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DIABETES MELLITUS (DM) IN PREGNANT WOMEN

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Presentation on theme: "DIABETES MELLITUS (DM) IN PREGNANT WOMEN"— Presentation transcript:

1 DIABETES MELLITUS (DM) IN PREGNANT WOMEN
How yoga helps? Dr. Shamanthakamani Narendran MD (Pead), PhD (Yoga Science)

2 Pregnancy induced DM Gestational Diabetes Mellitus is glucose intolerance during pregnancy. Prevalence of DM among women of childbearing age is increasing. Sedentary lifestyles - changes in diet. Childhood and adolescent - obesity.

3 Pregnancy induces progressive changes in maternal carbohydrate metabolism.
As pregnancy advances insulin resistance and diabetogenic stress due to placental hormones necessitate compensatory increase in insulin secretion. When this compensation is inadequate gestational diabetes develops.

4 Women diagnosed to have GDM are at increased risk of future diabetes predominantly type 2 DM as are their children. Thus GDM offers an important opportunity for the development, testing and implementation of clinical strategies for diabetes prevention. Timely action taken now in screening all pregnant women for glucose intolerance, achieving euglycemia in them and ensuring adequate nutrition may prevent in all probability, the vicious cycle of transmitting glucose intolerance from one generation to another.

5 Women and diabetes Diabetes no longer means Abstinence Amenorrhea
Inability to conceive Inability to deliver healthy children Death during pregnancy

6 Diabetes and fertility
Delayed menarche in T1 Menstrual abnormalities Premature Ovarian Failure PCOD

7 Diabetes in pregnancy Placental structure and function is affected
Early IUGR as high BG inhibits trophoblast proliferation Hypertension, renal disease more frequent High glycogen content in placenta BG – Blood glucose

8 Fetal morbidity in GDM Miscarriages Growth restriction
Fetal macrosomia

9 Newborn complications
Birth defects Birth injury Polycythemia Hypoglycemia Hypocalcemia Hyperbilirubinemia Respiratory problems

10 Maternal morbidity Diabetic retinopathy Renal complications
Chronic hypertension Preeclampsia

11 Screening for GDM WHO: FBG and 2h PPBG or 2h post-75 g glucose BG
1 h post- 50 g glucose load BG [GCT] ADA: FBG, 1 h, 2 h, 3 h post- 75 or 100 g glucose BG One-step or two-step protocol At first visit; reassess at 24 – 28 weeks

12 Screening for GDM 1 hr GCT 75 g GTT 100 g GTT 140 mg % 130 mg %
2 h: 155 mg % 100 g GTT 1 h: 180 mg % 2 h: 155 mg % 3 h: 140 mg % Any time of day No regards to meals

13 Criteria for diagnosis of GDM with 100 gm oral GTT
Time Whole blood (mg %) Plasma Fasting 90 105 1 hour 165 190 2 hours 145 3 hours 125 In any two or more values are elevated, the glucose tolerance test result must be considered abnormal

14 Criteria for diagnosis of impaired glucose tolerance and diabetes with 75 gm (WHO) oral glucose
Time Normal Impaired glucose tolerance Diabetes Fasting <105 105 to <140 >/= 140 2 hours post glucose < 160 160 to <200 >/= 200 Venous whole blood values are 15% less than the plasma m mol/L = mg% x

15 Management Dietary therapy Glucose monitoring Insulin therapy
Oral hypoglycemic agents –Metformin Timing of delivery

16 Management of delivery
Referred to well equipped hospital to prevent maternal and fetal complications.

17 DIET

18 Medical Nutrition Therapy
6 meal pattern Substantial night snack; light breakfast Encourage complex carbohydrates, fruits 30 cal/kg/day = 1500 cal for a 50 kg lady Avoid starvation/ketosis Increase intake in 3rd trimester Weight reduction if BMI > 27

19 High fiber foods – fresh fruits and vegetables, whole grain breads, cooked dried beans and bran cereals. Beverages with added sugar, corn syrup, honey, maple syrup, jams and jellies. Read the labels of packaged foods to find the grams of carbohydrate a serving has in it. Avoid

20 Calorie Intake Needs about 300 extra calories per day in the second and third trimesters to gain enough weight. This equals about 16 to 17 calories per pound of ideal body weight. An extra 10 to 12 grams of protein per day helps baby grow normally. It helps to get 45-60% of calories from carbohydrates, 15-25% from protein and 20-30% from fat.

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22 Food Selection Pyramid
Prefer Bajra, Jowar, Wheat flour mixed with black channa flour whole, Split & sprouted pulses, Green leafy vegetables & fresh fruits, Skimmed milk & curd, Light tea, Vegetable juices.

23 Food Selection Pyramid
Limit Rice, Biscuts, Naan & food prepared with maida, Roots & tubers – potato, arbi jimikand & sweet potato, Whole milk, Tea & coffee

24 Food Selection Pyramid
Avoid Fat, Sweets, Pastries, Fruits like – mango, grape, banana, chiku dates, custard apple, Cold drinks & alcoholic drinks, Non-veg food stuffs, All nuts & oil.

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26 Yoga practices Hands in & out Breathing Hands stretch breathing
Ankle stretch breathing with wall support Side twist breathing Instant relaxation technique [IRT]

27 Yoga practices Leg raise breathing Hip raise breathing
Spine & abdominal stretch breathing Cycling in the supine pose Tiger breathing

28 Yoga practices Ankle rotation Kneecap contraction

29 Yoga practices Avoid Eye exercises Alternate nostril breathing
Shavasana in left lateral position. Avoid Jogging Suryanamaskar Kapalabhathi & Bhastrika

30 Group practice Ankle Stretch Hands In & Out

31 Tiger Stretch Side Stretch

32 Loosening Exercises Forward Bending Backward Bending

33 Sitting Postures Vajrasana Ardha Matsyendrasana

34 Badha Konasana Squatting

35 Uphavista Konasana

36 Sasankasana

37 Supine Postures Viparita Karani Viparita Karani with Wall Support

38 Pranayama Mastery over Prana – Slowing of breath
– Awareness of breathing – Balance between the two nostrils. 2. There is intimate connection between mind and Prana.

39 Cooling Pranayamas Sitkari (Folded – up – Tongue Pranayama)
Sitali (Beak – Tongue Pranayama) Sadanta (Suck – through – Teeth Pranayama

40 Relaxation Techniques
Instant Relaxation Technique (IRT) Quick Relaxation Technique (QRT) Deep Relaxation Technique (DRT)

41 Meditation Omkar Meditation

42 Mudra Aswini Mudra

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