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.
[email protected]
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. |