Download Antenatal Mother

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1
NAME OF THE
MRS. VANITHA
CANDIDATE AND
FIRST YEAR M.Sc (N)
ADDRESS
ADARSHA COLLEGE OF NURSING,
BANGALORE -43, KARNATAKA
2
3
4
NAME OF THE
ADARSHA COLLEGE OF NURSING,
INSTITUTION
BANAGLORE-43
COURSE OF STUDY
1ST YEAR M.SC(N)
AND SUBJECT
COMMUNITY HEALTH NURSING
DATE OF ADMISSION
TO THE COURSE
5
TITLE OF THE TOPIC
EVALUATE THE EFFECTIVENESS
OF PLANNED TEACHING
PROGRAMME ON IMPORTANCE OF
CALCIUM AND VITAMIN D DURING
PREGNANCY AMONG ANTENATAL
MOTHERS IN A SELECTED URBAN
AREA AT BANAGLORE
BRIEF RESUME OF THE INTENDED WORK
6. INTRODUCTION
“A special sweetness is to be tasted in the participation of creation” (Pamela S
Nadav)
“Life is always a rich and steady time when you are waiting for something to
happen or to hatch”. (E.B White)
Vitamins and Minerals help to regulate bodily functions without providing energy
and are essential towards sound health .E.g. calcium forms the hard substance of
bones and teeth. Vitamins of organic substances needed by the body in small amounts for
normal metabolism, growth and maintenance.
Vitamin D promotes bone growth and is to be regarded as a hormone rather than
a vitamin because of the way it works. Vitamin D receptors have been found in tissues not
usually associated with bone metabolism such as adrenal glands, pancreas, prostate and
lymphocytes. Vitamin D has role in immunity and can be protective against auto immune
process.
Adequate maternal nutrition is important for optimal fetal growth and
development. Supplementations with multiple micronutrients have been demonstrated to
improve fetal growth among undernourished population. Calcium and vitamin D are
micronutrients that are fundamental to cellular function, maintaining tissue strength and
structure in particular bone integrity. Adequate dietary intake of calcium and vitamin D
are critical to replenish the body stored in the loss of urine, faces, sweats and is then taken
up into bone and soft tissue.8
6.1 NEED FOR STUDY
The World Health Organization (WHO) estimated that 150 million pregnancies occur
annually. The World wide incidence of congenital deformity is estimated at 30 -76 per
1000 live birth. India shows that 2.5% of newborns have a birth defect and this rises to 4%,
if the children are followed defect up to 5 years of age. Musculo skeletal disorders and
maternal morbidity are the most common problems in India.10
Calcium and vitamin D are the two most important nutrients for the body especially
for bones. Calcium and vitamin D are not just for the bones but for the healthy nerve and
muscle functioning.6 The bone deformity are dysplasia of hip occur 10 per 1000 live
births, clubfoot 95% approximately, osteosarcoma approximately 65% to 85%,
osteogenesis imperfect about 50% disorder are found as stillbirth, leg-clave-perthes
disease about 90% of cases.7
All human life on the planet is based on birth of a woman. Women are important for
a family. Pregnant women secure her baby inside the uterus from embryo to fetus. 1 The
pregnant mother requires 1000mg calcium per day and 400 I.U vitamin D per day for
preventing bone deformity like osteoporosis, spine deformity, craniofacial skull deformity
clubfoot, hyperirritability and tetany leading to death.11
Osteoporosis is most common in post menopausal, fair completed white women. A women
loses 2 to 5% of bone tissue per year immediately before and for about 8 years after
menopause. The most rapid loss of bone occurs in the first 5 years after menopause
.
Rickets occurred in Philadelphia between 1974 and 1978 among children who
belonged to a religious sect that wore long hooded robes and ate vegetarian diets.
More recently 4 cases were reported in Newyork, all children under 24 months
who were breastfed without formula supplements and two cases in Philadelphia.
Children 14 and 15 months old breastfed without supplements by mothers who
eliminated dairy products from their own diet.
6.2 REVIEW OF LITERATURE
“Polit, Hungler stated that the Review of Literature is a systematic identification on
research problem”
Review of literature is an important source for development of research project, it helps
to gain insight into the research problem and provide information of what has been done
previously. It helps the researcher to be familiar with the existing studies, provides basis
for future investigation and helps to develop the methodology tools for data collection and
research design.19
“Good research does not exist in vacuum”.19 This chapter deals with the literature
which is reviewed and relevant to the present studies.
6.2.1 Review of literature related to the role of calcium and vitamin D.
6.2.2 Review of literature related to the effects of calcium and vitamin D deficiency
during pregnancy.
6.2.1 Review of literature related to the role of calcium and Vitamin D.
Brooke OG, Brown IR, Bone CD (March 1980) conducted a study on double-blind
trial of vitamin D supplements in pregnant women of Asia. The study to determine effects
on calcium status and fetal growth in pregnant women, administered calciferol to 59
women and placebo to 67 controls during the last trimester. Maternal serum
25-hydroxy vitamin D (25-OHD) concentrations were low in both treatment and control
groups and significantly lower in vegetarians than non-vegetarians. Mothers in the
treatment group gained weight faster in the last trimester than those in the control group,
and at term they and their infants all had adequate plasma 25-OHD concentrations,
Mothers and infants in the control group, however, had low plasma concentrations of
25-OHD and calcium and raised plasma alkaline phosphatase (bone isoenzyme) activity.
Five of these infants developed symptomatic hypocalcaemia. Almost twice as many
infants in the control group were small for gestational age (29% v 15%), but there were no
significant difference between the two groups of infants in anthropometric measurements.
Infants in the control group had larger fontanelles, suggesting impaired ossification of the
skull. The study revealed that mothers and infants in treatment group had absence of side
effect.23
National Institutes of Health, Bethesda, Maryland (Oct 1990) conducted a study on a
randomized, double-blinded controlled clinical trial of calcium supplementation (2.0 gm
of elemental calcium as calcium carbonate) and a placebo. All participants were less than
17 years of age or less and clinically healthy pregnant women. Treatment consisted of 2.8
(+/- 1.5) tablets per day in the placebo group (N = 95) and 3.0 (+/- 1.4) tablets per day in
the calcium group (N = 94). Dietary calcium intake was similar in both groups at about
1200 mg/day. The calcium group had a lower incidence of preterm delivery (less than 37
weeks; 7.4% vs 21.1%; p = 0.007); spontaneous labor and preterm delivery (6.4% vs
17.9%; p = 0.01); and low birth weight (9.6% vs 21.1%;
p = 0.03). This effect was
also present after stratified analysis by level of treatment compliance, urinary tract
infection, and chlamydial infection. The results revealed that it was an important
preventive intervention for prematurity in high-risk populations.21
Endocrinology and Metabolism Research Center, Medical Sciences, University
of Tehran, Tehran, Iran (Sep 2007) conducted a study on evidence of changes in the
markers of bone formation and bone resorption during pregnancy. The study was to
determine the association between maternal and cord blood bone markers. Five hundred
and fifty-two pregnant women were recruited from Tehran University educating hospitals
in the winter of 2002. Maternal and cord blood samples were taken at delivery. The serum
was assayed for osteocalcin and crosslaps, calcium, and parathyroid hormone. The study
significant correlation between maternal and cord blood serum osteocalcin and crosslaps
levels, and the mean cord blood levels of osteocalcin and crosslaps were significantly
higher at about 1.59- and 1.62-fold maternal levels, respectively. Serum calcium levels
strongly
correlated
with
osteocalcin
and
crosslaps
in
mothers
(r
=
0.21,
p = 0.001 and r = 0.25, p = 0.001, respectively). Skeletal calcium release may play a major
role in calcium homeostasis during pregnancy.20
Memorial University, St John's, Newfoundland, Canada (April 2009) conducted
a study on vitamin D deficiency associated with poor bone health, colorectal cancer, type 1
diabetes and multiple sclerosis. . Lifestyle changes, such as sunscreen use, spending less
time outdoors and insufficient intake of vitamin D-containing foods as well as northern
latitude, may be affecting human vitamin D status. A cross-sectional analysis of 25hydroxyvitamin D[25-(OH)D] was conducted in pregnant women, newborns (umbilical
cord blood) and children. Samples were analyzed by liquid chromatography mass
spectrometry. Published ranges for 25-(OH)D were used to determine vitamin D status.
The prevalence of 25-(OH)D deficiency for the three groups studied revealed most
concentrations in the 25-(OH)D deficiency. There were significant differences in all groups
studied between seasons, with the exception of maternal blood and female cord blood
samples. 25-(OH)D insufficiency was common in all groups for winter and summer, more
so in winter. 25-(OH)D insufficiency was common in the three groups studied. The
Newfoundland and Labrador population may be at increased risk for
vitamin D
insufficiency because of factors such as northern latitude and lifestyle issues. Further
research on the vitamin D status of this population is important, considering the potential
adverse health-related outcomes and the recommendations on supplementation being
made.22
6.2.2 REVIEW OF LITERATURE RELATED TO THE EFFECTS OF CALCIUM
AND VITAMIN D DEFICIENCY DURING PREGNANCY.
Brunvard L, Quigstand E, Urdal P, Hang E (July 1996) in Pakistan conducted a study
on calcium, vitamin D deficiency and fetal growth. The study was to evaluate the relation
between maternal serum calcium and parathyroid hormone with reduced fetal growth in
vitamin D deficient pregnant women. Thirty Pakistani women were included in the study
at delivery. Anthropometric data and blood samples were collected after the delivery. The
positive correction was found between the level of ionized calcium in maternal serum and
the crown heel length of the infant. The study indicates that vitamin D deficiency affect
fetal growth through an effect on maternal calcium homeostasis.27
University of Melbourne of Paediatrics and Murdoch children research institution (Nov
2004) had done a study among 147 antenatal mothers with calcium supplementation.
Blood pressure and glucose were checked along with LDL cholesterol the result revealed
of the number of significant association between maternal calcium supplementation blood
pressure and fasting glucose. Maternal calcium supplements support and promote health
benefit on newborn and mother.31
Alok Sachan, Renu Gupta, Vinita Das (May 2005) in Lucknow conducted a study
about prevalence of calcium and vitamin D deficiency among pregnant women and their
new borns. The sample size was 207 pregnant women and 117 newborns. Detailed history
and physical examination was used to find out the symptoms of osteomalacia, assess the
daily calcium and vitamin D intake. Maternal blood was collected for calcium, albumin,
phosphorus and cord blood sample was collected for serum 25(OH) D. The result revealed
a high prevalence of significant hypovitaminosis D among pregnant women and their
newborns.24
A Ganpule, C.S. Yajnik (2006) in Pune conducted a study about the bone mass in
Indian Children influenced by maternal nutritional status during pregnancy. Nutritional
status was measured at 18 and 28 weeks gestation in 797 pregnant in rural India women.
Measurement included anthropometry, dietary intakes, physical workload and circulating
micronutrients. Six years postnatal total body and total spine bone mineral content and
bone mineral density were measured using dual-energy X-ray absorptiometry in the
children and parents. Modifiable maternal nutritional factors may influence bone health in
offspring.25
Sabour H, Hossein- Nezhad A, Maghbooli (Oct 2006) in Tehran University of
Medical sciences, conducted a study to determine the association between newborn
outcomes and maternal calcium and vitamin D intakes. The results revealed that 64.3% of
pregnant mother were not supplemented with calcium and vitamin D, 33.8% had adequate
calcium and vitamin D. Maternal anthropometric data and energy, protein, calcium and
vitamin D intake were collected and newborn outcomes (weight, length, head
circumference and 1-min Apgar score) were determined. Mean length at birth and
1min Apgar score were higher in newborns whose mothers had adequate calcium and
vitamin D intake than in newborns whose mothers had calcium and vitamin D intake than
in newborns whose mothers had inadequate intake (p=0.03 and p= 0.4 respectively).26
S H Dijkstra, A Van Beek, J W Janssen ( Nov 2007) in Netherlands conducted a study
to determine high prevalence of vitamin D deficiency in newborn infant of mother at risk
of vitamin D deficiency because of dark skin and concealing clothing (risk group) or light
skin. The study found a significant difference in the prevalence of vitamin D deficiency
(0.25- hydroxyvitamin D3 <25 nmol/L) between newborn infant of mother at risk and
mother in the control group (63.3 % vs 15.8 %; P<0.01).28
Diana Avendano- Badilo, Mauricio Hernandez Avila (Nov 2008) in Mexico
conducted a study on dietary calcium intake during pregnancy. The study was to evaluate
the association of calcium and bone demineralization during pregnancy. At each trimester
of pregnancy a validated frequency of food intake questionnaire was administered to
assess individual daily calcium intake in a cohort of 206 pregnant women. Sample of urine
were collected to measured levels of cross- link N-telopeptide of type 1 collagen which is
a biomarker of bone resorption. High dietary calcium intake was associated with lower
bone resorption (β=-0.015; P<0.05). The result revealed calcium ingestion, specifically
from dietary product, reduces bone resorption during pregnancy.30
Jarjou LM, Laskey M A, Pretice A (Aug 2010) in Keneba conducted a study on
investigation among pregnant mother with low calcium intake. The sample was 125 in a
double-blind randomized and placebo-controlled trial in pregnant women and measured
bone mineral status of the whole body, lumbar spine and hip by using dual–energy X-ray
absoptiometry and bone mineral status of the forearm by using single photon
absoptiometry. Pregnant mother who received calcium supplement in pregnancy had
significantly lower bone mineral content, bone area and bone mineral density at the hip.
Calcium supplementation in pregnant women with calcium intake may disturb metabolic
adaptation and not benefit maternal bone health.29
Wang I,Yang F, Mao M ( Aug 2010) in China conducted a study to determine high
prevalence of calcium and vitamin D deficiency among pregnant women and their
newborns. Maternal serum and cord level of calcium, 25 hydroxyvitamin D [25(OH) D],
alkaline phosphate and parathyroid hormone were studied on 77 urban and rural motherneonates pairs at term. The mean level of calcium serum 25(OH) D was 35.95+/ -18.89
nmol/L. The intake of calcium and vitamin D was uniformly low, although it was higher
in urban ( 1010 +/- 210 mg /d, 237+/- 169)IU /d than in rural (320+/-210 mg/d, 62+/- 66
IU /d) women. Maternal serum 25 (OH) D was correlated positively with cord blo 25
(OH) D (r=0.94, P<0.01). The study revealed that high prevalence of calcium and
vitamin D insufficiency in pregnant women and neonates.16
6.3 STATEMENT OF PROBLEM
“
A study to evaluate the effectiveness of planned teaching programme on
importance of calcium and vitamin D during pregnancy among antenatal mothers in
a selected rural area at Bangalore.”
6.4 OBJECTIVES

To assess the level of knowledge regarding importance of calcium and
vitamin D among antenatal mothers.

To evaluate the effectiveness of planned teaching programme on
importance of calcium and vitamin D among antenatal mothers.

To associate the knowledge of pregnant women with the selected
demographic variables.
6.5 HYPOTHESIS
H1 - There will a significant difference between the knowledge before and
after the planned teaching programme.
H2 - There will a significant association between the knowledge and the
selected demographic variables.
6.6 OPERATIONAL DEFINITIONS
Effectiveness:
Effectiveness refers to significant gain in difference between pre test and post
test on importance of calcium and vitamin D during pregnancy among antenatal
mother.
Planned Teaching Programme:
Refers to the instruction and teaching aids developed and designed for pregnant
mothers to provide information on calcium and vitamin D.
Antenatal Mother:
The women who are pregnant for the first time (primigravid mother)
from 1 to 9th months.
st
6.7
ASSUMPTION:

Antenatal mother will have some knowledge regarding importance of
calcium and vitamin D during antenatal mother.

Antenatal mother have potential to learn about importance of calcium
and vitamin D during antenatal mother.

The knowledge of antenatal mother does have influence on the
importance of calcium and vitamin D during antenatal mother.

Planned teaching programme is an effective way to improve the
knowledge of antenatal mother on prevention of calcium and vitamin D
deficiency.
6.8
DELIMITATION

The study will be limited only to the pregnant women in the selected
rural area at Bangalore

The study is delimited only to those who can speak and write Kannada
and English.

The study is delimited only for 4 weeks.

The study is delimited only to 50 samples.
7. MATERIALS AND METHOD
7.1 Source of Data:
Antenatal mother in selected rural area in Bangalore.
7.2 Method of Data collection:
Research Method
– Quasi experimental method.
Research Design
– Pre experimental design.
Sampling Technique – Non probability convenience sample.
Sample Size
Setting of the study
– 50 pregnant women.
– Study will be conducted at selected rural area in Bangalore.
7.2.1 CRITERIA FOR SELECTION OF SAMPLE
Inclusive Criteria –
Antenatal mothers who are:

carrying a fetus from first to last trimester.

present at the time of data collection.

willing to participate in the study.

mothers who can speak Kannada and English.
EXCLUSIVE CRETERIA:
Antenatal mothers who are:

sick during data collection.

previously participated in the same health programme.

not willing to participate.

mothers unable to speak Kannada and English.
7.2.2 DATA COLLECTION TOOL:
It consist of knowledge questionnaire to assses the pretest and posttest
knowledge on pregnant women regarding importance of calcium and vitamin D
during pregnancy among antenatal mother. A planned teaching programme will be
prepared on importance of calcium and vitamin D during pregnancy among
antenatal mother. Content validity of the tool will be obtained in consultation with
guide and experts in the fields of gynaecologist, dietitian, education and
biostatistics. Reliability of the tool will be established by test retest method. The
tentative period of collection will be form April-May 2013.
7.2.3 METHOD OF DATA ANALYSIS:
Description and inferential statistics will be used for data analysis that is mean.
Standard deviation frequency, percentage distribution and paired‘t’ test to compare
that pre and post test knowledge on practice scores and chi square (x2) test to find
out association with the level of knowledge on practice and selected demographic
variables of staff nurse.
7.3. DOES THE STUDY REQUIRE ANY INTERVENTION?
Yes,
1.
Intervention as a planned teaching programme on importance of calcium and
vitamin D will be conducted for the antenatal mothers.
7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED?
Yes
1. Confidential and anonymity of the subject will be maintained.
2. Informed consent will be obtained from the subjects.
3. A written permission from institutional authority will be obtained prior to the
study
8. BIBLIOGRAPHY:
1.
Radhika. K, Kalpana. Warning Signs in Pregnancy among Primi-Gravida
Women.2005; 1- 4.
2.
www.wellsphere.com
3.
Annama Jacob. A comprehensive Textbook of Midwifery, 2 th edition: Jaypee
Brother Medical Publishers (P) Ltd., 2008; 75-78.
4.
www.medicinenet.com
5.
Parul Datta. Pediatric Nursing; 2nd edition: Jaypee Brothers Medical
Publishers (P) Ltd., 2009; Page 456-463.
6.
Brody, Tom. Nutritional Biochemistry. San Diego:Academic Press, 1998.
7.
K.Park. Textbook of Prevention and Social medicine, 20th edition: Banarsidas
Bhanot Publishers. 2008; 462-463.
8.
Chittari V Harinarayan, Tirupati Ramalakshmi, Upadrasta V Prasad. High
prevalence of low dietary calcium, high phytate consumption, and vitamin D
deficiency in healthy south Indians. Am J Clin Nutr. 2007; 85:1062–7.
9.
Bonny specker. Vitamin D requirement in pregnancy. American Journal of
Clinical Nutrition. 2004; 80(6):1740-1747.
10.
Abdel-Aleem H, Merialdi M. The effect of calcium supplementation during
pregnancy on fetal and infant growth: a nested randomized controlled trial within
WHO calcium supplementation trial. Journal Matern Fetal Neonatal Med. 2009 Feb;
22(2):94-100.
11.
Grant WB, Holick MF. Benefits and requirements of vitamin D for optimal
health. Altern Med Rev. 2005; 10(2): 94-111.
12.
Polit, Hungler. Essential of Nursing Research. 6th ed. Philadelphia: J.B.
Lippincott Company; 2001.
13.
Villar J, Repke JT. Calcium supplementation during pregnancy may reduce
preterm delivery in high-risk populations. Am J Obstet Gynecol. 1990 Oct; 163(4 Pt
1):1124-31.
14.
Newhook LA, Sloka S, Grant M, Randell E .Vitamin D insufficiency
common in newborns, children and pregnant women living in Newfoundland and
Labrador, Canada Matern Child Nutr. 2009 Apr; 5(2):186-91.
15.
Alok Sachan, Renu Gupta, Vinita Das. High prevalence of vitamin D
deficiency among pregnant women and their newborns in northern India. American
Journal of Clinical Nutrition. 2005 May; 81(5):1060-1064.
9. SIGNATURE OF THE STDUEDNT
:
10. REMARKS OF THE GUIDE
: THE TOPIC SELECTED FOR STUDY IS
RELEVANT
11.1 NAME AND DESIGNATION OF GUIDE
HEAD OF
: MRS. BEULLAH JANET PROFESSOR,
DEPARTMENT COMMUNITY HEALTH
NURSING, ADARSHA COLLEGE OF
NURSING, #1877/5, 80 FEET ROAD,
KACHARAKANAHALLI,
KALYANANAGAR, BANGALORE-43
11.2 SIGNATURE
:
11.3 HEAD OF THE DEPARTMENT
: MRS. BEULLAH JANET PROFESSOR,
HEAD OF DEPARTMENT COMMUNITY
HEALTH NURSING
ADARSHA COLLEGE OF NURSING,
#1877/5, 80 FEET ROAD,
KACHARAKANAHALLI,
KALYANANAGAR, BANGALORE-43
11.4 SIGNATURE OF HEAD OF THE DEPARTMENT :
12. REMARKS OF CHAIRMAN AND PRINCIPAL
: MRS. VASANTHAKUMARI,
PRINCIPAL/PROFESSOR, ADARSHA
COLLEGE OF NURSING, #1877/5, 80 FEET
ROAD, KACHARAKANAHALLI,
KALYANANAGAR, BANGALORE-43
The topic selected for study is relevant.