PREVALENCE OF GLYCOSURIA AMONG THE PREGNANT WOMEN ATTENDING ANTI-NATAL CARE AT DUTSE GENERAL HOSPITAL DUTSE, JIGAWA STATE

CHAPTER ONE

1.0 INTRODUCTION

Glucose is a simple sugar with the molecular formula C6H 1206. It is a monosaccharide, which means a basic building block of larger organic molecules named carbohydrate. Most carbohydrates are used to store chemical energy for later use in the body where glucose molecules are stored all over the body. Glucose is also primarily synthesized in plant via the process of photosynthesis. In the human, glucose is stored in the liver after being converted to another form called glycogen. Also, glucose can be stored in the muscle as muscle glycogen which helps for muscular activities like exercise. Glucose can still be sent to the skin or adipose tissue where they are stored as fats or fatty acids. (Baker, et. al, 2002).

Glucose is synthesized in the liver via the process of glycogenesis or received in the blood from chemical energy needed by the body via oxidation by glycolytic pathway and tricarboxylic cycle.

Blood glucose concentration depends in the variable input in the cells of the muscle, adipose tissue and other organs as well as other output. Excess amount of glucose in the body known as hypoglycemia or lower amount known as hypoglycemia cannot be tolerated; hence they are very fatal to the body. (Gowan, 1998).

Blood glucose is normally maintained within a fairly narrow range. It has been observed that blood glucose haemostasis is viewed in terms of the balance between the amounts living in it. The principle determinants are therefore; dietary intake, the rate of entry and activities as influenced by the several hormonal interaction. (Gowan, 1998).

Insulin is the most important hormone that controls the level of glucose in the blood system of the body. It also regulates the rate at which glucose is absorbed by the tissue as well as conversion of glucose to glycogen.

The renal threshold of glucose (RJG) is the blood glucose at which glucose begins to be excreted by the kidney to the urine. This usually occurs in healthy adults approximately 9-10mmol/l (162-180mg/dl).

In many adults, particularly those with long- standing diabetes, the renal threshold of glucose may increase substantially. This raised blood level may exist without glucose being detected in the urine. Conversely, some individuals mainly children and pregnant women may have very low or variable renal.

Threshold for glucose, resulting in glucose being present in the urine even with normal blood glucose value. The values used for the renal threshold of glucose are:

HIGH: 11mmol/I (198mg/dl)

LOW: 2.3mmol/1 (41mg/dl)

NORMAL: 7mmol/l (126mg/dl)

Glycosuria also known as glucosuriais the excretion of glucose in the urine. Ordinarily urine contains no glucose because the kidney is able of re-claiming all of the filtered glucose back into the blood stream by glomerular filtrate and proximal tubules respectively. Only small amount of glucose is usually excreted in the urine approximately 0.1% or less which cannot be detected by most test. Glycosuria is always caused by the elevated blood glucose level, almost commonly due to untreated diabetes mellitus. Rare glycosuria is as a result of an intrinsic problem with glucose re-absorption within the kidney themselves. A condition termed "Renal Glycosuria". Glycosuria leads to excessive loss of glucose into the urine with resultant dehydration. A process known as" Osmotic Diuresis". (Ochei, et. al, 2007).

There are many possible causes of glycosuria. One of the most common causes is diabetes mellitus which is a condition characterized by high sugar levels in the blood known as HYPERGLYCAEMIA. Individual suspected of having diabetes mellitus have their urine tested for glycosuria. Hyperglycaemia can also be manifested by other conditions like Cystinosis,

Thyroxicosis. Pregnancy has also been associated with glycosuria therefore any pregnant woman with this condition should be evaluated in order to rule out the development of gestational diabetes.

Glycosuria is always caused by elevated glucose levels due to an intrinsic problem with glucose reabsorption within the kidney themselves, a condition termed glycosuria. Glycosuria leads to excessive water loss into the urine which results to dehydration a process known as osmotic dieresis.

1.1 PREGNANCY

Pregnancy also known as gravidity or gestation is a period in which one or more offspring, embryo or foetus develops inside the woman's womb. It can occur after sexual intercourse or assisted reproductive technology. This period usually lasted for 36-40 weeks. (9-10 lunar months) from the last menstrual period (LMP). This is about 38^th weeks after conception, an embryo is the developing offspring during the 8^th weeks following conception after which the term "foetus" is used until birth. The signs and symptoms of early pregnancy may include; a missed menstrual period, tender breast, nausea, vomiting, hunger and frequent urination. Pregnancy may be confirmed using pregnancy test.

Pregnancy is typically divided into three trimesters namely: 1^st trimester (1-12 weeks of gestation including conception), 2^nd trimester (13-28 weeks of gestation). It is at this period that the movement of the foetus can be felt; and 3rd trimester (29- 40 weeks of gestation) where the3 prenatal care is improved.

This is a type of diabetes mellitus that arises during pregnancy especially during the 2^nd and 3^rd trimesters. In some women, gestational diabetes mellitus occur because the body cannot produce enough insulin to meet the extra need of pregnancy. In other women, gestational diabetes may be found due during the first trimester of pregnancy. A test called Oral Glucose Tolerance Test (OGTT) is used to diagnose gestational diabetes mellitus. At a booking appointment, pregnant women will be assessed for risk factors which can make them more likely to have gestational diabetes. This includes:

ü Obesity

ü A family history of gestational diabetes.

ü A very large infant 4.5kg/10 pounds or over having gestational diabetes.

ü Family originated from South Asia or Black Caribbean. Any pregnant woman having any of these characteristics should be offereda test for gestational diabetes. In most cases, gestational diabetes comes to light during the 2^nd trimester of pregnancy.

However, babies of women who have blood glucose problem which was not diagnosed before pregnancy has a higher risk of malformation. Diabetes UK recommendation (2003).

1.2 STATEMENT OF THE PROBLEM

Glycosuria in pregnant women has become a serious health problem in our society today especially among the pregnant women, which in most cases is related to poor hygiene, poor advise on healthy eating, lack of proper care for women during pregnancy as well as health care facilities that will care for the health status of the pregnant women.

Thus, the need of conducting this research arises with a view of strengthening the awareness health implication and to identify the solution to such problems.

1.3 GENERAL OBJECTIVES

To determine the prevalence risk factor of glycosuria among pregnant women attending ant-natel care at Dutse General Hospital.

Specific Objectives

              i.          To determine the prevalence of glycosuria among pregnant.

            ii.          To access the pre disposing factor of glycosuria.

         iii.          To determine the distribution glycosuria among pregnant women according to age.

1.4 RESEARCH QUESTION

What is prevalence of glycosuria among pregnant.

What is predisposing factor of glycosuria

What is the distribution of glycosuria among pregnancy according to age.

1.5 SIGNIFICANCE OF THE STUDY

At the end of this research work will be important to the entire population especially the pregnant women in the area of study as well as others in various places and countries. It will equally be useful to both government and non- government organisations, private sector and research institutions during further research. However, the need to conduct this research arose in order to enlighten or create awareness about glycosuria among pregnant women, its cause and risk towards their health and that of their baby. It will also serve as a reference material.

1.6 SCOPE OF THE STUDY

The scope of this study is limited only to the incidence of glycosuria among the pregnant women attending ante-natal clinic at Dutse General Hospital, Dutse Local Government Area, Jigawa State.

1.7 DEFINITION OF TERMS

DIABETES: A condition in which the amount of glucose level in the Blood increases.

PREGNANCY: A period during which a woman carries a developing Foetus normally in the uterus.

INCIDENCE: The rate at which something occurs.

DIURESIS: Excretion of more urine.

GLUCOSE: A sugar which comes from the digestion of starchy food, such as bread, rice, yam.

HYPERGLYCEAMIA: High amount of blood glucose, above 10mmol/lor (180mg/dl).

HYPOGLYCEAMIA: Low amount of blood glucose, about 2.2mmol/1 or (40mg/dl).

RENAL THRESHOLD: The maximum blood glucose level in the blood at which the kidney begins to excrete it into the urine.