Assessing the effectiveness of educational program for patients with gestational diabetes in Assiut university
Lobna   F el Toony, Walaa A Khalifa, Osama Ghazaly
Internal medicine department , Endocrinology and Diabetes unit, Assiut university

Abstract 
Background :Women with gestational diabetes mellitus (GDM) are at increased risk of both fetal and maternal adverse outcome  and future type 2 diabetes . So early diagnosis, good education and proper management of GDM is crucial to reduce its risks1

Objective : To evaluate the effectiveness of individualized educational program in improving patients awareness, knowledge and attitude and to assess its  role in reducing  the GDM burden

Method : This study was conducted at the pregnancy diabetes clinic , Assiut university as a part of GDM care project in upper Egypt under WDF supervision (WDF 13-797) . All  pregnant women diagnosed to have GDM at 24-28 weeks of gestation according to DIPSI criteria 2 (2 hours blood glucose ≥140 mg/dl  after 75 gm glucose ) between the period from  December 2015 to December 2016 were included . Those women were enrolled in GDM  educational program   . Topics covered during the education session were   pertinent to identifying GDM and its risks  ,  managing GDM during pregnancy and postpartum follow up .The educational sitting was individualized for every patient (one by one)   .  A   modified and shortened version   of a validated  questionnaire  developed by  Carolan et al 3 were tested  before and after education to evaluate  the feedback of education . Questions addressed medical risks, management, outcomes of GDM  and postpartum follow up as well as nutritional and exercise benefits. The studied women    were categorized into 3 groups : poorly   , moderately and well educated according to their GDM posttest knowledge score  .  Follow up   was every two weeks till labor to assess awareness together with maternal and fetal outcome 
Results : Sixty  pregnant women diagnosed to have GDM were included (from 600 pregnant women screened for GDM , with an incidence rate of  10% ), with mean age 28 ± 5years  , mean age of marriage 24 ± 8 years and parity of  4 ± 2 times.
Conclusion 
Health education plays an important role in increasing pregnant women awareness regarding GDM risk and its proper management in order to reduce its complications both for the mother and fetus  . 
 Individualization of education in our study found to be very essential as it increased patients ability to understand each topic and to easy communicate with educator especially that most of the included patients were rural and fairly educated  . Also it enabled us to counsel each woman with GDM about her own risk; the need to monitor the risk, including regular follow-up; and the need for preventive measures (e.g., weight loss and physical activity) in order to achieve good outcome. As regard GDM outcome previous studies have demonstrated the link between education and percent of macrosomic baby  but our study extends these findings by demonstrating the association between level of GDM education and both fetal and maternal outcome.

Reference

1-	Reece EA. The fetal and maternal consequences of gestational diabetes mellitus. J Matern Fetal Neonatal  Med .Mar 2010;23(3):199-203
2-	Seshiah V, AK Das, Balaji V, Shashank R Joshi, MN Parikh, Sunil Gupta
For Diabetes In Pregnancy Study Group (DIPSI). Gestational Diabetes Mellitus – Guidelines. JAPI • VOL. 54 •  2006
3-	Carolan M, Steele C, Margetts H Attitudes towards gestational  diabetes among a multiethnic cohort in Australia. J Clinical Nurs19: (2010)  2446–5