comparison of nutrient intakes of women with and without gestational diabetes (Nutritional Management of Gestational Diabetes Mellitus )

 
dissection part of dissertation I have already start write the dissection part and i wrote the main information but I need to re-write and add more and reorganize the structure .. please reword the red text in the file attached

Discussion structure updating
the main finding of this study that pre-pregnancy overweight or obese woman is at high risk to develop Gestational diabetes Miletus. The association between weight and the risk of develop GDM was more obvious among overweight women . depend on Nice recommended the woman who have BMI more than 27kg/m2 should seek for weight management adviser in order to achieve healthy BMI , However in this study we found that the relation between nutritional intake including energy ,macronutrient and micronutrient and develop GDM is not significant in addition the social factors such as smoking and alcoholic has the same result
1-advantage of study and method food diary “study use information for nutritional intake ,weight , life social factors and biomedical test the original sample size is 1639 ,food diary advantage ….
the strength of this study include collected information background for multiable area like social factor background like matrial statue ,number of children ,breast feeding ,smoking, and alcoholic and anthropometric background like weight ,high, age ,and BMI in addition a biomedical test including 1,2hours blood glucose ,and HAb1c the original sample size is 1639 which give the study advantage of have large number of cases and enough to support the evidence ,that will decrease the limitation of have misreport or incomplete 7 days food dairy , however only 120 cases of the total number has included in this study
2-On the other hand disadvantage of study was the pre-pregnancy weight was estimated, because of the study data collection start in 28weeks of pregnancy and we had no information before that . One of the limmetation The rates of under-reporting were substantially higher than in other studies looking at nutrition in pregnant women with a range of BMI, for example the ALSP AC study on11,923 women in the South West of England had a rate of under-reporting 11% lower than in this”investigation (Rogers et al. 1998)he rates of under-reporting were substantially higher than in other studies
one of common of food diary limitation is under-reporting which will effect negatively on the accuracy of the collected data practically in obese or over weight woman ,The researcher was faced with a significant amount of difficulty while trying to gather and analyse the information taken from the food diaries. First, there were some instances in which the researcher encountered unknown kinds of foods that were recorded in the food diaries. There were also some cases in which the research participants failed to record the portion size of their food intake. Other research study limitations included the use of home food measurement and the risk of the research participants’ misreporting the kind of food they ate and the portion size they had consumed throughout each meal. Finally, we lacked information on some potential confounders, such as physical activity, so we were not able to assess the association between pre-pregnancy weight and GDM independent of these factors.,
finelly No data for physical activety Regular physical activity is key to ensure a healthy life for diabetic woman whether before conception, during pregnancy or after (Mottola, 2007)

weight discussion
Being overweight or obese immediately before getting pregnant may result in the development of gestational diabetes (Clerisme & Rand, 2009).study showed that pregnant women should gain 7-15kgs depending on their body weight before pregnancy and their height (Connor et al, 2003).and the The American Institute of Medicine (2008) recommendation that women with a pre-pregnancy BMI that is greater than 30kglm2 should gain 11-20 pounds. In this study we found that the GDM group are heavier than Non-GDM group.
for Non GDM characteristics for the women mention in the descriptive statistics clarify that the pre-pregnancy weight of participant is (62.31 kg) and BMI (23.51kg/m2) the weight after 28 weeks (73.31 kg) with BMI (27.62kg/m2) shows that the participant gain 11kg in average.
While for GDM the gain more weight during the pregnancy period with pre-pregnancy weight of participant is (78.52 kg) with BMI (29.98 kg/m2)the weight after 28 weeks (91.06 kg) with BMI(34.88 kg/m2).The weight gain 13kg in average.
From this we conclude that the GDM gain 2 kilos more than The NON-GDM.
The extra gained weight affects not only the mother but also the baby with increased risk of developing complications. (Maicon, 2012). For Example In a study examining 1092 woen, it was established that material weight was the factor affected baby’s birth weight by raising it. This was linked to macrosomia which is a symptom of GDM in a mother (Dawes et al, 1991).
Glucose result discussion
The Gold standard test for diagnosing gestational diabetes is considered to be the oral glucose tolerance test. There is a range of recommendations and guidelines for the identification and diagnosis of women with gestational diabetes (WHO 1999, Expert Committee 2000, NICE 2008 and ADA Metzger et al 2007) The ADA guidelines are in the process of changing following the Hyperglycaemic and Adverse Pregnancy Outcome (HAPO) study. New diagnostic criteria for GDM as a result of this study have been recommended but are not yet universally adopted (Metzger et al 2008; 2010;add the range NON GDM The mean value of 1 hour glucose (7.437) and 2 hours glucose (5.841) shows the difference of two points, for GDM The mean value of 1 hour glucose (10.3) and 2 hours glucose (8.508) shows the difference of two points
HAb1c GDM The mean value of HBA1c at 28 weeks (5.13)
FOR NON GDM The mean value of HBA1c at 28 weeks (4.83)
AGE GDM The age of participants at 28 weeks is around (32.67 years) with 16 year of education which shows the good maturity level. The participants serve the breast feeding to child for 28.14 days.while in NON GDM The age of participants at 28 weeks is around (29.8 years) with 16 year of education which shows the good maturity level
7–there is no relation between social factor like smoke and employed years of eduction with rick of GDM” please see result section file and add the resul
Nutrients intake discussion
8- during the pregnancy energy requirements increase due to the physiological change in the body to meet the mother and the fetus requirements in relation to that We found that No significant association between nutrient intake and risk of develop GDM ,
The energy consume by each percipients (2052.60 Kcal) on average the total fat and carbohydrate shows the mean value (73.52g) and( 286.33g) .The usage of englyst fibre (15.92g), protein (80.41g) and vitamin D (2.94u) shows the mean value at large extent. The height of participants mentioned in meters i.e. (1.62 m) which is (5.31 feet) on average. The value shows the estimated pre-pregnancy weight and group wise classification of GDM and non-GDM.
the distribution on energy depend on nutrient intake within GDM group and Non GDM group :
In GDM group 54% of total energy intake for carbohydrates with mean (291.2g)while in NON GDM 56.8% , with mean (283.9g)
GDM total fat intake is 33.7% of total energy with the mean value (80.97g) ,while NON GDM total fat intake 31% with mean value (69.81g), depend on the total daily allowance of fat intake for those with GDM should not be more than 35% of the total daily energy intake(ADA, 2006).the Total fat intake is not above the allowance level ,
protein consumption should be approximately 15% of the daily calorific intake (0.8-1g/1kg of the ideal body weight) (ADA, 2006) in GDM group was 15.8% with the mean value (85.68) while the protein intake slightly lower in non GDM group with 15.5% mean value (77.77g) . However both group are above the recommendation level .
Non GDM energy consume by each percipients is 1998 Kcal. On the other hand, the total fat and carbohydrate shows the and (283.9). The mean value of, Vitamin D (2.888), and t fibre (15.61) shows the consumption level.
While the energy consume in GDM Group by each percipients is 2158 Kcal. On the other hand, the total fat and sugar shows and (119.3). The mean value of starch (171.1), Vitamin D (3.05), Cholesterol (291.2) and fibre (16.59) shows the consumption level.

Better education on the risks of beingoverweight and pregnant is necessary, as well as simple ways for women to estimate their calorie intakes, such as portion size aids.

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