ABSTRACT

This was a cross sectional type of descriptive study which was carried out with a
view to find out the relationship between gestational diabetes mellitus and
asymptomatic urinary tract infection among pregnant mothers in Chapai Nawabganj
The sample size was 119 which was selected purposively. Regarding age distribution
of the respondents it was found that majority (52.1%) were in the age group of
<25years and the mean age of the respondents was 25.14 ± 4.82 years. The mean
monthly family income of the respondents was Taka 19354.256 ± 6522.63. It was
found that most (58.0%) the respondents were Muslim, majorities (55.46%) of them
from urban area, 59.66% from joint family and 67.23% of them had pucca house.
Majorities (58.0%) of the respondents were housewives, 65.5% of them had good
and hygienic sanitation system and most (90.8%) of them had homemade food habit.
It was found that 66.3% of the respondents had 5-12 weeks of GDM and majorities
(65.5%) of the respondents had up to 20 weeks of gestation. It was revealed that
most (87.4%) of the respondents had 3 times major meal, majority (41.2%) of them
had 2 times light meal per day, 59.7% of them had tube well as source of drinking
water and majority (84.9%) of them drunk 7-10 glasses of water per day. It was
recognized that majority (68.9%) of the respondents had 6-8 times of micturation,
most (91.6%) of them did not have history of urine retention and majorities (92.4%)
of them did not have any systemic diseases. It was revealed that majority (92.4%) of
the respondents did not take any medicine during gestational time; 52.l% of them had
family history of DM, 51.6% of their fathers had history of DM. It was remarkable
that majority (86.7%) of the respondents had gestational DM. It was found that
majorities (86.6%) of the respondents had history of normal household work as
physical activity during pregnancy and most (89.9%) of them did not have any
complications during pregnancy. Majorities (69.7%) of the respondents did not know
about their urinary tract infection and most (98.3%) of them did not have any blood in
urine. The relationships of urinary tract infection with pattern of DM and duration of
GDM were not found statistically significant (p>0.05). The relationship between
family history of DM and urinary tract infection was found statistically significant
(p<0.01). The study might be the basis for further in-depth study in this regards.
1. INTRODUCTION

For more than a century, it has been known that diabetes antedating pregnancy can
have severe adverse effects on fetal and neonatal outcome. As early as in the 1940s,
it was recognized that women who developed diabetes years after pregnancy had
experienced abnormally high fetal and neonatal mortality. By the 1950s the term
"gestational diabetes" was applied to what was thought to be a transient condition
that affected fetal outcomes adversely, then abated after delivery .In the 1980s those
cut-off points were adapted to modern methods for measuring glucose and applied to
the modern definition of gestational diabetes - glucose intolerance with onset or first
recognition during pregnancy. 1
Gestational diabetes (or gestational diabetes mellitus, GDM) is a condition in which
women without previously diagnosed diabetes exhibit high blood glucose levels
during pregnancy. Gestational diabetes mellitus (GDM) can also be defined as any
degree of glucose intolerance with onset or first recognition during pregnancy.2

There are 2 subtypes of gestational diabetes (diabetes which began during

pregnancy): Type Al: abnormal oral glucose tolerance test (OGTI) but normal blood
glucose levels during fasting and 2 hours after meals; diet modification is sufficient
to control glucose levels Type A2: abnormal OGTI compounded by abnormal
glucose levels during fasting and/or after meals; additional therapy with insulin or
other medications is required.3

The presence of fasting hyperglycemia (>105 mg/di or >5.8 mmoVl) may be

associated with an iJ!crease in the risk of intrauterine fetal death during the last 4-8
weeks of gestation. Although uncomplicated GDM with less severe fasting
hyperglycemia has not associated with increased perinatal morta:fity, GDM of any
severity increases i:he_ risk of fetal macrosomia. Neonatal hypoglycemia, jaundice,
polycythemia, and hypocalcemia may complicate GDM as- well. Typically women
with gestational diabetes exhibit no symptoms but some women may demonstrate
increased thirst, ined urlliation, fatigue, nausea and vomiting, .bladder infection, yeast
infections and blurred vision.4

Gestational diabetes affects 3-10% of pregnancies, depending on the population

studied. Approximately 7% of all pregnancies are complicated by GDM, resulting in
more than 200,000 cases annually. In the United States toda , 21 million people
(7'1J of the population) have s0me form of diagnosed diabetes. 5 Another 6 million
people may be diagnosed.6 Approximately 3-10% of pregnancies in the Uted States
are-complicated by diabetes, of which 90% is gestational diabetes and 8% is
preexisting, insulin-resistant diabetes. The incidence of insulin-resistant diabetes is
increasing markedly in the United States, probably related to nsing population obesity
and shifts in ethnicity l35,000 pregnant women get the condition every year; approx 1
in 2,014 or 0.05 or 135,000 people in USA are affected. Incidence extrapolations for
USA for Gestational diabetes: 134,999 per year!11,249 per month, 2,596 per week,
369 per day, 15 per hour, 0 per minute, 0 per secohd. Gestational diabetes accounted
for 9% of new cases of diabetes in Australia 1999-2002 (The National Diabet«?S
Register,- Australia's Health 2004.7

Urinary tract consists of kidneys, ureters, bladder and urethra. An infection caused by
pathogenic organisms like bacteria, fungi or parasites in any of the structures that
comprise urinary tract is called as UTI. Ex: urethritis, cystitis, pyelonephritis. 8 UTI is
a common problem in pregnant women. Around 8.3 million pregnancy cases are
reported every year. It is because of changes in the urinary tract. The uterus sits
directly on top of the bladder. As the uterus grows, its increased weight can block the
drainage of urine from the bladder causing infection. The most common organisms
that implicate UTI is e.coli (80%), staphylococcus aureus and staphylococcus
saprophyicus. Urinary catherization is a common risk factor for UTI. 9 Depending on
the site of infection UTI can produce different symptoms such as burning micturition,
feeling of urgency, lower abdominal pain, fever, urinary incontinence, urine looks
cloudy and so on.10

Untreated UTI can lead to complications such as abortion, prematurity, low birth
weight baby, still birth, preterm labour, preeclampsia, chronic pyelonephritis and
rarely kidney failure. If it is treated early, then it will not harm the baby. Prevention of
UTI is through drinking minimum 8 glasses of water in a day, empty the bladder
before and after the sex, wash genital area with warm water before sex, take showers
instead of bath, avoid tight fitting clothing and pantyhose, so on. It is typically treated
with cephalexin or nitrofurantoin for 7 days. Take the medication even if the
symptoms go away.11
1.1 Justification of the study

There are both fetal and maternal complications associated with GDM. Fetal
complications include macrosomia, neonatal hypoglycemia, perinatal mortality,
congenital malformation, hyperbilirubinemia, polycythemia, hypocalcemia, and
respiratory distress syndrome. Macrosomia, defined as birth weight > 4,000 g, occurs
in 20-30% of infants whose mothers have GDM. Maternal factors associated with an
increased incidence of macrosomia include hyperglycemia, high BMI, older age, and
multiparity. This excess in fetal growth can lead to increased fetal morbidity at
delivery, such as shoulder dystocia, and an increased rate of cesarean deliveries. 12
Neonatal hypoglycemia can occur within a few hours of delivery. This results from
maternal hyperglycemia causing fetal hyperinsulinemia.13

The association between GDM and perinatal mortality has been more controversial.
Several studies have concluded that the rate of perinatal mortality (including
stillbirths and neonatal deaths) was increased in women with GDM in the past.
However, recent studies have shown that, with the combination of increased
antepartum monitoring, medical nutrition therapy (MNT), and insulin therapy if
needed, this difference in perinatal mortality rates is potentially avoidable. 14
Maternal complications associated with GDM include hypertension, preeclampsia,
and an increased risk of caesarean delivery. In addition, women with a history of
GDM have an increased risk of developing diabetes after pregnancy compared to the
general population, with a conversion rate of up to 3% per year.15 There are scarce
statistical data on the risk of other conditions in women with GDM; in the Jerusalem
Perinatal study, 410 out of 37962 patients were reported to have' GDM, and there was
a tendency towards more breast and pancreatic cancer, but more research is needed to
confirm this finding .The prevalence may range from 1 to 14% of all pregnancies,
depending on the population studied and the diagnostic tests employed Gestational
diabetes mellitus accounts for 90% of cases of diabetes mellitus in pregnancy. Type
IT diabetes mellitus accounts for 8% of cases of diabetes mellitus in pregnancy, and
given its increasing incidence, pre-existing diabetes mellitus now affects 1% of
pregnancies.16
The two main risks GDM imposes on the baby are growth abnormalities and chemical
imbalances after birth, which may require admission to a neonatal intensive care unit.
Infants born to mothers with GDM are at risk of being both large for gestational age_
(macrosomic) and small for gestational age.13 Macrosomia in turn increases the risk
of instrumental deliveries or problems during vaginal delivery .Macrosomia may
affect 12% of normal women compared to 20% of patients with GDM. However, the
evidence for each of these complications is not equally strong; in the Hyperglycemia
and Adverse Pregnancy Outcome (HAPO) study for example, there was an increased
risk for babies to be large but not small for gestational age. Research into
complications for GDM is difficult because of the many confounding factors labeling
a woman as having GDM may in itself increase the risk of having a caesarean
section.14 Women with GDM have a higher risk of preeclampsia. In the HAPO study,
the risk of preeclampsia was between 13% and 37% higher, although not all possible
confounding factors were corrected.17

According to 1997 survey, urinary tract infection accounted for nearly 7 million
outpatient cases and 1 million emergency cases during pregnancy. It is resulting in o.l
million hospitalizations. As per the WHO report, 20 to 50% of pregnant women will
experience bacteriuria in their pregnancy, 5 to 10 % of them are getting expose in
their 1st pregnancy.18 A descriptive study was conducted to determine the incidence of
urinary tract infection among pregnant women. 250 mothers were randomly
selected for screening and mid stream urine was collected for the study. 15% of
mothers were found positive and treatment started with cephalexin. They
recommended that women with urinary B staphylococcus infection should be treated
and receive intrapartum prophylactic therapy.19

A cross sectional study is conducted to investigate epidemiology of UTI among

pregnant women. 235 pregnant mothers were randomly selected in antenatal clinic.
Mid stream urine was collected and standard culture media is used to identify
organisms. Results expressed that 12.1% of women were symptomatic and 14.7%
were asymptomatic. E.coli was the most prevalent organism found. They
recommended to use standard culture method for the screening and diagnosis.20 A
study was conducted to identify prevalence of micro organisms in UTI and their
sensitivity to antibiotics. 792 consecutive urine samples were selected from pregnant
women in outpatient department and clinics.

Resul_ts shown 29.2% of mothers were positive and showed growth of

microorganisms especially for E.coli. 78.6% of organisms were sensitive to
Gentamicin and Nalidixic acid. Researcher suggested that culture and sensitivity that
should be carried out and Nalidixic acid can be the 1st choice of treatment. 21 A study
was conducted to examine the frequency of UTI inpregnancy. Urine samples from
137 pregnant women were randomly collected and sent for culture with drug
sensitivity. This study shown that 30% of the women suffered from UTI. E.coli was
most frequently isolated organism. They were sensitive to chloramphenicol more.
53.7% of women were primi mothers and 48.8% of mothers were in 3rd trimester.22

1.2 Research question:

Is gestational diabetes mellitus associated with asymptomatic urinary tract infection

among the pregnant mothers?

1.3 Objectives:

l.3.1 General objective

The study was carried out with a view to find out gestational diabetes mellitus and its
relationship with asymptomatic urinary tract infection among the pregnant mothers in
Chapai Nawabganj.

1.3.2 Specific objectives

 To find out UTI by routine urine examination of pregnant mothers.

 To find out gestational diabetes mellitus among the pregnant mothers.

 To find out socio-demographic characteristics of the pregnant mothers.

 To find out relationship between gestational diabetes mellitus and

asymptomatic urinary tract infection among the pregnant mother.

1.4 Variables used in this study

A. Dependent variable
 Gestational diabetes mellitus
Asymptomatic urinary tract infection

B. Socio-demographic variables
1. Age
2. Sex
3. Educational status
4. Occupation
5. Religion
6. Residence
7. Type of family
8. Monthly family income & Eating habit
9. Family history of DM
10. Duration of GDM

1.5 Operational definitions

Type of family:

In this study families were classified as follows:

(a) Nuclear family: Parents or parent (either father or mother) with one
or more unmarried children.
(b)Extended (Non nuclear) family: Parents or parent with married or
never married children with or without relatives (e.g., father-in-law,
mother-in-law, uncle, aunt, etc) eating from the same kitchen.

Income:

Material return in kind or cash in exchange of goods and services earned by the
person (respondent) only is known as personal income and by the household
members is known as household income. Household income or total family
income consists of total income of all the members of the family living in the same
household and taking food from the same cooking pot.
2. LITERATURE REVIEW

A study conducted on "Diabetes and pregnancy: women's opinions about the care
provided during the childbearing year."The extended programmes for pregnant
women with diabetes, needed to improve pregnancy outcome, might negatively
influence the experience of expecting a baby. The study was done to investigate
opinions about care during pregnancy, childbirth and the postnatal period among
women with diabetes mellitus (DM) and gestational DM (GDM). A four-part
questionnaire was constructed, covering the childbearing year, with a focus on
treatment and information. A total of 156 women were asked to participate. The
questionnaire was anonymous. The reply frequency was 94%. Comments showed
focus on diabetes, forcing the healthy pregnancy aspects into the background. The
answers concerning treatment indicated satisfaction Women with GDM felt badly
prepared before the glucose tolerance test. Lack of knowledge among staff was
pointed out. Need for more written material was expressed. Satisfaction with care was
shown. A discussion about the implication of informed choice with both staff and
mothers are needed. Sharper implementation of the diabetes-care chain was also an
area for improvement.23

A study on ''Treatments for gestational diabetes." was conducted. It was found that
Gestational diabetes (GDM) affects 3% to 6% of all pregnancies. Women are often
tensively managed wth increased obstetric monitoring, dietary regulation, and insulin.
was done to compare the effect of alternative treatment policies for GDM on both
emal and infant outcomes. Eight randomized controlled trials (1418 women) were
included. Caesarean section rate was not significantly different when comparing any
specific treatment with routine antenatal care (ANC) including data from five trials
with 1255 participants .There was a reduction in the risk of pre-eclampsia with
intensive treatment (including dietary advice and insulin) compared to routine
ANC .ore women had their labour induced when given specific treatment compared to
routine ANC: There was a reduction in the proportion of infants weighing more than
4000 grams and the proportion of infants weighing greater than the 90th birth centile
of mothers receiving specific treatment for GDM compared to routine ANC.
However, there was no statistically significant difference in this proportion between
infants of mothers receiving oral drugs compared to insulin as treatment for GDM.
Specific treatment including dietary advice and insulin for mild GDM reduces the risk
of maternal and perinatal morbidity.24

A study was conucted on "Beliefs about health and illness in women managed for
gestational diabetes in two organisations."The objective was to explore beliefs about
health, illness and health care in women with gestational diabetes mellitus (GDM)
managed in two different organisations based on diabetology or obstetrics.: an
explorative qualitative study using semi-structured interviews.: clinic A: a specialist
abetes clinic with regular contact with a diabetologist and antenatal care provided by a
midwife; clinic B: a specialist maternity clinic providing regular contact with a
midwife, a structured programme for self-monitoring.of blood glucose and insulin
treatment, and a I-day diabetes class by an obstetrician, a diabetologist, a midwife and
a dietician. 13 managed in clinic A and 10 managed in clinic B. All respondents
reported a delay in the provision of information about GMD and an information gap
about GDM and the management of the condition, form diagnosis until the start of
treatment at the specialist clinic. Respondents from clinic A expressed fear about
future development of type 2 diabetes. Women from clinic B discussed different
causes of GDM, and many claimed that health-care staff informed them that GDM
was a transient condition during pregnancy. It is important to recognize the context of
information given on GDM, as it will substantially influence the beliefs and attitudes
of women towards GDM as a transient condition during pregnancy or as a potential
risk factor for diabetes.25

A study was done on Neonatal complications in infants born to diabetic mothers. The
objective of the study is to determine the range of complications occurring in infants
of diabetic mothers. A cross-sectional study at Federal Government Services Hospital,
Islamabad. Maternal history was obtained and a detailed physical examination was
performed to detect congenital abnormalities. Babies were screened for
hypoglycemia, hypocalcemia, hyperbilirubinemia, birth asphyxia, respiratory distress
syndrome (RDS) and birth trauma. A total number of 40 babies with IDM were
included in the study. Hypoglycemia was noted in 35% and hypocalcemia in 15%.
Hyperbilirubinemia was observed in 12 (30%) newborns. Mortality was 7.5%. The
results of this study show high frequency complications in IDMs. The diabetic
mothers should have regular antenatal follqw-up and maintain good glycemic control
throughout pregnancy. Cesarean section may be allowed more liberally, especially
with clinical evidence of macrosomic baby, to avoid birth injury and asphyxia. All
deliveries of diabetic mother should be attended by pediatrician to minize
complications.25

A study was done (2005) on "Characteristics of gestational diabetic mothers and their
babies in an Indian diabetes clinic". To compare clinical and metabolic features of
mothers with gestational diabetes (GDM) and their offspring with those in non-
diabetic pregnancies at the King Edward Memorial Hospital, Pune, India. Antenatal
information was obtained from hospital records. GDM was diagnosed by 75 g OGTI
(Oral Glucose Tolerance Test) in clinically high-risk women. Anthropometric
measurements of mother and the babies were recorded within 24h of delivery and a
maternal blood sample collected for hematological and biochemical measurements .
Compared to non-diabetic mothers GDM mothers were older, more obese, centrally
obese and had higher blood pressure. Sixty percent GDM mothers and 34% of non-
diabetic mothers were delivered by caesarean-section, 23% of GDM mothers
delivered pre term. Despite the smaller gestation, babies of GDM mothers were
heavier, longer and more adipose. Babies of GDM mothers suffered higher neonatal
morbidity. Neonates of GDM mothers are heavier, longer and more adipose than
those born to non-diabetic mothers, and suffer higher neonatal morbidity.26

A descriptive study was conducted to determine the prevalence of UTI in pregnancy,

aetiologic agents and to assess predisposing factors in Nigeria. 200 urine samples
were randomly collected from pregnant women attending antenatal clinics and Bonyi
hospital . The prevalence was found to be 48%. There was high incidence in 21-25
age group (41.7%). Infection rate is found more in 3rd trimester (82.3%). Primiparity
is associated with increased UTI. Staphylococcus aureus was the most frequently
isolated pathogen (44.8%). These findings underscore the importance of screening
pregnant women for UTI and proper treatment for the cases.27
A retrospective study was conducted to determine the incidence of UTI among
pregnant women. Midstream urine was collected from 250 pregnant mothers and
streaked on blood agar. UTI was confirmed based on the growth of micro organisms
specially bacteriae. 28.5% of mothers found positive to UTI and 24.4% of them had
symptoms like incontinence, nocturia and urgency and others were asymptomatic.
They recommended to administer prophylactic antibiotics during pregnancy in last
trimester.28
A prospective study was conducted to determine the prevalence of lower UTI and
antimicrobial pattern among pregnant women in Chennai. Midstream urine was
collected from 1157 pregnant women and culture tests were done by a quantitative
method. 525 (47.5%) of mothers were found positive to UTI and E. coli was the most
commonly seen bacteria. They concluded that pregnant women with poor personal
hygiene have more chances to develop UTI.29
A study was conducted to determine the frequency and risk factors of asymptomatic
UTI during pregnancy in Hyderabad. Pregnant women visiting obstetrical OPD
without symptoms were selected in the study. Dipstick test was performed and urine
was cultured. Data was analyzed on SPSS version. 59% of mothers were found
positive to bacteriuria. Prevalence was 100% in women who had past history of UTI.
They concluded that asymptomatic bacteriuria is a common infection during
pregnancy.30
A cross sectional study was conducted to determine the prevalence of UTI among
symptomatic and asymptomatic pregnant women in Bangalore. A total of 247
pregnant women were enrolled in study. Of these 78 (31.5%) were found positive and
was diagnosed using midstream urine. 17.5% were asymptomatic and 14% of them
were asymptomatic. They suggested that asymptomatic bacteriuria is prevalent in our
setting and E.coli is most commonly seen.31
A prospective study was conducted to determine the incidence of UTI among last
trimester pregnant mothers in Mangalore. Data was collected in one month. 88
mothers were enrolled in the study. Dipstick test was performed to identify the
infection. 16% of mothers were found positive and treated with Nalidixic acid. They
recommended that irrespective of symptoms every pregnant mother should undergo
serum examination to le out UTI in pregnancy.32
A retrospective cohort study was conducted to examine the effectiveness of nursing
care in reducing labor abnormalities in pregnant mothers in New York. 150 eligible
pregnant mothers were randomly selected and health education was given about
prevention of UTI and antibiotic treatment. Inpretest, 70 % of mothers shown
inadequate knowledge. After intervention their posttest scores revealed 86% of
mothers achieved adequate knowledge and they delivered the baby without any
complications. They recommended that an effective teaching in antenatal period
will improve perinatal outcome.33
A descriptive study was performed to determine the knowledge among pregnant
mothers regarding prevention of complications. 180 mothers who were in 1st
trimester, were selected to conduct the study. Data was collected by using structured
questionnaire. Yajority of questions were from UTI and complications of pregnancy.
Results revealed that 68% of pregnant women had inadequate knowledge and
investigator suggested to have education program during pregnancy to educate
illiterate women.34

3. METHODOLOGY

3.1 Type of study: This was a cross-sectional type of descriptive study.

3.2 Place of study: The study was carried out in the Dept. of Public Health of
Varendra University.
3.3 Duration of the study: This research work was a part of Master of Public Health
(MPH) programme of Varendra University with duration of 4 months in the summer
session from May, 2018 to August, 2018.
3.4 Study population: All the pregnant mothers with gestational diabetes mellitus in
Chapai Nawabganj during the study period constituted the study population.Sample
size:
3.5 Sample size: The of this study was 119.
2.6 Determination of sample size: The sample size was determined by using the
following formula:
Sample size, n = (z2pq)/d2

Where, p = Response distribution i.e., proportion of factor in the population or the

expected frequency value, q = 1-p, d = Margin of error is the amount of error that one
would tolerate. Z = Area under normal curve corresponding to the desired confidence
level (Cl) and it is the amount of uncertainty that one can tolerate.
Now for the present study, Z = 1.96 at 9.5% Cl, p = 0.6 (Prevalence of gestational
DM), q = 0.4 and d = 0.05,

n = [(1.96)2 (0.6) (0.4)] I (0.05)2 = 368

Due to unavailability of respondents, total sample size taken for this study was 119.
3.6 Sampling technique: Purposive sampling technique was followed.

3.8 Data collection instruments: A partially structured questionnaire which was duly
pre-tested was used to collect data from the respondents.
3.9 Data collection procedure: The researcher herself collected data from the
pregnant mothers with gestational diabetes mellitus in Chapai Nawabganj by face to
face interview through a partially structured questionnaire. All efforts were made to
collect data accurately. For open questions, the respondents were asked in such a
manner so that they could speak freely and explain their opinion in a normal and
neutral way. No leading questions were asked.
3.10 Inclusion criteria of the respondents: All the pregnant mothers with gestational
diabetes mellitus in Chapai Nawabganj during study period were included in the
study.
3.11 Exclusion criteria: Unwilling to participate in the study.
3.12 Data analysis: After proper verification, data were coded and entered into the
computer by using SPSS/PC programme. Data were analyzed according to the
objectives of the study by using SPSS/PC+ software computer programme.
Descriptive variables were explained with percentage, mean and standard deviation.
Statistical significance was found by applying relevant statistical tests at appropriate
probability level (p = 0.05 or p= 0.01).

3.13 Ethical consideration: Prior to the commencement of the study, the research
protocol was approved by the research committee (Local ethical committee) of the
department of Public Health of Varendra University. The aim and objectives of the
study along with its procedure, risks and benefits of the study were explained to the
respondents in easiiy understandable language and then informed consent was taken
from each of them. Then it was assured that all information and records would
be kept confidential and would be used only for research purpose and the findings
would be helpful for the improvement of the condition of the pregnant mothers with
gestational Diabetes Mellitus and were suffering from asymptomatic urinary tract
infection.
4. RESULTS

Table no. 01: Distribution of the respondents by age

Age in group Respondents

No. %

<25 years 62 52.1

25 - 29 years 31 26.1

30+ years 26 21.8

Total 119 100.0

X ± SD = 25.14 ± 4.82 years
Regarding age distribution of the respondents it was found that out of 119
respondents majority (52.l%) were in the age group of <25years, 26.1% were in 25-
29 years age group and 21.8% were JO+ years age group. The mean age of the
respondents was 25.14 ± 4.82 years (Table No. 1).
Table no. 02: Distribution of the respondents by monthly family income
Monthly family income Respondents

No. %

Up to Taka 15000 36 30.3

Taka 15001 - 30000 78 65.5

Taka >30000 5 4.2

Total 119 100.0

X ± SD = Taka 19354.256 ± 6522.63

Regarding monthly family income it was observed that 65.5%, 30.3% and 4.2% of
the respondents had monthly family income of Taka 15001-30000, up to Taka 15000
and Taka >30000 respectively. The mean monthly family income of the respondents
was Taka 19354.256 ± 6522.63 (Table no. 02).
Table no.03: Distribution of the respondents by duration of GDM
Duration of GDM Respondents

No. %

Up to 4 weeks 18 21.7

5 - 12 weeks 55 66.3

>12 weeks 10 12.0

Total 83 100.0

X ± SD = 11.12 ± 22.69 weeks

From the table no 3, it was found that 66.3% of the respondents had 5-12 weeks of
GDM, 21.7% had up to 4 weeks and 12.0% had > 12 weeks of GDM. The mean
duration of GDM was 11.12 ± 22.69 weeks (Table No. 3).

Table no. 04: Distribution of the respondents by duration of gestation

Duration of gestation Respondents

No. %
 Up to 20 weeks 78 65.5

21 - 28 weeks - 32 26.9

>28 weeks 9 7.6

Total 119 100.0

X ± SD = 19.06 ± 5.62 weeks

Regarding duration of gestation it was observed that majorities (65.5%) of the
respondents had up to 20 weeks of gestation, 26.9% had 21-28 weeks of gestation
and 7.6% had >28 weeks of gestation. The mean duration of gestation was 19.06 ±
5.62 weeks (Table No. 4).

Table no. 05: Distribution of the respondents by occupation

Occupation Respondents

No. %

Student 30 25.2

Housewife 69 58.0

Official Job 17 14.3

Business 3 2.5

Total 119 100.0

Above table showed that majorities (58.0%) of the respondents were housewives,
25.2% were students, 14.3% were in official job and 2.5% were in business (Table No.
5).
Table no. 06: Distribution of the respondents by sanitat6ion & hygienic condition
Sanitation Respondents

No. %

Poor 8 6.7f

Good but unhygienic 33 27.7

Good and hygienic 78 65.5

Total 119 100.0

Above table showed that most (65.5%) of the respondents had good sanitation and
hygienic condition, 27.7% had good but unhygienic sanitation and 6.7% had poor
sanitation and hygienic condition (Table No. 6).

Table no. 7: Distribution of the respondents by food habit

Food habit Respondents

No. %

Home made 108 90.8

Restaurants/Fast food 10 8.4

Other food habit 1 0.8

Total 119 100.0

Above table showed that most (90.8%) of the respondents had homemade food habit,
8.4% ate restaurants I fast food and 0.8% had other food habits (Table No. 7).

Table no. 8: Distribution of the respondents by major meals per day

Respondents
Major meals per day
No. %

2 times 13 10.9
 3 times 104 87.4

4times 2 1.7

Total 119 100.0

It was revealed that most (87.4%) of the respondents had 3 times major meal, 10.9%
had 2 times major meal and 1.7% had 4 times major meal (Table No. 8).

Table no. 9: Distribution of the respondents by light meal per day

Light meal per day Respondents

No. %

No 19 16.0

1 time 47 39.5

2 times 49 41.2

3 times 4 3.4

Total 119 100.0

It was found that majority (41.2%) of the respondents had 2 times light meal per day,
39.5% had single time per day, 16.0% did not take any light meal and 3.4% took 3
times light meal per day (Table No. 9).

Table no. 10: Distribution of the respondents by source of drinking water

Source of drinking water Respondents

No. %

Tube well 71 59.7

River/Pond - 9 7.6

Boil water 30 25.2

 Mixed 9 7.6

Total 119 100.0

It was found that majority (59.7%) of the respondents had tube well as
source of drinking water, 25.2% used boil water, 7.6% drunk water from
river or pond and 7.6% drunk mixed water (Table No. 10).
Table no.11: Distribution of the respondents by amount ot g\asswatl' per day
Amount of glass water per day Respondents

No. ' %

3-6 glasses 11 9.2

7-10 glasses 101 84.9

11-13 glasses 7 5.9

Total 119 100.0

It was established that majority (84.9%) of the respondents drunk 7-10

glasses of water per day, 9.2% drunk 3-6 glass of water and 5.9% drunk
11-13 glasses of water per day (Table No. 11).

Table no.12: Distribution of the respondents by frequency of micturation per

day

Frequency of micturation per day Respondents

No. %

3-5 times 24 20.2

6-8 times 82 68.9

>9 times 13 10.9

Total 119 100.0

It was recognized that majority (68.9%) of the respondents had 6-8 times of
micturation per day, 20.2% had 3-5 times and 10.9% had >9 times of micturation
per day (Table No. 12).

Table no. 13: Distribution of the respondents by H/O urine retention

H/O urine retention Respondents

No. %

Yes 10 8.4

No 109 91.6

Total 119 100.0

-
It was discovered that most (91.6%) of the respondents did not have history of urine
retention and 8.4% had history of urinary retention (Table No. 13).

Table no. 14: Distribution of the respondents by H/O systemic disease

H/O systemic disease Respondents

No. %

Yes 9 76

No 110 92.4

Total 119 100.0

It was discovered that majorities (92.4%) of the respondents did not have any
systemic diseases and 7.6% had systemic disease(s) (Table No. 14).

Table no. 15: Distribution of the respondents by name of the disease

Name of the disease Respondents

- No. %

HTN 9 100.0
 T 9 100.0
o
It was discovered that all the respondents, who had disease, had
hypertension as systemic disease (Table No. 15).

Table no. 16: Distribution of the respondents by H/O taking medicine

HIO taking medicine Respondents

No. %

Yes 9 7.6

- No 110 92.4

Total 119 100.0

It was revealed that majority (92.4%) of the respondents did not take any medicine and
7.6% took medicine (Table No. 16).

Table no.17: Distribution of the respondents by name of the medicine taken.

Name of the medicine taken Respondents

No. %

Anti Hypertensive 9 100.0

Total 9 100.0

It was found that all the hypertensive patients took anti hypertensive drugs (Table
No.17).

Table no. 18: Distribution of the respondents by family history of DM

Family history of DM Respondents

No. %

Yes 62 52.1

No 57 47.9

Total 119 100.0

It was found that majority (52.1%) of the respondents had family history of DM and
47.9% did not have family history of DM (Table No. 18).

Distribution of the respondents by religion

60%

50%

40%

30%

20%

10%

0%
Muslim Religion of the respondents
Hindu Christian
Figure no. 01: Distribution of the respondents by religion

It was found that most (58.0%) the respondents were Muslim, 37.8% were Hindu and
4.2% were Christian (Fig. no. 01).
 Distribution of the respondents by residence

Urban

44.54% Rural

55.46%

Figure no. 02: Distribution of the respondents by residence

It was found that majorities (55.46%) of the respondents from urban area and 44.54%
were from rural area (Fig. no. 02).
 Distribution of the respondents by type of family

40.34%

Joint
Nuclear

59.66%

Figure no. 03: Distribution of the respondents by type of family

It was found that 59.66% of the respondents were from joint family and 40.34% were
from nuclear family (Fig. no. 03).
 Distribution of the respondents by type of house

19.33%

Kacha
Pakka
13.45%
Semi Pakka

67.23%

Figure no. 04: Distribution of the respondents by type of hous

It was found that 67.23% of the respondents had pucca (building) house, 19.33% had
semi pucca use and 13.45% had kancha (soil/bamboo made) house (Fig. no. 04).
Table no. 19: Distribution of the respondents by person, who had DM
Person, who had DM Respondents

No. %

Father 32 51.6

Mother 11 17.7

Brother 8 12.9

Sister 5 8.1

Multiple 6 9.7

Total 62 100.0

It was found that majorities (51.6%) of the respondents' fathers had history of DM,
17.7% had history of DM of the mothers, 12.9% had history of brothers, 9.7% had
history of multiple persons in the family and 8.1% had history of sisters for having
DM (Table No. 19).
 Table no. 20: Distribution of the respondents by pattern of DM
Pattern of DM Respondents

No. %

Diabetes 11 13.3

Gestational diabetes 72 86.7

Total 83 100.0

It was found that majority (86.7%) of the respondents had gestational DM and 13.3%
had diabetes (Table No. 20).

Table no. 21: Distribution of the respondents by physical activity during

pregnancy
Physical activity during Respondents
pregnancy
No. %

Normal household work 103 86.6

Office work 13 10.9

Labour work 3 2.5

Total 119 100.0

'

It was found that most (86.6%) of the respondents had history of normal household
work as physical activity during pregnancy, 10.9% had physical activity at office
work and 2.5% had history of labour work (Table No. 21).
Table no. 22: Distribution of the respondents by complications during pregnancy
Complications during pregnancy Respondents

No. %

Yes 12 10.1

No 107 89.9

Total 119 100.0

It was found that most (89.9%) of the respondents did not have any complications
during pregnancy and 10.1% had history of complication (Table No. 22).

Table no. 23: Distribution of the respondents by urinary tract infection

Urinary tract infection Respondents

No. %

Yes 3 2.5

.No 33 27.7

Don't .know 83 69.7

Total 119 100.0

It was found that majorities (69.7%) of the respondents did not know about their
urinary tract infection, 27.7% did not have any UTis and 2.5% had UTis (Table No.
23).

Table no. 24: Distribution of the respondents by blood in urine

Blood inurine Respondents

No. %
-
Yes 2 1.7

No 117 98.3

Total 119 100.0

 It was found that most (98.3%) of the respondents did not have any blood in urine and
1.7% had blood inurine (Table No. 24).

Table no. 25: Relationship between pattern of DM and urinary tract infection
Pattern of DM Urinary tract infections Total
Yes No Don't know

Diabetes
0 (0.0%) 4 (36.4%) 7 (63.6%) 11 (13.3%)
Gestational Diabetes
2 (2.8%) 15 (20.8%) 55 (76.4%) 72 (86.7%)
Total
2 (2.4%) 19 (22.9%) 62 (74.7%) 83 (100.0%)
x2= 1.51, df = 2, p> o.o5
Above table showed the relationship between pattern of DM and urinary tract
infection. About 63.6% of the respondents who had diabetes did not know about
UTIS, 76.4% who had gestational DM did not know about UTIS. The relationship
between pattern of DM and urinary tract infection was not found statistically
significant (p>0.05) [Table no. 25].

Table no. 26: Relationship between duration of GDM and urinary tract infection
Duration of GDM Urinary tract infections Total

Yes No Don't know

Up to 4 weeks
0 (0.0%) 2 (11.1%) 16 (88.9%) 18 (21.7%)
5 - 12 weeks
1 (1.8%) 16 (29.l %) 38 (69.1%) 55 (66.3%)
>12 weeks
1 (10.0%) 1 (10.0%) 8 (80.0%) 10 (12.0%)
Total
2 (2.4%) 19 (22.9%) 62 (74.7%) 83 (100.0%)

x2= 6.4, df = 4, p> o.o5

Above table showed the relationship between duration of GDM and urinary tract
infection. About 99.8% of the respondents who had duration of GDM up to 4 weeks
did not know about UTis, 69.1% who had GDM for 5-12 weeks did not know about
UTis and 80.0% who had GDM for >12 weeks did not know about UTls. The
relationship between duration of GDM and urinary tract infection was not found
statistically significant (p>0.05) [Table no. 26].

Table no. 27: Relationship between family history of DM and pattern of DM

Family history of DM Pattern of DM Total
Diabetes Gestational Diabetes
Yes 50 (60.2%)
2 (4.0%) 48 (96.0%)
No
9 (27.3%) 24 (72.7%) 33 (39.8%)
Total 83 (100.0%)
11 (13.3%) 72 (86.7%)

x2= 9.36, df = 1, p< 0.01

Above table showed the relationship between family history of DM and pattern of
DM. About 96.0% of the respondents who had family history of DM had gestational
DM and 72.7% who did not have family history of DM had gestational DM. The
relationship between family history of DM and pattern of DM was found statistically
significant (p<0.01) [Table no. 27].
DISCUSSION
This was a cross sectional type of descriptive study which was carried out with a
view to find out the gestational diabetes mellitus and its relationship with
asymptomatic urinary tract infection among pregnant mothers residing in Chapai
•
Nawabganj. The sample size was 119 which was selected purposively. Regarding
age distribution of the respondents it was found that out of 119 respondents
majority (52.1%) were in the age group of <25years, 26 .l% were in 25-29 years
age group and 21.8% were 30+ years age group. The mean age of the respondents
was 25.14 ± 4.82 years. In another study the mean age was 23.12 & 24.78 years.13 19

Regarding monthly family income it was observed that 65.5%, 30.3% and 4.2% of the
respondents had monthly family income of Taka 15001-30000, up to Taka 15000 and
Taka >30000 respectively. The mean monthly family income of the respondents was
Taka 19354.256 ± 6522.63 . It was found that 66.3% of the respondents had 5-12
weeks of GDM, 21.7% had up to 4 weeks and 12.0% had > 12 weeks of GDM. The
mean duration of GDM was 11.12 ± 22.69 weeks. Epidemiological studies of risk
factors for GDM are limited and are typically afflicted by confounding factors.8

In addition, inconsistencies in diagnostic criteria for GDM and measurements of risk

factors make it difficult to compare findings across studies. Despite these concerns,
several risk factors for GDM emerge consistently. These include
overweight/obesity,12 excessive gestational weight gain,15 westernized diet,24
ethnicity,23 genetic polymorphisms,3 advanced maternal age,7 intrauterine
environment (low or high
birthweight), 16
family and personal history of GDM, 17
and other diseases of insulin
resistance, such as polycystic ovarian syndrome (PCOS).26 It was found that
majorities (58.0%) the respondents were Muslim, 37.8% were Hindu and 4.2% were
Christian. It was found that majorities (55.46%) of the respondents from urban area
and 44.54 % were from rural area. It was found that 59.66% of the respondents from
joint family and 40.34% were from nuclear family. It was found that 67.23% of the
respondents had pucca (building) houses, 19.33% had semi pucca (semi building)
houses and 13.45% had kancha (soil & bamboo made) houses.

Regarding duration of gestation it was observed that most (65.5%) of the respondents
had up to 20 weeks of gestation, 26.9% had 21-28 weeks of gestation and 7.6% had
>28 weeks of gestation. The mean duration of gestation was 19.06 ± 5.62 weeks. The
American Diabetes Association (ADA) formally classifies GDM as "diabetes first
diagnosed in the second or third trimester of pregnancy that is not clearly either
preexisting type 1 or type 2 diabetes".3

Most (58.0%) of the respondents were housewives, 25.2% were students, 14.3% were
in official job and 2.5% were in business. Most (65.5%) of the respondents had good
and hygienic sanitation system, 27.7% had good but unhygienic sanitation and 6.7%
had poor sanitation system. Most (90.8%) of the respondents had homemade food
habit, 8.4% ate restaurants I fast food and 0.8% had others food habits. It was
revealed that most (87.4%) of the respondents had J times major meal, 10.9% had 2
times major meal and 1.7% had 4 times major meal. Diets that are high in saturated
fats, refined sugars, and red and processed meats are consistently associated with an
increased risk of GDM,36 while diets high in fiber, micronutrients, and
polyunsaturated fats are consistently associated with a reduced risk of GDM.2

It was found that majority (41.2%) of the respondents had 2 times light meal per day,
39.5% had single time per day, 16.0% did not take any light meal and 3.4% took 3
times light meal per day. It was found that majority (59.7%) of the respondents had
tube well as source of drinking water, 25.2% used boil water, 7.6% drunk water from
river or pond and 7.6% drunk mixed water. It was established that majority (84.9%)
of the respondents drunk 7-10 glasses of water per day, 9.2% drunk 3-6 glass of water
and 5.9% drunk 11- 13 glasses of water per day. It was recognized that majority
(68.9%) of the respondents had 6-8 times of micturation, 20.2% had 3-5 times and
10.9% had >9 times of micturation. It was discovered that majority (91.6%) of the
respondents did not have history of urine retention and 8.4% had that history. During
pregnancy, changes in urinary tract predispose women to infection.19
It was discovered that majorities (92.4%) of the respondents did not have any
systemic diseases and 7.6% had systemic diseases. It was discovered that all (100.0%)
of the respondents had hypertension as systemic disease. It was revealed that majority
(92.4%) of the respondents did not take any medicine and 7.6% took medicine. It was
found that all (100.0%) of the respondents took anti-hypertensive drugs. It was found
that majority (52.1%) of the respondents had family history of DM and 47.9% did not
have family history of DM. It was found that mainstream (51.6%) of the respondents
fathers had history of DM, 17.7% had history of mothers, 12.9% had history of
brothers, 9.7% had history of multiple and 8.1% had history of sisters for having DM.
It was found that majority (86.7%) of the respondents had gestational DM and 13..3%
had diabetes. It was found that popular (86.6%) of the respondents had history of
normal household work as physical activity during pregnancy, 10.9% had physical
activity at office work and 2.5% had history of labour work. It was found that most
(89.9%) of the respondents did not have any complications during pregnancy and
10.1% had history of this complication. It was found that majorities (69.7%) of the
respondents did not know about their urinary tract infection, 27.7% did not have any
UTis and 2.5% had UTis. In the postpartum period, changes in bladder sensitivity and
bladder over distention may predispose to UTI.28

It was found that most (98.3%) of the respondents did not have any blood in urine and
1.7% had blood in urine. The relationship between pattern of DM and urinary tract
infection was not found statistically significant (p>0.05). The relationship between
duration of GDM and urinary tract infection was not found statistically significant
(p>0.05). The relationship between family history of DM and pattern of DM was
found statistically significant (p<O.01). Pregnancy is a state of
relative irnrnunocomprornise. This irnrnunocompromise may be another cause for the
increased frequency of UTis seen in pregnancy.31
CONCLUSION AND RECOMMENDATION

Conclusion
This was a cross sectional type of descriptive study which was carried out with a view
to find out gestational diabetes mellitus and its relationship with asymptomatic
urinary tract infection among pregnant mothers in Chapai Nawabganj. The sample
size was 119. Majorities (52.1%) of the respondents were in the age group of
<25years and the mean age of the respondents was 25.14 ± 4.82 years. The mean
monthly family income of the respondents was Tak.a 19354.25 ± 6522.63. It was
found that majorities (66.3%) of the respondents had 5-12 weeks of GDM and the
mean duration of GDM was 11.12 ± 22.69 weeks. Majorities (65.5%) of the
respondents had up to 20 weeks of gestation and the mean duration of gestation was
19.06 ± 5.62 weeks. It was found that majorities (58.0%) the respondents were
Muslim, 55.46% of them from urban area, 59.66% from joint family and 67.23% of
them had building houses.
Majorities (58.0%) of the respondents were housewives and 65.5% of them had good
sanitary and hygienic condition . Most (90.8%) of the respondents had homemade
food habit, 87.4% of them had 3 times major meal and majority (41.2%) of them had
2 times light meal per day. It was established that majority (84.9%) of the
respondents used to drink 7-10 glasses of water per day. It was found that majority
(68.9%) of the respondents had 6-8 times of micturation, most (91.6%) of them did
not have history of urine retention and most (92.4%) of them did not have any
systemic diseases. Those who had systemic disease (7.6%), all of them had
hypertension as systemic disease. Most (92.4%) of the respondents did not take any
medicine during pregnancy except hypertensive patients.
It was found that majority (52.1%) of the respondents had family history of DM and
majorities (51.6%) of the respondents' fathers had history of DM. It was found that
majority (86.7%) of the respondents had gestational DM and 13.3% had diabetes.
Most (86.6%) of the respondents had history of normal household work as physical
activity during pregnancy and majorities (89.9%) of them did not have any
complications during pregnancy. It was found that mass (69.7%) of the respondents
did not know about their urinary tract infection, 27.7% did not have any UTis and
2.5% had UTI. The relationship between pattern of DM and urinary tract infection
was not found statistically significant (p>0.01). The relationship between duration of
GDM and urinary tract infection was not found satistically significant (p>0.05). The
relationship between family history of DM and pattern of DM was found
statistically significant (p<0.01). The findings provided by the study might help in the
management of asymptomatic urinary tract infection during pregnancy.

Recommendations
In the light of the present study findings, I would like to make the following
recommendations:
1. Screening for asymptomatic UTI should regularly be done of the
pregnant mothers having gestational diabetes mellitus.
2. Nutrition counseling and physical activity should be the primary and maJor
strategies.

3. If lifestyle modification alone fails to maintain normoglycemia, OADs and

insulin should be considered .
4. Postpartum care should not be overlooked , as it plays a critical role m the
prevention of future chronic non-communicable diseases.
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