Relationship Among Non-Modifiable Risk Factors For Gestational Diabetes Mellitus, Pregnancy Weight Gain And Delivery Outcomes At Mama Lucy Kibaki Hospital, Nairobi

TABLE OF CONTENTS

ABSTRACT ......................................................................................................................... ii

TABLE OF CONTENTS .................................................................................................... iii

LIST OF FIGURES ............................................................................................................ vi

LIST OF APPENDICES .................................................................................................... vii

ABBREVIATIONS .......................................................................................................... viii

OPERATIONAL TERMS .................................................................................................. ix

CHAPTER ONE: INTRODUCTION ............................................................................. 1

1.1 Background Information ................................................................................................ 1

1.2 Statement of the Problem .............................................................................................. 4

1.3 Rationale ........................................................................................................................ 5

1.4 Objectives of the Study .................................................................................................. 6

1.4.1 Main Objective ........................................................................................................... 6

1.4.2 Specific Objectives ..................................................................................................... 6

1.5 Null Hypotheses ............................................................................................................. 7

CHAPTER TWO: LITERATURE REVIEW ............................................................... 10

2.1 Association of Pregnancy Weight Gain with Maternal History of Gestational Diabetes and Family History of Diabetes ......................................................................................... 10

2.2 Association of Pregnancy Weight Gain with Previous Macrosomia Births and Previous Unexplained Pre-term Births .............................................................................. 12

2.3 Influence of Pregnancy Weight Gain and Gestational Diabetes Mellitus on Macrosomia Births and Pre-term Births ............................................................................ 14

2.3.1. Preterm Birth ................................................................................................................ 18

2.3.2. Fetal Distress ................................................................................................................ 19

2.3.3. Apgar Score .................................................................................................................. 19

2.3.4. Congenital Anomalies .................................................................................................. 19

2.4 Influence of Pregnancy Weight Gain and Gestational Diabetes Mellitus on Cesarean Section and Mal-presentation ............................................................................................ 20

2.4.1. Pre-eclampsia ............................................................................................................... 21

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2.4.2. Postpartum Hemorrhage ............................................................................................... 22

2.4.3. Cesarean Birth and Operative Vaginal Delivery .......................................................... 22

2.4.4. Postpartum Weight Retention ....................................................................................... 23

CHAPTER THREE: METHODOLOGY .................................................................... 29

3.1 Research Site ................................................................................................................ 29

3.2 Target Population ......................................................................................................... 30

3.3 Study Design ................................................................................................................ 30

3.4 Description of Study Process ....................................................................................... 31

3.4.1 Recruitment and Allocation of Study Cohorts/groups to Research Assistants ......... 31

3.4.2 Recruitment and Follow-up on Study Participants ................................................... 32

3.5 Sample Size Determination ......................................................................................... 35

3.6 Sampling Procedures ................................................................................................... 38

3.6.1 Inclusion Criteria for Women with Non-modifiable Risks for GDM ...................... 38

3.6.2 Exclusion Criteria for Women with Non-modifiable Risks of GDM and Members of Comparison Group ............................................................................................................. 38

3.7 Description of Research Instruments ........................................................................... 38

3.8 Validity and Reliability of Research Tools .................................................................. 39

3.8.1 Validity ..................................................................................................................... 39

3.8.2 Reliability .................................................................................................................. 39

3.9 Data Collection Methods ............................................................................................. 40

3.10 Data Analysis ............................................................................................................. 41

3.11 Study Limitations ....................................................................................................... 44

3.12 Ethical Considerations .............................................................................................. 45

APPENDIX I: DATA COLLECTION TOOLS ............................................................ 55

APPENDIX II: TIME-PLAN FOR PhD PROGRAMME ........................................... 62

APPENDIX III: BUDGET FOR RESEARCH WORK ............................................... 63

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LIST OF TABLES

Table 2.1: Operationalization of the study variables ......................................................... 28

Table 3.1: Research assistants and the groups/cohorts they will handle ........................... 31

Table 3.2: Cluster and sub-cluster sample sizes ................................................................ 37

Table 3.3: Distribution of cluster and sub-cluster study participants who will be recruited into each arm of the study on monthly basis ...................................................................... 37