Presentation on theme: "DIABETES MELLITUS (DM) IN PREGNANT WOMEN"— Presentation transcript:
1DIABETES MELLITUS (DM) IN PREGNANT WOMEN How yoga helps?Dr. Shamanthakamani NarendranMD (Pead), PhD (Yoga Science)
2Pregnancy induced DMGestational 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.
3Pregnancy 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.
4Women 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.
5Women and diabetes Diabetes no longer means Abstinence Amenorrhea Inability to conceiveInability to deliver healthy childrenDeath during pregnancy
6Diabetes and fertility Delayed menarche in T1Menstrual abnormalitiesPremature Ovarian FailurePCOD
7Diabetes in pregnancy Placental structure and function is affected Early IUGR as high BG inhibits trophoblast proliferationHypertension, renal disease more frequentHigh glycogen content in placentaBG – Blood glucose
8Fetal morbidity in GDM Miscarriages Growth restriction Fetal macrosomia
11Screening 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 BGOne-step or two-step protocolAt first visit; reassess at 24 – 28 weeks
12Screening for GDM 1 hr GCT 75 g GTT 100 g GTT 140 mg % 130 mg % 2 h: 155 mg %100 g GTT1 h: 180 mg %2 h: 155 mg %3 h: 140 mg %Any time of dayNo regards to meals
13Criteria for diagnosis of GDM with 100 gm oral GTT TimeWhole blood (mg %)PlasmaFasting901051 hour1651902 hours1453 hours125In any two or more values are elevated, the glucose tolerance test result must be considered abnormal
14Criteria for diagnosis of impaired glucose tolerance and diabetes with 75 gm (WHO) oral glucose TimeNormalImpaired glucose toleranceDiabetesFasting<105105 to <140>/= 1402 hours post glucose< 160160 to <200>/= 200Venous whole blood values are 15% less than the plasmam mol/L = mg% x
18Medical Nutrition Therapy 6 meal patternSubstantial night snack; light breakfastEncourage complex carbohydrates, fruits30 cal/kg/day = 1500 cal for a 50 kg ladyAvoid starvation/ketosisIncrease intake in 3rd trimesterWeight reduction if BMI > 27
19High 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
20Calorie IntakeNeeds 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.