Presentation on theme: "DIABETES MELLITUS (DM) IN PREGNANT WOMEN Dr. Shamanthakamani Narendran MD (Pead), PhD (Yoga Science) How yoga helps?"— Presentation transcript:
DIABETES MELLITUS (DM) IN PREGNANT WOMEN Dr. Shamanthakamani Narendran MD (Pead), PhD (Yoga Science) How yoga helps?
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.
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.
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.
Women and diabetes Diabetes no longer means Abstinence Amenorrhea Inability to conceive Inability to deliver healthy children Death during pregnancy
Diabetes and fertility Delayed menarche in T1 Menstrual abnormalities Premature Ovarian Failure PCOD
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
Fetal morbidity in GDM Miscarriages Growth restriction Fetal macrosomia
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
Screening for GDM 1 hr GCT 140 mg % 130 mg % 75 g GTT 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
Criteria for diagnosis of GDM with 100 gm oral GTT TimeWhole blood (mg %)Plasma Fasting hour hours hours In any two or more values are elevated, the glucose tolerance test result must be considered abnormal
Criteria for diagnosis of impaired glucose tolerance and diabetes with 75 gm (WHO) oral glucose TimeNormalImpaired glucose tolerance Diabetes Fasting< to <140 >/= hours post glucose < to <200 >/= 200 Venous whole blood values are 15% less than the plasma m mol/L = mg% x
Management of delivery Referred to well equipped hospital to prevent maternal and fetal complications.
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 3 rd trimester Weight reduction if BMI > 27
Avoid 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.
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.