chapter.5 5. discussion and limitationsshodhganga.inflibnet.ac.in/bitstream/10603/62462/8/chapter...

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CHAPTER.5

5. DISCUSSION AND LIMITATIONS

This study was carried out to assess the effectiveness of yoga on clinical

parameters of Gestational Diabetes Mellitus among mothers with Gestational

Diabetes Mellitus at Government hospital, Tambaram, Chennai. This research study

sswas conducted in the Antenatal Outpatient Department, Government hospital,

Tambaram, Chennai. The sample size of this study was 220 with attrition 212

Antenatal mothers with Gestational Diabetes Mellitus, in Study group (n=108) and in

control group (n=104) of the samples were participated in the study.The investigator

had collected required data about demographic and Obstetrical variables which

includes past and present obstetrical variables from all the selected mothers with

Gestational Diabetes Mellitus of study and control group by personal interview.

Investigator had prepared a booklet on yoga for Gestational Diabetes Mellitus. It

consists of two parts. First part deals with details about Gestational Diabetes Mellitus

and its management, Second part deals with demonstration of Yoga therapy. Study

group received both part 1 and part 2 including hospital routine treatments whereas

control group received only hospital routine treatment. For both the groups the

clinical parameters (Fasting blood glucose, Urine sugar and Postprandial blood

glucose and urine sugar and mean weight gain), Maternal, fetal and neonatal outcome

were assessed. The level of satisfaction on yoga was assessed for study group. The

results of the study were discussed in terms of objectives here.

The conceptual framework of this was study based on weidenbach’s

helping art of Clinical nursing theory (1964). This model describes a desired situation

and way to attain it. In this study the first component was identifying the need for

help. This Step involves determining the need for help. Based on this the investigator

selected the Antenatal Mother with Gestational Diabetes Mellitus for the study based

on the Inclusion, exclusion criteria. Matching of the samples was done based on the

level of Gestational diabetes Mellitus. Non probability purposive Sampling technique

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was used and control group assessment was completed prior to the study group. The

demographic and Obstetrical information of mothers those who were participated for

the study was assessed under this component for both the study and control group and

the results were depicted.

The Demographic variables results are interpreted as follows,

Among the study group majority 67(64.4%) of the mothers belong to

the age of 20-25 Yrs,79(76%) were hindus,53(51%) were in the nuclear

family,32(30.8%) had middle school certificate,69(66.3%) were sedentary

workers,48(46.2%) had Rs 4810-8009 as their Income and 80(76.9%) of them had

Non consanguineous Marriage.

Regarding control group majority 65(60.2%) of the mother belongs to

the age of 20-25 Yrs, 89(82.4%) were hindus,58(53.7%) were in the nuclear

family,36(33.3%) had middle school certificate l,60(55.6%) were sedentary

workers,54 (50%) had between Rs 1601 to Rs 4809 as their income and 89(82.4%) of

them had non consanguineous Marriage.

The Obstetrical information results were as follows

Regarding past obstetrical variables like diagnosis of GDM at

previous pregnancy in gestational weeks, treatment of gestational diabetes at previous

pregnancy, previous history of type of delivery, weight of the previous child, effect of

diabetes in previous pregnancy, previous history of children with congenital

abnormalities of study group and control group was not applicable to the majority of

the antenatal mothers because 59(56.7%)in study group,72(66.7%) in control group

were primi mothers and 44(42.3%) in study group,33(30.6%) in control group were

not having a previous history of Gestational Diabetes Mellitus. Regarding family

history of diabetes 84(80.8%) in study group and 84(77.8%) in control group had no

family history of diabetes.

Pertaining with present obstetrical information in study group

majority 52(50%) of their height was 140-150cm,59(56.7%) were in the category of

gravida1, 61(58.7%) were in the category of parity1,99(95.2%)of them had no

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abortion, 100(104%) none of them had still birth and death of their child,61(58.7%)

of them had no children and 78(75%) of them received Tab.calcium,Tab.FST and

Inj.Insulin.

Regarding present obstetrical information in control group majority

70(64.8%) of their height was 140-150cm,72(66.7%) were in the category of

gravida1, 75(69.4%) were in the category of parity1,106(98.1%)of them had no

abortion, 107(99.1%) had no still birth and 100(104%) none of them had death of

their child,77(71.3%) of them had no children and 79(73.1%) of them received Tab.

Calcium, Tab. FST and Inj. Insulin.

The demographic and Obstetrical information of mothers those who were

participated for the following study on “Assess the effectiveness of yoga on clinical

parameters of Gestational Diabetes Mellitus among Mothers with Gestational

diabetes Mellitus at Government hospital, Tambaram, Chennai were not having

statistically significant difference between study and control group. It was calculated

using chi square test.

The first objective of the study was to assess and compare the pretest level of

clinical parameters of Gestational Diabetes Mellitus (GDM) between study

group and control group

The data provided in 4.2.1 and 4.2.2 shows the pretest means core and

pretest level of clinical parameters of Gestational Diabetes Mellitus in study group

and control group. There was no significant difference found in the pretest mean

score and pretest level of clinical parameters of Gestational Diabetes Mellitus

between study group and control group. Statistical significance was calculated using

Student independent t-test.

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Findings related to comparison of pretest mean score of clinical parameters of

GDM between study group and control group

In pretest mean score,

Statistically no significant difference was found in the mean and standard

deviation of Fasting blood glucose among mothers with Gestational Diabetes

Mellitus between study group and control group.( t = 0.29 and P =0.77)


deviation of Postprandial blood glucose among mothers with Gestational Diabetes

Mellitus between study group and control group. (t = 0.67 and

P =0.50)


deviation of Fasting urine sugar among mothers with Gestational Diabetes Mellitus

between study group and control group.( t =0.00 and P =1.00)


deviation of Postprandial urine sugar among mothers with Gestational Diabetes

Mellitus between study group and control group. (t =0.00 and P =1.00)


deviation of weight gain among mothers with Gestational Diabetes Mellitus between

study group and control group.( t =0.67 and P =0.50)

Findings related to comparison of pretest level of clinical parameters of GDM

between study group and control group

The P value for fasting, postprandial blood glucose level, urine sugar

level and for weight gain were 1.00.. The Chi-square test value shows that the

difference between study group and control group not statistically significant.

Statistical significance was calculated using chi square test.

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The first hypothesis of the study was that there is a significant difference in the

pretest level of clinical parameters among mothers with Gestational Diabetes

Mellitus between study group and control group.

The data provided in 4.2.1 and 4.2.2 shows that there was no

significant difference found in the pretest mean score and pretest level of clinical

parameters of Gestational Diabetes Mellitus between study group and control group.

Hence the hypothesis stated that there is a significant difference in the pretest

level of clinical parameters among mothers with Gestational Diabetes Mellitus

between study group and control group was not accepted.

As mentioned by the investigator in the first phase of conceptual

frame work [Identifying need for help] the investigator done the Pre assessment

level of clinical parameters (Fasting and Post Prandial Blood sugar, Urine Sugar, and

weight gain) of Gestational Diabetes Mellitus for both the study and control group..

The second objective of the study was to assess and compare the posttest level of

clinical parameters of Gestational Diabetes Mellitus between study group and

control group

The data provided in table 4.3.1 to 4.3.4 shows the posttest mean

score and posttest level of clinical parameters of Gestational Diabetes Mellitus in

study group and control group. Statistically significant reduction in the Fasting blood

glucose, urine sugar and postprandial blood glucose, Urine sugar and appropriate

weight gain was found in the posttest mean score and post test level of clinical

parameters of Gestational Diabetes Mellitus between study group and control group.

These tables reveal the effectiveness of yoga on clinical parameters of Gestational

Diabetes Mellitus. The findings were summarized as follows,

Findings related to comparison of posttest mean score of clinical parameters of

Gestational Diabetes Mellitus between study group and control group

Significant reduction was found in the fasting, postprandial blood glucose

and urine sugar and mean weight gain was found among antenatal mothers with

Gestational Diabetes Mellitus in the Study group at the level of p�0.001.Statistical

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significance was calculated using student independent t- test. The clinical parameters

were fasting blood glucose, urine sugar and postprandial blood glucose, urine sugar

and all those parameters were divided under four levels for matching as normal

tolerance, mild, moderate and severe. Weight gain was categorized as normal weight

gain and abnormal weight gain

In posttest mean score,

Statistically significant reduction was found in the mean and standard

deviation of Fasting blood glucose at 28th week.( Post test 1; t = 6.23 and P =0.001),

32nd week.( Post test 2; t =5.40 and P =0.001), 36th week.( Post test 3; t =9.88 and P

=0.001) among mothers with Gestational Diabetes Mellitus between study group and

control group.


deviation of postprandial blood glucose at 28th week.( Post test 1; t = 4.10 and P

=0.001), 32nd week.( Post test 2; t =5.96 and P =0.001), 36th week.( Post test 3; t

=6.64 and P =0.001) among mothers with Gestational Diabetes Mellitus between

study group and control group


deviation of Fasting urine sugar at 28th week.( Post test 1; t = 0.64 and P =0.52) but

from 32nd week onwards it was significant,( Post test 2; t =4.49 and P =0.001), 36th

week.( Post test 3; t =5.95 and P =0.001) among mothers with Gestational Diabetes

Mellitus between study group and control group


deviation of postprandial urine sugar at 28th week.( Post test 1; t = 2.96 and P

=0.001), 32nd week.( Post test 2; t =4.52 and P =0.001), 36th week(Post test 3; t =

4.75 and P =0.001) among mothers with Gestational Diabetes Mellitus between study

group and control group

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Statistically no significant improvement was found in the mean and

standard deviation of weight gain at 28th week.( Post test 1; t = 0.68 and P =0.48) But

from 32nd week onwards it was significant ( Post test 2; t = 2.17 and P =0.03) till 36th

week ( Post test 3; t =3.24 and P =0.001) among mothers with Gestational Diabetes

Mellitus between study group and control group

Findings related to Comparison of Posttest level of clinical parameters of

Gestational Diabetes Mellitus between study group and control group

In posttest level of clinical parameters of Gestational Diabetes Mellitus

statistically significant improvement was found in the study group at the level of

p�0.001.Statistical significance was calculated using chi-square test.

Regarding fasting and postprandial blood glucose level after Yoga the

Normal tolerance group were gradually increased and it was depicted as 42(40.4%)

of them at 28th week, 44(42.3%-fasting),43(41.3%-postprandial) of them at 32nd week

and 65(62.5%.) of them at 36th week. In control group normal tolerance group were

16 (14.8%-fasting),12 (11.1%-postprandial) of them at 28th week and 12(,32(29.6%)

of them at 32nd week and 33(30.6%) of them at 36th week. So this depicts in study

group majority of the antenatal mothers Fasting and Postprandial Blood glucose level

was reduced than the Control group which was Statistically Significant at P

Value<0.001.

Regarding fasting urine sugar after yoga the Normal tolerance group were

gradually increased and it was 43(41.3%) of them at 28th week, 44(42.3%) of them at

32nd week and 65(62.5%.) of them at 36th week. In control group Normal tolerance

group were16(14.8%) of them at 28th week, 32(29.6%) of them at 32nd week and

33(30.6%.) of them at 36th week. Pertaining to postprandial urine sugar Normal

tolerance group were gradually increased to 37(35.6%) of them at 28th week,

42(40.4%) of them at 32nd week and 61(58.7%) of them at 36th week but in control

group Normal tolerance group were 15(13.9%) at 28th week, 31(28.7%) at 32nd week

and 32(29.6%.) at 36th week So this depicts in study group majority of the antenatal

mothers Fasting and Postprandial urine sugar level was reduced than the Control

Group which was statistically significant at P Value<0.05 and P Value<0.001.

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In accordance with weight gain in study group at 28th week 77 (74%),at

32nd week 83(79.8%) and at 36th week 94(90.4%) had a Normal weight gain Where

as in control group 28th week 27(25%),at 32nd week 42(38.9%) and at 36th week

45(41.7%) of them only had normal weight gain and is statistically significant at P

Value<0.003 at 28th week and 0.001 in rest of the weeks.

Findings related to Comparison of overall pre and Posttest mean score of

clinical parameters of Gestational Diabetes Mellitus between study group and

control group

The data provided in table 4.3.5 shows the comparison of overall pre and

posttest mean score of clinical parameters of GDM between study group and control

group. In pretest at 24th week statistically no significant difference was found

between mean and standard deviation of clinical parameters Gestational Diabetes

Mellitus in study group and control group ( t=0.29 p=0.76 ).Statistically positive

improvement was found between study group and control group in the post test done

at 28th week (t=3.41 p=0.001***), 32nd week (t=4.82 p=0.001***,) and 36th week

(t=6.34 p=0.001***).This results strongly reports that yoga has shown statistically

significant reduction in the clinical parameters of Gestational Diabetes Mellitus at

p�0.001.

Findings related to Comparison of overall pre and Posttest level of clinical

parameters of Gestational Diabetes Mellitus between study group and control

group

The findings of the table 4.3.6 shows that comparison of overall pre and

posttest level of clinical parameters of Gestational Diabetes Mellitus between study

group and control group. In week 24 there was no statistical difference was found

between study group and control group. But from 28th week onwards the Normal

tolerance level was gradually increased from 34.6%, 32nd week 40.4% and at 36th

week 58.7% where as in Control group in week 28 the Normal tolerance level was

12%,week 32 it was 23% and week 36 it was 26%.The level of difference was large

between study and control group and it was statistically significant at P Value 0.002

at 28th week,��0.001 at 32nd week,36th week. This results strongly reports that yoga

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has shown statistically significant reduction in the clinical parameters of Gestational

Diabetes Mellitus at p�0.001

The second hypothesis stated that there is a significant difference in the post test

level of clinical parameters among mothers with Gestational Diabetes Mellitus


The data provided in 4.3.1 and 4.3.4 shows that there was significant

difference found in the posttest mean score and posttest level of clinical parameters

of Gestational Diabetes Mellitus between study group and control group. Hence the

hypothesis stated that there is a significant difference in the post test level of

clinical parameters among mothers with Gestational Diabetes Mellitus between

study group and control group was accepted at p�0.001

The study findings were consistent with the following studies. Singh S,

Malhotra V, Singh KP, Madhu SV, Tandon OP conducted a study on role of yoga

in modifying certain cardiovascular functions in type 2 diabetic patients. The

objective of the study was to assess the effect of forty days of Yogic exercises on

cardiac functions in Type 2 Diabetics.To study the effect of forty days of

Yogicexercises on blood glucose level, glycosylated hemoglobin the study done in

twenty-four Type 2 DM cases provides metabolic and clinical evidence of

improvement in glycaemic control and autonomicfunctions. These middle-aged

subjects were type II diabetics’ on antihyperglycaemic and dietary regimen. Their

baseline fasting and postprandialblood glucose and glycosylated Hb were monitored

along with autonomic function studies. The expert gave these patients training in

yoga asanas and they pursued those 30-40 min/day for 40 days under guidance. These

asanas consisted of 13 wellknown postures, done in a sequence. After 40 days of

yoga asanas regimen, theparameters were repeated.The results indicate that there was

significant decrease in fasting blood glucose levels from basal 190.08 +/- 18.54 in

mg/dl to 141.5 +/- 16.3 in mg/dl after yoga regimen. The post prandial blood glucose

levels decreased from 276.54 +/- 20.62 in mg/dl to 201.75 +/- 21.24 in mg/dl,

glycosylated hemoglobin showed a decrease from 9.03 +/- 0.29% to 7.83 +/- 0.53%

after yoga regimen. The pulse rate, systolic and diastolic blood pressure decreased

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significantly (from 86.45 +/- 2.0 to 77.65 +/- 2.5 pulse/min, from 142.0 +/- 3.9 to

126.0 +/- 3.2 mm of Hg and from 86.7 +/- 2.5 mm of Hg to 75.5 +/- 2.1 mm of Hg

after yoga regimen respectively). Corrected QT interval (QTc) decreased from 0.42

+/- 0.0 to 0.40+/- 0.0.These findings suggest that better glycemic control and stable

autonomic functions can be obtained in Type 2 DM cases with yoga asanas and

pranayama.[144]

According to the conceptual frame work after assessing the pretest level

of clinical parameters of Gestational diabetes Mellitus, the second phase

[Ministering the need for help] where teaching about Yogic position (Sukshma

Vyayamas )& demonstration of steps for study group by the Investigator who is a

Certified yoga teacher ( 5 groups -each group 22 in number ) for 6 days continuously

(30-40 mints/ day) with the routine hospital treatment was provided to the study

group Whereas the Control group received only hospital routine treatment.

The third component was validating that the need for help. It is

accomplished by Means of Post assessment level of clinical parameters (Fasting and

Post Prandial Blood sugar, Urine Sugar, and weight gain) was assessed for both the

groups. The data that revealed that significant difference found in the posttest mean

score and posttest level of clinical parameters of Gestational Diabetes Mellitus


The third objective of the study was to determine the effectiveness of yoga on

clinical parameters of Gestational Diabetes Mellitus in study group

The data provided in table 4.4.1,4.4.2, 4.4.3 shows the pre and posttest

means core and pre and posttest level of clinical parameters of Gestational Diabetes

Mellitus in study group statistically significant reduction in the Fasting blood

glucose, Urine sugar and Postprandial blood glucose, Urine sugar and appropriate

weight gain was found in the posttest mean score and posttest level of clinical

parameters of Gestational Diabetes Mellitus in study group. These tables revealed the

effectiveness of yoga on clinical parameters of Gestational Diabetes Mellitus.

Statistically significance difference was found between pre and posttest level of

clinical parameters of Gestational Diabetes Mellitus in study group at p �0.001.

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The findings were summarized as follows,

Findings related to comparison of pretest and posttest mean score of clinical

parameters of Gestational Diabetes Mellitus among study group

Among study group in week 24 before YogaFasting blood glucose mean

score was 122.99, After 12 weeks of intensive practice of Yoga at 36th week it was

90.27 mg/dl (F=25.70,p=0.001***).Post prandial mean score before yoga at 24th

week 160.45 mg/dl, after yoga at 36th week117.13 mg/dl. (F=34.97,p=0.001***)

.Fasting urine sugar mean score at 24th week before yoga 1.50 after yoga at 36th week

0.49. (F=22.88,p=0.001***).Post Prandial Urine sugar mean score at 24th week

before yoga 1.50 after yoga at 36th week0.52. (F=24.39,p=0.001***) .Weight gain

mean score at 24th week before yoga 58.97Kg after yoga at 36th week 66.82Kg.

(F=19.74,p=0.001***)

So this reduction in all the Clinical parameters was statistically

significant. It was assessed using Repeated measures analysis of variance F-test .

Between weeks like 24th week and 28th week differences was calculated using

bonferroni t-test.

Findings related to comparison of pretest and posttest level of clinical

parameters (Blood glucose and urine sugar) of Gestational Diabetes Mellitus

among study group

Table 4.4.2 shows the Comparison of pretest and posttest level of Clinical

Parameters of GDM among study group. Before Yoga at 24th Week 25% of them

were in Normal tolerance. After Yoga the Mild, Moderate and Severe Level of GDM

Mothers Clinical parameters were reduced markedly to the level of Normal tolerance

at 36th week. 62.5% of them fasting, postprandial blood glucose and fasting urine

sugar and 58.7% of them postprandial urine sugar were normal tolerance level in

Study group at 36th week and it was statistically significant at P Value � 0.001.

Findings related to comparison of pretest and posttest level of clinical

parameters (mean weight gain) of Gestational Diabetes Mellitus among study

group

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Regarding weight gain 100% of the mothers were belong to the category

of normal weight at 24th week but after Yoga their weight gain was normal

throughout the antenatal period and at 36th week 90.4% of them were Gained weight

normally and it was statistically significant at P Value�0.001.

The third hypothesis stated that there is a significant difference between pre and

posttest level of clinical parameters among mothers with Gestational Diabetes

Mellitus in study group and in control group


difference found between pre and posttest mean score and pre and posttest level of

clinical parameters of Gestational Diabetes Mellitus among study group and control

group. Hence the hypothesis stated that there is a significant difference between

pre and posttest level of clinical parameters among mothers with Gestational

Diabetes Mellitus in study group was accepted at p� 0.001

The study findings were consistent with the following studies Malhotra

V, Singh S, Tandon OP, Sharma SB conducted a study on the beneficial effect of

yoga in diabetes.Twenty NIDDM subjects (mild to moderate diabetics) in the age

group of 30-60 years were selected from the out patient clinic of G.T.B. hospital.

They were on a 40 days yoga asana regime under the supervision of a yoga expert. 13

specific Yoga asanas < or = done by Type 2 Diabetes Patients included. Surya

Namaskar, Trikonasana, Tadasana, Sukhasana, Padmasana, Bhastrika Pranayama,

Pashimottanasana, Ardhmatsyendrasana, Pawanmuktasana, Bhujangasana,

Vajrasana, Dhanurasana and Shavasana are beneficial for diabetes mellitus. Serum

insulin, plasma fasting and one hour postprandial blood glucose levels and

anthropometric parameters were measured before and after yoga asanas. The results

indicate that there was significant decrease in fasting glucose levels from basal 208.3

+/- 20.0 to 171.7 +/- 19.5 mg/dl and one hour postprandial blood glucose levels

decreased from 295.3 +/- 22.0 to 269.7 +/- 19.9 mg/dl. The exact mechanism as to

how these postures and controlled breathing interact with somatoendocrine

mechanism affecting insulin kinetics was worked out. A significant decrease in waist-

hip ratio and changes in insulin levels were also observed, suggesting a positive

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effect of yoga asanas on glucose utilisation and fat redistribution in NIDDM. Yoga

asanas may be used as an adjunct with diet and drugs in the management of Type 2

diabetes.[143]

Rakhshani, A.Nagarathna, R., Mhaskar, R., Mhaskar, A., Thomas,

A., Gunasheela, S.conducted a randomized controlled trial on the effects of yoga in

prevention of pregnancy complications in high-risk pregnancies.This randomized

controlled trial investigated the effects of yoga in prevention of pregnancy

complications in high-risk pregnancies for the first time.68 high-risk pregnant women

were recruited from two maternity hospitals in Bengaluru, India and were

randomized into yoga and control groups. The yoga group (n = 30) received standard

care plus one-hour yoga sessions, three times a week, from the 12th to the 28th week

of gestation. The control group (n = 38) received standard care plus conventional

antenatal exercises (walking) during the same period. The results were Significantly

fewer pregnancy induced hypertension (PIH), preeclampsia, gestational diabetes

(GDM) and intrauterine growth restriction (IUGR) cases were observed in the yoga

group (p = 0.018, 0.042, 0.049, 0.05 respectively). Significantly fewer Small for

Gestational Age (SGA) babies and newborns with low APGAR scores (p = 0.006)

were born in the yoga group (p = 0.033). This first randomized study of yoga in high-

risk pregnancy has shown that yoga can potentially be an effective therapy in

reducing hypertensive related complications of pregnancy and improving fetal

outcomes.[146]

According to the conceptual framework the third component was

validating that the need for help. It is accomplished by Means of Post assessment

level of clinical parameters(Fasting and Post Prandial Blood sugar, Urine Sugar, and

weight gain) was assessed. It was evident from the conceptual framework that the

posttest value of study group had showed marked reduction in the clinical parameters

of Gestational Diabetes Mellitus, favourable maternal, fetal and neonatal outcome

was found than the control group.

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Findings related to comparison of pretest and posttest mean score of clinical

parameters of Gestational Diabetes Mellitus among control group

The data provided in table 4.4.4 and 4.4.5 shows the pre and posttest

means core and pre and posttest level of clinical parameters of Gestational Diabetes

Mellitus among control group. Statistically significant reduction in the Fasting blood

glucose, Postprandial blood glucose and appropriate weight gain was found in the

posttest mean score and post test level of clinical parameters of Gestational Diabetes

Mellitus in control group at p�0.001,p�0.05 where as in fasting and postprandial

urine sugar no statistically significant reduction was found . It was assessed using

Repeated measures analysis of variance F-test.

Among control group in week 24 before Yoga the Fasting blood glucose

mean score was 123.88, After 12 weeks of Intensive practice of Yoga at 36th week it

was 113.40 mg/dl (F=7.73,p=0.001***) .Post prandial blood glucose mean score

before yoga at 24th week 157.14 mg/dl, after yoga at 36th week 146.16 mg/dl.

(F=2.89,p=0.04*) Fasting Urine sugar mean score at 24th week before yoga 1.50

after yoga at 36th week (F=1.78,p=0.15). Post Prandial Urine sugar mean score at

24th week before yoga 1.50 after yoga at 36th week0.85(F=1.80,p= 0.14) .Weight gain

mean score at 24th week before yoga 59.97 Kg after yoga at 36th week 70.30 Kg.

(F=69.19, p=0.001***).

The third hypothesis was that there is a significant difference between pre and

posttest level of clinical parameters among mothers with Gestational Diabetes

Mellitus in study group and in control group


difference found between pre and posttest mean score and pre and posttest level of

clinical parameters such as fasting blood glucose, postprandial blood glucose and

weight gain of Gestational Diabetes Mellitus among control group. Hence the

hypothesis stated that there is a significant difference between pre and posttest

level of clinical parameters such as fasting blood glucose, postprandial blood

glucose and weight gain among mothers with Gestational Diabetes Mellitus in

control group was accepted at p�0.001 level where as for fasting and postprandial

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urine sugar there was no significant difference found between pre and posttest mean

score and pre and posttest level of clinical parameters of Gestational Diabetes

Mellitus among control group. Hence the hypothesis stated that there is a

significant difference between pre and posttest level of clinical parameters such

as fasting and postprandial urine sugar among mothers with Gestational

Diabetes Mellitus in control group was not accepted.

Findings related to comparison of percentage of reduction in clinical parameters

of Gestational Diabetes Mellitus between study and control group

Table 4.4.8 shows percentage of reduction in clinical parameters of

Gestational Diabetes Mellitus between study and control group. Differences between

study group and control group score was analyzed using proportion with 95%

Confidence interval and mean difference with 95% Confidence interval. The results

conclude the mean difference with 95% CI was greater extent in study group than the

Control group in all the clinical parameters of Gestational Diabetes Mellitus.

Table 4.4.9 depicts the effectiveness of yoga on clinical parameters of

Gestational Diabetes Mellitus among Mothers with Gestational diabetes Mellitus. In

Study group the Percentage of benefit was more than the control group.

Fasting blood glucose =23.65%

Postprandial blood glucose=20%

Fasting urine sugar=47.65%

Postprandial urine sugar=34.70%

Weight gain=5.60%

This result strongly reports that the there was a significant difference in

the pre and posttest level of clinical parameters of Gestational diabetes Mellitus

between study group and control group.

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The fourth objective was to associate the mean difference score of clinical

parameters of Gestational Diabetes Mellitus with their demographic and

Obstetrical variables in Study group and in Control group

Findings related to association of mean difference score of clinical parameters

(Fasting blood glucose level) of Gestational Diabetes Mellitus with their

demographic variables and obstetrical variables in study group

Regarding demographic variables mothers between the age group of 26 to

30 years(F=17.33,p=0.001***),extended family( F=13.26,p=0.001***)and mothers

who were graduate and postgraduate(F=15.74,p=0.001***) found to have significant

reduction in Fasting blood glucose level of Gestational Diabetes Mellitus

Regarding the past obstetrical variables mothers who had normal vaginal

delivery (F=11.47,p=0.001***), mothers whose birth weight of the previous child

was 3.6 to 4 kg.(F=9.57,p=0.001***) and mothers with the family history of diabetes

(t=5.48,p=0.001***), were found to have significant reduction in Fasting blood

glucose level of Gestational Diabetes Mellitus.

In accordance with present obstetrical variables mothers belongs to the

category of Gravida 3(F=7.08,p=0.001***),parity 3(F=6.02,p=0.001***),No of

Children 2.(F=5.93,p=0.001***)and Medication taken during pregnancy -Tab

Calcium ,Tab FST & Inj Insulin (F=7.94,p=0.001***) were found to have significant

reduction in Fasting blood glucose level of Gestational Diabetes Mellitus.

In Multiple regression analysis there was no influence was found on

Fasting blood glucose level with demographic and Obstetrical variables.


(postprandial blood glucose level) of Gestational Diabetes Mellitus with their




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reduction in postprandial blood glucose level of Gestational Diabetes Mellitus.

Regarding the past obstetrical variables mothers who had Normal vaginal


was 3.6 to 4 kg(F=8.03,p=0.001***) and mothers with the family history of

diabetes(t=8.18,p=0.001***),were found to have significant reduction in postprandial

blood glucose level of Gestational Diabetes Mellitus.


category of Gravida 2 (F=11.25,p=0.001***),parity 2(F=6.02,p=0.001***),No of


Calcium ,Tab FST & Inj Insulin .(F=6.41,p=0.001***) were found to have significant

reduction in postprandial blood glucose level of Gestational Diabetes Mellitus.


postprandial blood glucose level with demographic and Obstetrical variables.


(Fasting urine sugar level) of Gestational Diabetes Mellitus with their



30 years(F=29.52,p=0.001***),extended family( F=34.10,p=0.001***).and mothers


reduction in Fasting urine sugar level of Gestational Diabetes Mellitus

Regarding the past obstetrical variables mothers who had Normal vaginal


was 3.6 to 4 kg.(F=14.61,p=0.001***)and mothers with the family history of diabetes

(t=6.28,p=0.001***),were found to have significant reduction in Fasting urine sugar

level of Gestational Diabetes Mellitus.

In accordance with present obstetrical variables mothers belong to the

category of Gravida 2 (F=13.11,p=0.001***),parity 2(F=10.48,p=0.001***),No of

216


Calcium ,Tab FST & Inj Insulin .(F=10.14,p=0.001***) were found to have

significant reduction in Fasting urine sugar level of Gestational Diabetes Mellitus.


Fasting urine sugar level with demographic and Obstetrical variables.


(postprandial urine sugar level) of Gestational Diabetes Mellitus with their





reduction in postprandial urine sugar level of Gestational Diabetes Mellitus

Regarding the past obstetrical variables mother who had Normal vaginal

delivery (F=21.53,p=0.001***)and mothers with the family history of diabetes

(t=6.60,p=0.001***) were found to have significant reduction in postprandial urine

sugar level of Gestational Diabetes Mellitus.


category of Gravida 2 (F=13.96,p=0.001***),parity 2(F=11.09,p=0.001***) and

Medication taken during pregnancy -Tab Calcium ,Tab FST & Inj Insulin

.(F=3.61,p=0.001***) were found to have significant reduction in postprandial urine

sugar level of Gestational Diabetes Mellitus.


postprandial urine sugar level with demographic and Obstetrical variables.


(weight gain) of Gestational Diabetes Mellitus with their demographic variables

and obstetrical variables in study group

Regarding demographic variables Mothers belong to the category of

extended family( F=13.82,p=0.001***) and mothers who were graduate and

217

postgraduate (F=10.95, p=0.001***) found to have significant improvement in

weight gain of mothers with Gestational Diabetes Mellitus

Regarding the past and present obstetrical variables, there were no

significant improvement and no association was found for the mothers with

Gestational Diabetes Mellitus.


weight gain with demographic and Obstetrical variables.

Findings related to association of mean difference score of total clinical


obstetrical variables in study group

Regarding demographic variables mother between the age group of 26 to

30 years(F=28.46,p=0.001***),extended family( F=3.01,p=0.05*)and mothers who

were graduate and postgraduate(F=9.02,p=0.001***) found to have significant

reduction in the total level of clinical parameters of Gestational Diabetes Mellitus

Regarding the past obstetrical variables mothers with the family history

of diabetes (t=2.49,p=0.01**),were found to have significant reduction in the total

level of clinical parameters of Gestational Diabetes Mellitus.


category of Gravida 2 (F=11.66,p=0.001***),parity 2(F= 9.27,p=0.001***),No of

Children 2(F=12.93,p=0.001***), and Medication taken during pregnancy -Tab

Calcium ,Tab FST & Inj Insulin (F=4.71,p=0.001***) were found to have significant

reduction in the total level of clinical parameters of Gestational Diabetes Mellitus.

In Multiple regression analysis there was no influence was found on the

total level of clinical parameters with demographic and Obstetrical variables.

218

Findings related to association of mean difference score of total clinical


obstetrical variables in control group


30 years(F=20.61,p=0.001***),extended family( F=5.85,p=0.01*).and mothers who

were graduate and postgraduate(F=14.84,p=0.001***) found to have significant

reduction in the total level of clinical parameters of Gestational Diabetes Mellitus

Regarding the past and present obstetrical variables there were no

significant reduction was found in the total level of clinical parameters of Gestational

Diabetes Mellitus.

In Multiple regression analysis there was no influence was found on the

total level of clinical parameters with demographic and Obstetrical variables.

The fourth hypothesis stated that there is a significant association in the mean

difference score of clinical parameters among mothers with Gestational Diabetes

Mellitus with their demographic and obstetrical variables in study group and in

control group.

Table 4.6.1 to 4.6.21 shows that in study group, Demographic variables

such as age (26-30yrs), type of family (extended family) and educational status

(graduate and postgraduate) and Obstetrical variables such as family history of

diabetes Gravida 3&2, parity 3&2, No of Children 2 and Medication taken during

pregnancy (Tab Calcium, Tab FST & Inj Insulin) were associated with the total level

of clinical parameters. Hence the hypothesis stated that there is a significant

association in the mean difference score of clinical parameters of Gestational

Diabetes Mellitus with their demographic and Obstetrical variables like age,

type of family, educational status, family history of diabetes, gravida, parity, no

of children and medication taken during pregnancy in study group were

accepted at p�0.001 where as other variables were not associated. Hence the

hypothesis stated that there is a significant association in the mean difference

219

score of clinical parameters of Gestational Diabetes Mellitus with other

demographic and Obstetrical variables were not accepted.

Table 4.6.22 to 4.6.29 shows that in control group, Demographic

variables such as age (26-30yrs), type of family (extended family) and educational

status (graduate and postgraduate) and present obstetrical variables such as parity 4,

and Medication taken during pregnancy (Tab Calcium, Tab FST & Inj Insulin) were

associated with the total level of clinical parameters. Hence the hypothesis stated

that there is a significant association in the mean difference score of clinical


Obstetrical variables like age, type of family, educational status , parity and

medication taken during pregnancy in control group were accepted at p�0.001

where as other variables were not associated. Hence the hypothesis stated that

there is a significant association in the mean difference score of clinical

parameters of Gestational Diabetes Mellitus with other demographic and

Obstetrical variables were not accepted.

The fifth objective was to assess and compare the maternal, fetal and neonatal

outcome of mothers with Gestational Diabetes Mellitus between study group

and control group

Findings related to comparison of maternal, fetal and neonatal outcome of

mother with Gestational Diabetes Mellitus between Study and control group

Table 4.5.1 depicts the comparison of maternal outcome of mother with

Gestational Diabetes Mellitus between study and control group. Regarding the weeks

of gestation at delivery in study group 47(45.2%) of the mothers were delivered

between 37 weeks to 39 weeks where as in control group 67(62%) of them were

delivered less than 37 weeks of gestation. Regarding mode of delivery 37 (35.6%) in

study group,83 (76.9%)in control group had undergone for LSCS. Regarding

Complications during labour in study group 74(71.2%) of them not developed any

complications where as in control group 39 (36.1%) of them developed Combined

Complications. It was inferred that statistically high significant difference was found

between study and control group at p value.(p=0.0).

220

Table 4.5.2 shows the Comparison of Fetal and Neonatal outcome of

mothers with Gestational Diabetes Mellitus between study and control group.

Regarding fetal outcome in study group 63(60.6%) and in control group 27(25%) of

them not developed any complications but 52 (48.1%) of the fetus were Macrosomic

and in study group 31 (29.8%)of the fetus were Macrosomic and it was statistically

significant at p value(P=0.0003).

Regarding Neonatal outcome in study group 96 (92.3%) and in control group

61 (56.5%) of the neonates had �7 APGAR Score at 1st minute.94 (90.4%) in study

group72 (66.7%) in control group had �7 APGAR Score at 5th minute and it was

statistically significant at p value (p=0.0001).

The fifth hypothesis stated that there is a significant difference in the maternal,

fetal and neonatal Outcome among mothers with Gestational Diabetes Mellitus

between study and control group.


difference found between maternal, fetal and neonatal outcome of mothers with

Gestational Diabetes Mellitus between study group and control group. Hence the

hypothesis stated that there is a significant difference in the maternal ,fetal and

neonatal Outcome among mothers with Gestational Diabetes Mellitus between

study and control group was accepted at p�0.001.

Regarding the multiple regression in study group

Table 4.6.4 depicts the result that there were influence found on Fasting

blood glucose level with the maternal outcome variables such as weeks of gestation

at delivery, fetal outcome, APGAR score at 1st min caused 76.6% of variance (R2

value 0.766, F value 9.196, weeks of gestation at delivery t value 0.46, fetal outcome

t value 0.000, APGAR score at 1st min t value 0.45) at p�0.001 for fetal outcome

which was highly significant and p�0.01 for weeks of gestation at delivery, APGAR

score at 1st min which was significant.

Table 4.6.8 shows the result that there were influence found on Post

prandial blood glucose level with maternal outcome variable such as weeks of

221

gestation at delivery, fetal outcome caused 76.1% of variance (R2 value 0.761, F

value 8.949, weeks of gestation at delivery t value 0.28, fetal outcome t value 0.000,)

at p�0.001 for fetal outcome which was highly significant and p�0.01 for weeks of

gestation at delivery which was significant.

Table 4.6.12 depicts the result that there were influence found on fasting

urine sugar level with the maternal outcome variable such as weeks of gestation at

delivery, fetal outcome caused 73.3 % of variance (R2 value 0.733, F value 7.725,

weeks of gestation at delivery t value 0.39, fetal outcome t value 0.000,) at p�0.001

for fetal outcome which was highly significant and p�0.01 for weeks of gestation at

delivery which was significant.

Table 4.6.16 depicts the result that regarding postprandial urine sugar

level there was no influence was found on postprandial urine sugar level with

Maternal, fetal and Neonatal outcome variables.

Table 4.6.24 depicts the result that there influence was found on total

level of clinical parameters with the maternal outcome variable such as weeks of

gestation at delivery, fetal outcome caused 74 % of variance (R2 value 0.740, F value

8.022, weeks of gestation at delivery t value 0.46, fetal outcome t value 0.000,) at

p�0.001 for fetal outcome which was highly significant and p�0.01 for weeks of

gestation at delivery which was significant.

Regarding the multiple regression analysis in control group

Table 4.6.25 shows that multiple regression analysis for fasting blood

sugar level with their demographic, Obstetrical and maternal, fetal and neonatal

variables among antenatal mothers with Gestational Diabetes Mellitus of control

group. The demographic variables such as age t value 4.575,type of family t value

0.000 and monthly income and fetal outcome t value 0.000 caused 84.2% of variance

(R2 value 0.842, F value 17.509) at p�0.001 for age, type of family and fetal

outcome, which was very high significance and p�0.01 for monthly income which

was highly significant.

222

Table 4.6.26 shows that multiple regression analysis for postprandial

blood sugar level with their demographic, Obstetrical and maternal, fetal and

neonatal variables among antenatal mothers with Gestational Diabetes Mellitus of

control group. The demographic variables such as age t value 0.000,type of family t

value 0.000 and monthly income t value 0.016 and fetal outcome t value 0.001

caused 82.1% of variance (R2 value 0.821, F value 15.064 ) at p�0.001 for age,type

of family, which was very high significance and p�0.01 for fetal outcome which was

highly significant and monthly income at p�0.05 which was significant.

Table 4.6.27 shows that multiple regression analysis for fasting urine

sugar level with their demographic, Obstetrical and maternal, fetal and neonatal


group. The demographic variables such as age t value 0.001,type of family, monthly

income and fetal outcome t value 0.000 caused 84.4% of variance (R2 value 0.844, F

value 17.756 ) at p�0.001 for type of family, monthly income and fetal outcome

which was very high significance and p�0.01 for age which was highly significant.

Table 4.6.28 shows that multiple regression analysis for post prandial

urine sugar level with their demographic, Obstetrical and maternal, fetal and neonatal


group. The demographic variables such as type of family and fetal outcome t value

0.001 caused 77.6% of variance (R2 value 0.766, F value 15.859 ) at p�0.001 for type

of family which was very high significance and p�0.01 for fetal outcome which was

highly significant.

Table 4.6.29 shows that multiple regression analysis for total level of

clinical parameters with their demographic, Obstetrical and maternal, fetal and

neonatal variables among antenatal mothers with Gestational Diabetes Mellitus of

control group. The demographic variables such as type of family ,monthly income

and fetal outcome t value 0.000 caused 80.5% of variance (R2 value 0.805, F value

18.697 ) at p�0.001 for type of family, monthly income and fetal outcome which was

very high significance.

223

The sixth objective was to assess the level of satisfaction on yoga among the

mothers with gestational diabetes mellitus in study group

Findings related to frequency and percentage distribution of level of satisfaction

on Yoga among the Mothers with Gestational Diabetes Mellitus in Study group

Table 4.7.1 shows the frequency and percentage distribution of level of

satisfaction on Yoga among the Mothers with Gestational Diabetes Mellitus in Study

group. In 28th week ,post test,I,76.9%(80) of them were very satisfied,17.3%(18) of

them were satisfied,5.8%(6) of them were neither satisfied nor dissatisfied after

yoga.In 32 week, posttest II, 88.5%(92) of them were very satisfied,7.7%(8) of them

were satisfied,3.8%(4) of them were neither satisfied nor dissatisfied after yoga.In

36thweek, posttest III, 97.1%(101) of them were very satisfied,2.8%(3) of them were

satisfied after yoga. The above result strongly says that level of satisfaction among

antenatal mothers with Gestational Diabetes Mellitus was increased gradually and it

was significant also.

This conceptual framework supported the present study by acting as a

skeleton which supports the body by proving that yoga will control and maintain the

clinical parameters of Gestational Diabetes Mellitus, provide good level of

satisfaction in life and favorable maternal, fetal and neonatal outcome.

The above discussion clearly represents that there has been statistically

significant impact of the yoga on clinical parameters of Gestational Diabetes

Mellitus and also on the selected demographic, obstetrical, maternal, fetal and

neonatal outcome variables of mothers with Gestational Diabetes Mellitus .These

study findings will help the nursing staff ,nursing students and other health personnel

to understand the effectiveness of yoga on clinical parameters of Gestational Diabetes

Mellitus among mothers with Gestational Diabetes Mellitus.So they can give

appropriate and comprehensive care to the antenatal mothers and their family

members.

224

5.3 LIMITATIONS OF THE STUDY

1. Posttest values of clinical parameters among mothers with Gestational

Diabetes Mellitus in control group reveals significant improvement while

comparing with their Pretest values. It would have been caused by compliance

with routine management strategies according to the hospital protocol.

2. The investigator faced difficulty in collecting the related literature since

sukshma vyayama is an ancient type of Yoga.

3. The investigator could not control the extraneous variables like Mass media

and diet pattern.

CHAPTER SUMMARY

Chapter -5 dealt the discussion and limitation.

Chapter-6: Gives the summary of the study and its conclusions, implications,

Limitations and recommendations.

References and appendices follow this chapter.

chapter.5 5. discussion and limitationsshodhganga.inflibnet.ac.in/bitstream/10603/62462/8/chapter...

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