They were:

Independent Variables:

The fasting blood sugar level and post prandial blood sugar level among antenatal mothers with gestational diabetes mellitus.

Dependent variable:

The post prandial exercise among antenatal mothers with gestational diabetes mellitus was the dependent variable.

Demographic variables:

It consists of baseline characteristics of antenatal mother such as age, education, occupation, diet, monthly income, gestational age, history of gestational diabetes mellitus, family history of diabetes mellitus and previous information about exercise in pregnancy.

Extraneous variables:

The extraneous variables in this study includes body weight, way of walking and daily activities of antenatal mothers.

Setting of the Study:

The study was conducted in antenatal ward of Women and Children‘s Hospital Alappuzha. It is a gynecological, obstetrical and pediatric specialty hospital with 306 bed capacity running under government of Kerala. This hospital provides all essential services under Directorate of Health Services. The hospital has got different facilities such as outpatient departments in obstetrics, gynecology and pediatrics, inpatient facilities such as antenatal ward, postnatal ward, gynecology ward, labour room, post-operative ward, pay ward, pediatrics ward, 24 hour casualty services, NICU, major and minor operation theatre, separate theatre for laparoscopic surgery, new born screening room, other facilities such as ultra sonography, laboratory, blood bank, pharmacy, ECG and 24 hours ambulance services.

Sample and Sampling Technique:

30 antenatal mothers, 15 on diet control and 15 on insulin in the second and third trimester with gestational diabetes mellitus in the antenatal ward of Women and Children‘s Hospital. Convenient sampling technique was used. On the average 3 samples were selected every day, until it reached 15 in each group.

Sampling Criteria:

Inclusion criteria:

1 Antenatal mothers were in 2nd and 3rd trimester and diagnosed with gestational diabetes mellitus in the present pregnancy.

2 Antenatal mothers who were on diet control for gestational diabetes mellitus.

3 Antenatal mothers who were on insulin therapy with Inj. Human Mixtard between 4units and 10 units daily.

4 Antenatal mothers who were willing to participate in the study

Exclusion criteria:

1 All antenatal mothers with non-compliance to exercises.

2 Antenatal mothers with disorders complicating pregnancy except gestational diabetes mellitus.

Tools /Instrument:

The data collection instruments used in the study was:

Tool 1: Structured interview schedule to assess the demographic and clinical variables of antenatal mothers with gestational diabetes mellitus.

Tool 2: Calibrated glucometer for assessing the blood sugar level on 1st day and 6th day of post prandial exercise among antenatal mothers with gestational diabetes mellitus.

Tool 3: Procedure for post prandial exercise among antenatal mothers with gestational diabetes mellitus.

Tool 4: Check list for assessing post prandial exercise of antenatal mothers with gestational diabetes mellitus.

Data Collection Process:

Data collection was done in the antenatal ward of Women and Children‘s Hospital. Based on the inclusion and exclusion criteria, 30 mothers were selected by convenient sampling. Everyday 3 samples were selected until it reached 15 in each group. The time of data collection was from 8am to 11am. On the first day, after obtaining an informed consent, demographic and clinical variables were collected from the antenatal mothers and fasting blood sugar and post prandial blood sugar level was checked. From day 2 to day 6, Post prandial exercise was given 1hr 30 min after breakfast. On the 6thday, fasting blood sugar and post prandial blood sugar level was checked and the blood sugar level on the first day and 6th day was compared to see the effect of exercise. There was cooperation in great measure from the samples and from the authorities of the institution throughout the study. This data collection process was concluded by thanking the samples and staffs in the institution.

Plan for Data analysis:

Section I Distribution of antenatal mothers based on socio demographic and clinical data.

Section II Assessment of fasting blood sugar level among antenatal mothers with gestational diabetes mellitus.

Section III Assessment of post prandial blood sugar level among antenatal mothers with gestational diabetes mellitus

Section IV Effect of post prandial exercise on fasting blood sugar level and post prandial blood sugar level among antenatal mothers with gestational diabetes mellitus.

Section V Comparison of the level of fasting blood sugar and post prandial blood sugar among antenatal mothers with gestational diabetes mellitus on diet control group and insulin group

Section VI Association between pretest level of fasting blood sugar and post prandial blood sugar and selected variables.

RESULTS:

Section I:

Table 1 Distribution Of Antenatal Mothers Based On Demographic And Clinical Data

Age in years	f	%	x²	df	p value
18-22	7	23.3	3.858	3	0.277(NS)
23-27	13	43.3
28-32	9	30.0
Above 32	1	3.4
Education
No formal education	0
Primary	0	0.0	2.885	2	0.236 (NS)
Education	f	%	^x2	df	p value
Secondary	11	36.7
Higher Secondary	5	16.7
Others	14	46.6
Monthly Income
Below 5000	0	0
5001 – 10000	17	56.7
10001 – 15000	5	16.7
Above 15001	8	26.7	1.236	2	0.539
Gestational Age in weeks
13 – 28	9	30
29 – 32	12	40	5	2	0.082
33 – 40	9	30
History of GDM
Yes	7	23.3	2.779	1	0.096
No	23	76.7
Use of Insulin
Yes	15	50	1.677	1	0.195
No	15	50
Family history of DM
Yes	12	40	1.118	1	0.29
No	18	60
Previous Information
Yes	9	30
No	21	70	3.913	1	P<0.05

SECTION II: ASSESSMENT OF THE FASTING BLOOD SUGAR AND POST PRANDIAL BLOOD SUGAR LEVEL AMONG ANTENATAL MOTHERS WITH GESTATIONAL DIABETES MELLITUS.

Table 2 and 3. Percentage, Range, Mean, Median and S.D of antenatal mothers with gestational diabetes mellitus based on their pre-test and post test level of post prandial blood sugar level on 1st day and 6^th day . n=30

Pre-test Level of FBS	%	Range	Mean	Median	S.D.
Less than or equal to Median	56.67%	88 – 140	102.33	98.0	12.696
Greater than 43.33%Median

Table 3.

Post-test Level of FBS on 6^th day	%	Range	Mean	Median	S.D.
Less than or equal to Median	50 %	60 – 125	86.6	85	13.22
Greater than 50%Median

Table 4 N=30

Pre-test Level of PPBS	%	Range	Mean	Median	S.D.
Less than or equal to Median	63.33%	118 – 255	139.87	130	30.41
Greater than 36.67% Median
Post-test Level of PPBS	%	Range	Mean	Median	S.D.
Less than or equal to Median	50 %	98 – 172	117.7	117	13.72
Greater than Median 50%

SECTION III : EFFECT OF POST PRANDIAL EXERCISE ON FASTING BLOOD SUGAR LEVEL AND POST PRANDIAL BLOOD SUGAR LEVEL AMONG ANTENATAL MOTHERS WITH GESTATIONAL DIABETES MELLITUS.

Table 5. Mean , S.D , Mean Difference , S.E and ‘t’ value of post prandial blood sugar level among antenatal mothers with gestational diabetes mellitus before and after post prandial exercise N=30

Level of FBS	Mean	S.D.	Mean difference	S.E	df	t	*p- value*
Pre-test	102.33	12.69	15.73	2.25	29	6.982	p < 0.01**
Post-test	86.6	13.22

Table 6 Mean, Standard deviation, Mean difference, Standard error and „ t‟ value of level of post prandial blood sugar level among antenatal mothers with gestational diabetes mellitus before and after post prandial exercise

Level of PPBS	Mean	S.D.	Mean difference	S.E	df	T	*p- value*
Pre-test	139.87	30.41	22.17	4.35	29	5.096	p < 0.01**
Post-test	117.7	13.72

SECTION IV COMPARISON OF THE LEVEL OF FASTING BLOOD SUGAR AND POST PRANDIAL BLOOD SUGAR AMONG ANTENATAL MOTHERS WITH GESTATIONAL DIABETES MELLITUS ON DIET CONTROL GROUP AND INSULIN GROUP.

Table 6. Comparison of The Level Of Fasting Blood Sugar And Postprandial Blood Sugar Among Antenatal Mothers With Gestational Diabetes Mellitus On Diet And Control Group And Insulin Group. N=30

Group	Mean change in FBS	S.D.	Difference between means	S.E.	df	t	*p- value*
Insulin	22.4	13.75	13.33	3.83	28	3.479	p < 0.01**
Diet control	9.07	5.57

Table 7. Comparison of The Level Of Fasting Blood Sugar And Postprandial Blood Sugar Among Antenatal Mothers With Gestational Diabetes Mellitus On Diet And Control Group And Insulin Group N=30

Group	Mean change in PPBS	S.D.	Difference between means	S.E.	df	t	*p- value*
Insulin	32.67	30.1	21.0	7.91	28	2.653	p < 0.05**
Diet control	11.67	5.81

LIMITATIONS:

The limitations of the study are;

1. The study was limited to 30 antenatal mothers with GDM

2. The study was limited to Women and Children‘s Hospital Alappuzha.

3. The study considered only one type of post prandial exercise that is walking.

RECOMMENDATIONS:

a) A similar study can be replicated with a control group

b) The study can be replicated on large samples.

c) A similar study can be conducted in rural area in the home setting.

CONCLUSION:

The present study assessed the effect of post prandial exercise on blood sugar level of antenatal mothers with gestational diabetes mellitus. Based on the findings, the following conclusions were drawn. Post Prandial Exercise is effective in reducing the level of FBS and PPBS among antenatal mothers with gestational diabetes mellitus.

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Received on 30.08.2014 Modified on 29.09.2014

Int. J. Nur. Edu. and Research 2(4): Oct.- Dec. 2014; Page 350-355