INTRODUCTION:

Pregnancy is a delicate equilibrium between the mother and her fetus. While fully dependent on mother’s blood supply, chemicals that freely pass the placenta can pose a risk for the developing child. There is increasing evidence that maternal lifestyle influences fetal development and can increase the risk for pregnancy complications and disease later in life. Several of these lifestyle factors, such as smoking, drinking and caffeinated beverages, have been identified, but uncertainty remains on the subject of nutrition.

Some nutritional components, like folic acid, have been shown to contribute to a healthy pregnancy, while excessive intake of other components, like vitamin A, caffeinated foods have proven harmful to the fetus.¹

As with any success in life a healthy pregnancy requires planning and preparation. If she is in good physical condition before she start or grow her family, she will greatly improve her chances of a healthy pregnancy and delivery. So that she can give her child the best opportunity for a strong start in life. These nine months may be the most challenging months of women’s life. So, when a woman discovers that she is pregnant, she must remember to protect and nourish the fetus by making wise choices. Many pregnant women express the wish that - “I hope my baby is born healthy”. To fulfill this wish, watching her diet should on top of her list. Eating a well-balanced diet important for a pregnant woman. This is because of the fact that the choice of food during pregnancy affects the health of the expectant mother as well as development of the fetus.

There are many sources of food which are potential harm to both developing fetus and mother. Caffeinated drinks and alcohol are bad for health. By these the delicate nature of prenatal development can often be jeopardized. "We have built a whole new ritual of coffee in this country," The coffee ritual in the morning is a normal part of life that we enjoy. The coffee had been prescribed for human use as far back as the sixth century B.C. The caffeine ranks as the world's most popular mood-altering substance because its power to counter the physical fatigue and increasing alertness. The widespread use of caffeinated food and drinks such as coffee, tea, soft drinks and energy drinks etc. in combination with the invention of electric light allowed people to cope with a work schedule set by the clock, not by daylight or the natural sleep cycle." So most of the women’s daily practice of consuming caffeinated food and drinks will be continued knowingly or unknowingly even throughout their pregnancy period, it ultimately resulted in most of the babies in the world entering the universe with traces of caffeine in their bodies, a transfer through the placenta from their mothers.^2,3

Coffee and tea are available worldwide and are commonly consumed during pregnancy. While antenatal consumption of these beverages is generally socially accepted and deemed innocent, several of their components possess a strong pharmacological effect on the human body. Caffeine is the major active chemical present in both coffee and tea and passes the placenta freely where the immature fetal liver enzyme CYP3A4 is unable to metabolize it. Caffeine has been shown to increase epinephrine concentrations in mother and fetus resulting in decreased placental blood flow and hypoxia.¹

Limiting intake begins with recognizing foods containing caffeine. So nurses for women contemplating pregnancy is to reduce their caffeine intake from all sources and information about high caffeine content foods before conception and during pregnancy. Once pregnancy is confirmed, they should make every effort to stop or markedly reduce caffeine consumption so as to prevent against danger to the fetus. It is highly advisable for pregnant women to avoid caffeinated food and drinks, because which may increase the risks of preterm birth, low birth weight, anemia, intrauterine growth restriction, birth defects and miscarriage.

There are a lot of delicious and healthy foods made for man to enjoy on this planet. We are not supposed to resort to eating natural plant pesticides such as caffeine.⁵ Good eating habits will also result in a more pleasurable nine months, leading to fewer complications. What one eats during pregnancy does affect one's health, as well as the way an unborn baby grows and develops. But many mothers are wonder about presence of caffeine in a cup of coffee or tea. So she must aware of caffeinated food which she consumes knowingly or unknowingly.

NEED FOR THE STUDY:

Despite the fact that man is the most intelligent animal on earth, many behaviors of man are beyond comprehension by all other creatures in the animal kingdom. In Nature, all animals pick and choose foods according to their instincts, and would avoid foods that taste bad, bad odour, or make them sick or uncomfortable. Mankind is one of a rare kind, if not the only kind, of species on earth that insists on taking caffeinated food despite of its bitterness and uneasy feelings after consumption. We mask our sense of rationality by adding a lot of sugar to the caffeinated food and beverages to make them taste sweet, and then choose to believe these items to be sweet and edible thereafter.⁵

Most of the women’s day begins with bed coffee. Many mothers may ingest caffeinated foods without realizing it. Caffeine in large doses can cause a number of serious reactions in pregnant mother and fetus. Caffeine is a legal drug, found in some of the food and drinks. Women and children have more limited capability to detoxify caffeine than men, hence experience more of its harmful effects. The excessive intake of caffeinated food in pregnancy causes preterm birth, low birth weight baby, still birth, spontaneous miscarriage and congenital anomalies etc.⁴

The current neonatal mortality rate ( NMR ) in world is 18 deaths/ 1000 live births (2019 ) and in India is 22 deaths / 1000 live births. ⁶The current stillbirth rate in India is 22.1/1000 births ( 2019).The current Infant Mortality Rate in India is 29 deaths/1000 live births(2020 ).In Karnataka the IMR in rural 58-37 deaths / 1000 live births , in urban 36-23 deaths / 1000 live births .At present India shares highest preterm birth burden, Nearly 13%, or one in ten children born prematurely across the globe in 2019 were from India. India recorded the highest number of births of preemies, or babies born before time, at 3,7 million a year.The current abortion rate in Karnataka is 23 % in 2019.As per world health rankings of congenital anomalies, the India takes world rank 141 for death due to congenital anomalies and the death rate is 4.7 / 1,00,000 population and it measures 0.73%.⁷

The health effects of coffee have been studied to determine how coffee drinking affects humans. Coffee contains caffeine, which acts as a stimulant of the central nervous system, Caffeine has the ability to cross the placental barrier, slip into the baby's blood circulation and impact the fetus directly. During pregnancy, the metabolism of caffeine is slowed, so it may hang around in the fetus nervous system for longer. The organs and systems in fetuses are not capable of fully metabolizing caffeine and excreting it.⁸ Therefore, the researcher has intended to provide teaching to the primigravida women and find effective result.

A prospective study was conducted to determine the association of coffee and tea incidence as a factor for cleft lip and palate in Karnataka and Kerala population. This study took into account of mothers of 1000 non-syndromic Oro- facial cleft subjects. They were questioned about their consumption of coffee – tea during first trimester and its frequency. Multiple logistic Regression for maternal coffee consumption during pregnancy shows that the odds ratio for mothers who consumed more than 3 cups was 1.84 ,1.31 and 1.23 with the confidence interval for the odds ratio was 1.46 to 1.99, 1.19 to 1.84, 1.06 to 1.45 in cleft lip, Cleft lip and palate and cleft palate group respectively. Where as the odds ratio for tea is 1.65, 1.56, 1.33 with the confidence interval for the odds ratio being 1.28 to 1.93, 1.24 to 1.78 and 1.17 to 1.54 in CL, CLP, CP group respectively. Results from our study showed a dose dependent association between coffee and tea consumption during pregnancy and increased risk of oral cleft in their children.

The main message for pregnant women from these findings is that they probably should consider stopping caffeine consumption during pregnancy because this research provides clearer and stronger evidence that high doses of caffeine intake during pregnancy can increase the risk of miscarriage, preterm birth, still birth, anemia, intrauterine growth restriction, low birth weight, fetal distress, sudden infant death syndrome, congenital anomalies, decreased level of iron and calcium etc. So, there is a need of midwife to give the latest advice on issues relating to what they can eat and drink while pregnant.⁹

STATEMENT OF THE PROBLEM:

A study to asses the effectiveness of structured teaching programme on knowledge regarding effect of caffeinated food on fetus among primigravida women in selected hospitals, Bangalore.

OBJECTIVE :

· To assess the knowledge regarding effect of caffeinated food on fetus among primigravida women.

· To evaluate the effectiveness of structured teaching programme on effect of caffeinated food on fetus among primigravida women.

· To find the association between the post-test knowledge score with selected demographic variables.

HYPOTHESIS:

H₁: There was a significant difference between pre-test and post-test knowledge score among primigravida women.

H₂: There was a significant association between level of knowledge regarding effect of caffeinated food on fetus among primigravida women and their selected demographic variables.

OPERATIONAL DEFINITIONS:

1. Assess: It refers to the process used to get information regarding knowledge of primigravida women regarding effect of caffeinated food on fetus.

2. Effectiveness: It refers to the significant increase in the level of knowledge among primigravida women after receiving structured teaching programme regarding effects of caffeinated food on fetus.

3. Structured teaching program: It refers to planned and organized teaching and learning programme aimed to improve knowledge regarding effect of caffeinated food on fetus among primigravida women.

4. Knowledge: It refers to information possessed by the primigravida women regarding effect of caffeinated food on fetus as measured by structured knowledge questionnaire.

5. Effect of caffeinated food :It refers to the adverse effect of caffeinated food on fetus such as preterm birth, abortion, low birth weight etc.

6. Caffeinated food :It refers to the food which contains the caffeine substance.

7. Fetus: It refers to the developing offspring in womb.

8. Primigravida women: It refers to the first-time pregnant women.

MATERIALS AND METHODS:

Research Approach: Evaluative research approach

Research Design:Pre experimental research design (one group pre-test post-test) was adopted for this study.

Population: The population of the study included all the Primigravida women who attend OPD at government hospital ,Anekal,Bangalore.

Sampling technique and sample size: The investigator selected 60 primigravida women through purposive sampling technique.

The major findings of the study was summarized as follows:

· Among 60 samples, 45( 75%) samples belong to the age groups of 21-30 years, 39(65%) samples belong to Hindu, 43(72%) of samples had PUC education, 44(73%) of samples were house wives, 32(53%) samples earned Rs.5001-20000, 23(38%) samples were having mixed diet (veg and non veg), 37(62%) samples had mild physical activity, 47(78%) samples belong to nuclear family, 44(73%) of samples were from rural area. All the samples 60(100%) had not received any health information on effect of caffeinated food on fetus.

· In pre-test, 17(28.33%) samples had inadequate knowledge, 43(71.66%) samples had moderate knowledge and none of them had adequate knowledge.

· The mean pre-test score was 12.21±2.74 and the mean post-test score was 15.4±3.99. The paired ‘t’ value at P≤0.05 level for knowledge was 5.25. It shows that the structured teaching program on knowledge regarding effect of caffeinated food on fetus among primigravida women. Hence H₁ is retained.

· There was a significant association between the level of knowledge and their selected demographic variables like family’s annual income. Hence H₂ retained

Figure 1: The pre-test and post-test mean percentage knowledge score

The above figure shows that the mean percentage knowledge scores of the pre-test was 40.70% and the mean percentage knowledge score of post-test was 5 1.30%. Which indicates the gain in knowledge was increased among primigravida women.

Table 1: Association of post-test knowledge score and selected demographic variables. n=60

Sl. No	Demographic variables	df	X²	P value	Significance
1.	Age in years	4	1.5	0.81	NS
2.	Religion	4	1.8	0.77	NS
3.	Educational status	2	0.6	0.73	NS
4.	Occupation	6	3.16	0.78	NS
5.	Family’s annual income	4	11.8	0.01	S
6.	Dietary pattern	4	1.31	0.85	NS
7.	Physical Activity	4	0.23	0.99	NS
8.	Type of family	2	4.24	0.11	NS
9.	Residential area	2	1.02	0.59	NS
10.	Source of information	8	0	1	NS

S= Significant

NS=Non significant

The above table shows an association between post-test knowledge score regarding effect of caffeinated food on fetus and selected demographic variables.

CONCLUSION:

The study was done to determine the effectiveness of STP on knowledge regarding effect of caffeinated food on fetus among primigravida women in selected hospital, Bangalore. The result of the study showed that most of the primigravida women had gained knowledge regarding the effect of caffeinated food on fetus.

RECOMMENDATIONS:

On the basis of the findings of the study following recommendations have been made:

1. A replication of present study can be conducted with a larger population.

2. A similar study can be conducted in different hospital settings such as antenatal ward and antenatal clinics in community area.

3. This study can be conducted in different settings in rural and urban areas and then due results can be compared.

4. Manuals and information booklets may be developed to enhance knowledge on effects of caffeinated food on fetus.

REFERENCES:

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2. Ricci. S.S. Essentials of Maternity, Newborn and Women’s Health Nursing. 2nd edition. Philadelphia: Lippincott Williams and Wilkins; 2009. Pp-565, 316, 599, 16.

3. Foods to avoid during pregnancy [Serial online]. 2010 Feb 8. Available from URL: http://articles.timesofindia.indiatimes.com/2010-02- 08/health/28144743_1_food-poisoning-canned-seafood-caffeine

4. T.R. Reid. Caffeine - what’s the buzz? [Serial online]. Available from URL: http://science.nationalgeographic.co. in/science/health-and-human-body/human- body/caffeine-buzz/

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6. Rain.E. Foods that contain caffeine [Serial online]. Available from URL: http://diet.lovetoknow.com/wiki/Foods_Containing_Caffeine.

7. Kounteya Sinha. India shares highest preterm birth burden [Serial online]. 2012 Jun 8. Available from: http://articles.timesofindia.indiatimes.com/2012-06- 08/india/32123625_1_preterm-premature-babies-joy-lawn.

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Received on 27.06.2024 Modified on 31.07.2024

Int. J. Nur. Edu. and Research. 2024; 12(3):205-208.

DOI: 10.52711/2454-2660.2024.00043