Health

Effects of diabetes on pregnancy

The interview is based on a recent findings of research presented at a conference on 'Effects of diabetes on pregnancy.' The meeting was attended by a team of eminent physicians including Prof. Michael de Swiet, Prof. Glanda Lenmark and Catherine Nelson Piercy.

by Ranga Chandrarathne

In an interview with Senior Lectures in Fetoe Maternity Medicine Dr. Hemantha Dodampahala stated that as women are increasingly becoming more and more professional, for instance, most of the medical students happened to be female medical students, the future doctor generation will be represented by females.

So women's health is becoming an important health issue. On one hand, they are mothers and on the other hand, they are going to be important figures in the country in time to come.

How does diabetes affects women in general and pregnant women in particular? It affects women in two ways. It would affect a pregnant mother and it would affect the future wellbeing of woman.

Compared with Western population, diabetes is more prevalent in Asian population. This is due to our hereditary and dietary patterns. By heritage, Asians are more prone to diabetes.

Asians tend to suffer more due to complications from diabetes than our counterparts in Europe. As coronary heart disease and other implications of diabetes in Asians are severe and fatal; controlling and preventing diabetes has become a health priority. It is a non commutable disease. In the terminal stages, heart disease, kidney problems draws a lot of money.

As we eat a lot of starchy food and consume sugar, at one stage, the body could not control the sugar level. Then one becomes a diabetic patient.

What are the types of diabetes that affect women?

There are two types of diabetes that can affect a pregnant mother; one type is a woman who is diabetic becoming pregnant and another is mother who is normal, becoming diabetic during the pregnancy and becomes normal after the delivery.

The first category is the established diabetes mellitus and gestational diabetes; diabetes developed as a result of pregnancy, the mothers who are diabetic and either they are on diabetic control or taking insulin.

They, certainly, run a risk during pregnancy but the risk can be minimized by an appropriate control of sugar and careful monitoring throughout the pregnancy and appropriate time delivery.

The advice for established diabetic mothers is that if a girl is found to be diabetic, she should marry early and there should be a concern about foliate and rubella. Take the girl to a physician and get the diabetes controlled and then plan the pregnancy.

Soon after the pregnancy, she should check her blood, at least, once a month. What is recommended is the use of insulin together with dietary measures. In order to achieve the control of the diabetes, these patients should consult a physician and obstetrician. What happens if the diabetes level is not controlled?

It has been clearly shown in the study that uncontrolled diabetes carries a high risk of fetal abnormalities. This has been confirmed by the studies carried out by the Faculty of Medicine in the University of Colombo.

This might cause miscarriage and if not miscarriage, it can cause abnormalities in the central nervous system, the heart and lungs of the baby and the baby can suffer from various degrees of heart problems. Chances are there that the large vessels can be inter-changed and the degree of the enlarged heart in the baby can be detected and treated while in the uterus.

Unfortunate result is that it can lead to sudden death in the uterus due to these abnormalities. Other abnormalities include womb abnormalities, urinal track abnormalities and gastro-intestine abnormalities.

If the mother is not suffering from abnormalities, still they can have the risk of the baby getting very b ig which can be a problem at the time of delivery. It increases caesarian section and increase risk of forcepts.

How can it be controlled?

Consult the doctor, control sugar and get a diet chart. He may have prescribed, some times, oral tablets. In the recent studies, it has been clearly shown even Metformin can be taken during pregnancy.

But other oral hyperglycemic drugs except Metformin can not be used. For these patients, the one and only option is to use insulin, exercise and diet. Any MBBS qualified doctor will be able to plan the pregnancy. All these effects can be minimized if the pregnancy is planned.

However, this is not enough to prevent risk. Once pregnant, regularly visits the obstetrician and get the sugar level set and use a dose of insulin and diet accordingly. In the case of an advanced pregnancy there is a risk; sugar level may change due to various hormones. So it is advisable for mothers to have, at least, once a month check up of sugar till the 28th week, and from the seventh months a twice a month check up.

How is the diabetes level checked?

For established diabetes mothers, the ideal checking of blood sugar levels is done after taking a meal. Sometimes fasting sugar values may not show in the real situation but post-prandial does. Post-prandial blood sugars are generally done two hours after a meal.

If somebody wants to asses the sugar level, the short cut is to take three post-prandial checks. Generally it should be less than 140, but if the sugar level goes more than that, immediately consult a doctor. When the insulin is used, take the appropriate dose and keep the insulin in appropriate storage condition and use the needle carefully. There are new pen-devices which will cost much more.

What is gestational diabetes mellitus?

As the name implies, gestational diabetes mellitus is a form of problem which occurs as a result of pregnancy. With the growth of the baby and growth of the placenta, various HPL secrete and these hormones will change the glucose balance and decide to increase sugar levels in the body.

This kind of patients can be traced in the initial stages of the pregnancy by a test called 'Oral Glucose Tolerant Test.' A seventy five grams of glucose be given and take blood, half an hour, one hour, one and half hour and two hours.

This will detect the potential patient who can develop gestational diabetes mellitus during the pregnancy.

Is the baby at risk if the mother developed gestational diabetes mellitus? These babies have been shown to be free from congenital abnormalities because at the time of organ formation, the mother's sugar level remained stable.

Therefore, it is very unlikely that this diabetes can cause fetal abnormalities. However, gestational diabetes can cause increase in the water content around the baby or polyhydramniof and increase of fetal weight or fetal macrosimia and the same risks.

Insulin may have to be taken occasionally. Most of the time, diet and exercise will suffice. But if the sugar level is not getting controlled, go for insulin.

If the sugar levels rebound despite getting insulin, consider exercise on advice of a doctor. Gestational diabetes may lead to develop long term diabetes.

However, you should know that we eat a lot and there should be some way of burning your energy. We eat more than what we burn. This is the problem we face currency.

Human lives are originally formed to eat, at least, once in three days. Body organs are originally developed to store food. The liver is developed to store food. What is happening is every day we put in food three times a day with a lot of carbohydrate, starch and chocolate.

What is metabolic syndrome?

Metabolic condition is a condition when we eat more than our sugar storage level and the body shows various symptoms. Characteristically, this has been shown in Asian population.

Characteristics of the metabolic syndrome are uncontrolled sugar levels and high blood pressure. The complications are that condition can lead to severe diabetes, hyper tension and even liver diseases such as cirrhoses. However, preventive measures are the same as in above cases.

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Childhood obesity a growing problem

by Pippa Wysong

Orlando - A new study has revealed one in eight school children has a cluster of risk factors that means they may develop heart disease and possibly diabetes at an age far younger than their parents or grandparents.

Researchers are calling this cluster of risk factors "metabolic syndrome" and replaces what was once called "insulin resistance syndrome".

In brief, it means the presence of a combination of risk factors that predispose people to developing Type-2 diabetes or coronary artery disease, said Joanne Harrell, PhD, professor of nursing and director of the Center for Research on Chronic Illness at the University of North Carolina. She spoke at the recent annual American Heart Association's Scientific Sessions in Orlando where she presented the results from the Cardiovascular Health in Children and Youth (CHIC) study.

The children have these risk factors because of a mix of inactivity, poor eating habits, and genetics. In the ongoing project, researchers are investigating the causes and development of risk factors for future heart disease, and are looking at how interventions such as exercise and nutrition can affect these risks. They have been tracking over 3,000 children from rural areas since 1990.

Dr. Harrell reported on findings from 2,034 children (1,020 female, 1,014 male) ages 8 to 17. In the study, 48.1% of the children were Caucasian, 42.9% were of African descent and 9.1% had other racial backgrounds.

Body mass index (BMI), blood pressure, lipids and glucose tolerance were all measured in each child.

It was found that among 8 and 9 year olds (n=384) 8.6% had three or more risk factors. Among 14 to 17 year olds (n=468), 11.3% had at least three risk factors. The highest rates of multiple risk factors were found in children who were aged 10 to 13 (n=1,182) at 17.1%.

The most frequently found risk factor was decreased HDL cholesterol, which occurred in 41.9% of the children. Levels were considered low if they fell below 40 mg/dL in boys or 50 mg/dL in girls. High triglyceride levels were found in 8.6% of the children.

A significant portion, more than 25%, of the children were overweight and had a BMI that was higher than it should be for children of similar weight, height and sex. In the US, obesity is considered an epidemic. According to the American Obesity Association, the rates of obesity in children have more than doubled since the 1970s.

Obesity key risk factor

Obesity alone can trigger further risk factors. For one, it is linked to the development of insulin resistance. "Insulin is needed to allow glucose to be used by the cells, and is required by the body.

But as cells become resistant to the action of insulin, the body compensates by producing more insulin, which makes sense, so you have glucose homeostasis," Dr. Harrell said.

Unfortunately, insulin resistance, in turn, is linked to the development of specific types of dyslipidemias (unhealthy levels of triglycerides, cholesterol and other lipids). Triglycerides go up and HDL cholesterol ("good" cholesterol) levels drop. In addition, high blood pressure can develop.

Over time, high insulin resistance can lead to the development of Type-2 diabetes, something which was once called adult-onset diabetes. In the population in general "researchers are finding about a third of diabetics aged 12 to19 have Type-2 diabetes instead of Type-1," Dr. Harrell said.

In the CHIC study population, about 5 per cent of the children had glucose intolerance. Typically, people have metabolic syndrome for a number of years before glucose tolerance becomes impaired.

Dr. Harrell's key message is to get children to be physically active on a regular basis, and to help them improve their eating habits and to fight obesity.