{"id":6062,"date":"2019-07-04T16:06:03","date_gmt":"2019-07-04T11:06:03","guid":{"rendered":"https:\/\/drmohans.com\/?p=6062"},"modified":"2024-11-27T14:43:53","modified_gmt":"2024-11-27T14:43:53","slug":"gestational-diabetes-amongst-pregnant-mothers","status":"publish","type":"post","link":"https:\/\/drmohans.com\/backend\/gestational-diabetes-amongst-pregnant-mothers\/","title":{"rendered":"GESTATIONAL DIABETES LEVELS AMONG PREGNANT MOTHERS"},"content":{"rendered":"\r\n<p class=\"wp-block-paragraph\"><strong>Introduction<\/strong><\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">Gestational diabetes mellitus (GDM) is a condition of high blood glucose levels are detected for the first trimester during pregnancy. \u00a0GDM is very common and some studies have reported that 10-20% of pregnant women in India have GDM. <\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"><strong>Who are at risk of GDM?<\/strong><\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\"><li>Older\r\nwomen<\/li><li>Overweight\r\nor obese.<\/li><li>Family\r\nhistory of diabetes<\/li><li>If\r\nthere was a previous history of Gestational Diabetes.<\/li><\/ul>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"><strong>Screening and diagnosis of hyperglycemia in\r\npregnancy<\/strong><\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"> &nbsp;All pregnant women should be screened at the first visit to antenatal clinic. Early in pregnancy screening is done usually at the booking visit to see if the woman already has diabetes complicating pregnancy which she did not know about. Screening can be done using either fasting plasma (FPG), glycosylated hemoglobin (A1C),or random plasma glucose(RPG). If a woman has high blood sugars early in pregnancy (FPG&gt;7mmol\/l (126 mg\/dl), A1c &gt;6.5% or RPG &gt;11.1 mmol\/l(200mg\/dl) then she should be treated as having pre-existing diabetes.<\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"> All women who have normal blood glucose levels of sugar early in pregnancy should be screened again with an oral glucose tolerance test (OGTT) between 24-28 weeks of the pregnancy to rule out GDM. They should come to the centre in fasting state at least 8 hrs-10 hrs and should not consume anything except water before the test. Fasting blood and urine are collected, 75 gms of oral glucose is given to drink in 300 ml of water. Blood is then drawn at one and two hrs of the glucose load. If fasting plasma glucose is between 92-125mg\/dl or 1 hr of glucose load >180mg\/dl or 2 hrs level is >153mg\/dl (International Association of Diabetes and Pregnancy Study Group, IADPSG criteria) the woman is said to have Gestational Diabetes.<\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"><strong>Weight gain during pregnancy<\/strong><\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"> \u00a0All pregnant women should gain some weight during pregnancy and the recommended weight gain is decided by the Pre-pregnancy body mass index (BMI) <\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; BMI = Weight (kg)\/ Height in m<sup>2<\/sup> <\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">Changes of body weight based on BMI<\/p>\r\n\r\n\r\n\r\n<table class=\"wp-block-table\"><tbody><tr><td>\r\n  &lt; 18.5\r\n  <\/td><td>\r\n  Underweight\r\n  <\/td><\/tr><tr><td>\r\n  18.5-22.9\r\n  <\/td><td>\r\n  Normal\r\n  <\/td><\/tr><tr><td>\r\n  23-24.9\r\n  <\/td><td>\r\n  Overweight\r\n  <\/td><\/tr><tr><td>\r\n  &gt;25\r\n  <\/td><td>\r\n  Obese\r\n  <\/td><\/tr><\/tbody><\/table>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">(According\r\nto Asian Indian guidelines<sup>1<\/sup>)<\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">Recommended\r\nweight gain according to pre pregnancy BMI<\/p>\r\n\r\n\r\n\r\n<table class=\"wp-block-table\"><tbody><tr><td>\r\n  BMI\r\n  <\/td><td>\r\n  Weight gain\r\n  <\/td><\/tr><tr><td>\r\n  &lt;18.5\r\n  <\/td><td>\r\n  12.5-18 Kg\r\n  <\/td><\/tr><tr><td>\r\n  18.5-24.9\r\n  <\/td><td>\r\n  11.5-16 KG\r\n  <\/td><\/tr><tr><td>\r\n  25-29.9\r\n  <\/td><td>\r\n  7-11.5 KG\r\n  <\/td><\/tr><tr><td>\r\n  &gt;30.0\r\n  <\/td><td>\r\n  5-7 KG\r\n  <\/td><\/tr><\/tbody><\/table>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"><strong>Managing Gestational Diabetes<\/strong><\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"> Gestational Diabetes levels can be managed through balanced and healthy diet, medication and exercise. Medication is usually indicated if blood sugars do not come to normal with diet and exercise. Recommended levels of glucose are fasting&lt;90mg\/dl(5.0 mmol\/l),1 hr&lt;140mg\/dl(&lt;7.8 mmol\/l),2 hrs &lt;120mg\/dl(&lt;6.7 mmol\/l)<\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"><strong>General guidelines for healthy eating<\/strong><\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"> Generally good nutrition is important during pregnancy and en effective way to manage gestational diabetes levels. A dietitian can guide to take portion size, right amount of protein, fat and carbohydrate.<\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">Here\r\nare some general tips:-<\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\"><li>Eat\r\nvariety of foods distributing calories, carbohydrate and taking enough protein<\/li><li>4-5\r\nserving of vegetables is recommended<\/li><li>Adequate\r\nfluids 2-3 liters should be taken but however water has to be restricted if\r\nthere is &nbsp;pedal edema.<\/li><li>Iron\r\nrich foods should be included. Eg: &#8211; Greens<\/li><li>Consume\r\n650 ml of milk\/ day to meet calcium requirements.<\/li><li>Avoid\r\ndirect sugars, artificial sweeteners.<\/li><li>Avoid\r\nAlcohol and tobacco.<\/li><li>Use\r\na combination of oils Eg: &#8211; Mono unsaturated fats and Poly unsaturated fats<\/li><li>Include\r\nplant protein like pulses, dhal etc.<\/li><li>Restrict\r\nanimal protein like red meat.<\/li><\/ul>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"><strong>Healthy plate<\/strong><\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">One\r\nway to decide how much to eat to divide the plate is given below. Up to half plate\r\nshould contain vegetables and fruits, about one quarter of plate should be\r\nstarch or grains and the reminder protein and calcium rich foods.<\/p>\r\n\r\n\r\n\r\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img decoding=\"async\" src=\"https:\/\/oldlive.drmohans.com\/wp-content\/uploads\/2019\/07\/health-food-plate.png\" alt=\"\" class=\"wp-image-6063\"\/><figcaption> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <\/figcaption><\/figure><\/div>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\" style=\"text-align:center\"> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  <br>Healthy food plate <\/p>\r\n\r\n\r\n\r\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img decoding=\"async\" src=\"https:\/\/oldlive.drmohans.com\/wp-content\/uploads\/2019\/07\/south-asian-foods.png\" alt=\"\" class=\"wp-image-6064\"\/><figcaption><br><br><\/figcaption><\/figure><\/div>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\" style=\"text-align:center\"> Example of Healthy food plate with South-Asian foods <\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"><strong>Physical Activity<\/strong><\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">Aerobic activity of moderate intensity for 30mins\/day on most days of the week has shown benefits in metabolic control. Start with light to moderate exercise. Any simple physical activity is better than no activity.<sup>2, 3<\/sup><\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"><strong>Caution<\/strong><\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\"><li>Don\u2019t exercise in flat position.<\/li><li>Stop if your heart rate is &gt;140\/min.<\/li><li>Stop if you feel contraction.<\/li><\/ul>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"><strong>Insulin<\/strong><\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"><strong> <\/strong> Insulin is indicated when target blood glucose levels are not attained with diet and physical activity. Different types of insulin is prescribed by the Diabetologist.<\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"><strong>Materials\r\nrequired for insulin injection<\/strong><\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\"><li>Insulin <\/li><li>Syringe or pen type needle.<\/li><li>Denatured spirit<\/li><li>Cotton.<\/li><\/ul>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"><strong>General\r\nguidelines for patient on bottle type insulin <\/strong><\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\"><li>Insulin must be refrigerated, not frozen<\/li><li>Store away from heat<\/li><li>It must be rolled between two hands before using.<\/li><li>Common site for taking Insulin are upper part of thigh. You may not want\r\nto use abdomen during pregnancy, hence arms and legs are preferred.<\/li><li>If refrigerator not available (ex. in villages) Insulin can be stored in\r\nclay pot.<\/li><li>Each bottle type contains 400 units<\/li><li>If using 100 u insulin then use a 100u&nbsp;\r\nsyringe<\/li><li>If using 40u&nbsp; insulin then use a\r\n40u&nbsp; syringe.<\/li><\/ul>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"><strong>General\r\nguidelines for patients on pen type insulin<\/strong><\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\"><li>The pens can be stored at room temperature while in use.<\/li><li>Should not get exposed to direct sunlight<\/li><li>Pen needle can be used 4-5 times without sterilization.<\/li><li>Each pen contains 300 units of insulin.<\/li><li>Insulin pens are available in two basic types, disposable and reusable.<\/li><li>&nbsp;Insulin pens are portable,discreet\r\nand convient to carry,<\/li><\/ul>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"><strong>Hypoglycemia\r\nduring pregnancy<\/strong><\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">Only those on insulin during pregnancy are at risk\r\nof getting hypoglycemia.<\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">Blood sugar drops when<\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\"><li>When skipping or delaying meals<\/li><li>One does lot of physical activity but has not eaten enough.<\/li><\/ul>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"><strong>Symptoms\r\nof Hypoglycemia<\/strong><\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\"><li>Excessive hunger<\/li><li>Sweating<\/li><li>Shivering<\/li><li>Palpitation<\/li><li>Weakness<\/li><li>Blurred vision<\/li><li>Giddiness<\/li><li>Tremors<\/li><\/ul>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"><strong>Treatment\r\nof Hypoglycemia<\/strong><\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\"><li>If possible blood sugar should be checked.<\/li><li>15 grams of sugar should be given i.e. \u00bd cup fruit juice, 3 tsp of sugar.<\/li><li>Wait for 15 minutes. If no improvement again 15 grams of sugar must be\r\ngiven.<\/li><\/ul>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"><strong>&nbsp;Prevention of Hypoglycemia<\/strong><\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\"><li>Follow 4 meal pattern<\/li><li>Adhere to timely meals<\/li><li>Include low calorie foods in between major meals.<\/li><\/ul>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"><strong>Monitoring\r\nblood sugar<\/strong><\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\"><li>Blood sugar will need to be checked several times during pregnancy.<\/li><li>It can be done using Glucometer or in nearby clinics.<\/li><li>Monitoring helps to improve blood sugar and achieve better glycosylated\r\nhemoglobin (HbA1C) level.<\/li><\/ul>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"><strong>Post\r\ndelivery screening<\/strong><\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">After the delivery, blood sugar to be checked. If\r\nthe blood sugars return to normal, women will no longer require insulin. For\r\nsome women blood sugar will not come under normal range level after the baby is\r\nborn this mean the diabetes is continuing after delivery also. They should be\r\nencouraged healthy eating and to follow proper medication if needed. All women\r\nneed to check an oral glucose tolerance test between 6-12 weeks after the delivery\r\nin the fasting state to see whether the diabetes has gone into remission or\r\nnot.<\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"><strong><em>Breast feeding should be encouraged. Breast feeding\r\nimproves blood sugar and has been shown to reduce the chances of developing diabetes\r\nin future.<sup>4<\/sup><\/em><\/strong><\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"><strong><em>Breast feeding offers some protection against next\r\npregnancy but it is not a guaranteed birth control method. <\/em><\/strong><\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"><strong>Reference<\/strong><\/p>\r\n\r\n\r\n\r\n<ol class=\"wp-block-list\"><li>Misra A,Chowbey, Makkar PM,Vikram NK,Wasir JS,Chanha D,et al.Consensus\r\nstatement for diagnosis of Obesity, Abdominal obesity and the Metabolic\r\nSyndrome for Asian Indians and Recommendations for Physical Activity, Medical\r\nand surgical management.JAPI2009;57<\/li><li>Metzger BE,BuchananTA,Coustan DR,De LeivaA,Hadden DR,Hod M.Summary and\r\nrecommendations of the fifth international workshop-conference on gestational\r\ndiabetes mellitus,Diabetes care 2007;30(Suppl 2 ):S251-260<\/li><li>Harris ,GD,White,RD.Diabetes management and exercise in pregnant patients\r\nwith diabetes. Clinical Diabetes 2005;23(4):165-168<\/li><li>Stuebe AM,\r\nRich-Edwards JW0, Willett WC, Manson JE, Michels KB: Duration of lactation and\r\nincidence of type 2 diabetes.&nbsp;<em>JAMA<\/em>&nbsp;294:2601\u20132610,&nbsp;2005<\/li><\/ol>\r\n","protected":false},"excerpt":{"rendered":"<p>Introduction Gestational diabetes mellitus (GDM) is a condition of high blood glucose levels are detected for the first trimester during [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":17280,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[350,466],"tags":[],"class_list":["post-6062","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blogs","category-pregnancy"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>GESTATIONAL DIABETES LEVELS AMONG PREGNANT MOTHERS - 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