diabetes mellitus (dm) in pregnant women dr. shamanthakamani narendran md (pead), phd (yoga science)...
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DIABETES MELLITUS (DM) IN
PREGNANT WOMEN
Dr. Shamanthakamani NarendranMD (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
Newborn complications
Birth defects
Birth injury
Polycythemia
Hypoglycemia
Hypocalcemia
Hyperbilirubinemia
Respiratory problems
Maternal morbidity
Diabetic retinopathy
Renal complications
Chronic hypertension
Preeclampsia
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 GCT140 mg %
130 mg %
75 g GTT 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
Criteria for diagnosis of GDM with 100 gm oral GTT
Time Whole blood (mg %) Plasma
Fasting 90 105
1 hour 165 190
2 hours 145 165
3 hours 125 145
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
Time Normal Impaired glucose tolerance
Diabetes
Fasting <105 105 to <140
>/= 140
2 hours post glucose
< 160 160 to <200
>/= 200
Venous whole blood values are 15% less than the plasma
m mol/L = mg% x 0.0555
Management
Dietary therapy
Glucose monitoring
Insulin therapy
Oral hypoglycemic agents –Metformin
Timing of delivery
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 3rd 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.
Food Selection Pyramid
PreferBajra, Jowar, Wheat flour mixed with black channa flour whole, Split & sprouted pulses, Green leafy vegetables & fresh fruits, Skimmed milk & curd, Light tea, Vegetable juices.
Food Selection Pyramid
LimitRice,
Biscuts,
Naan & food prepared with maida,
Roots & tubers – potato, arbi jimikand & sweet potato,
Whole milk,
Tea & coffee
Food Selection Pyramid
AvoidFat,
Sweets,
Pastries,
Fruits like – mango, grape, banana, chiku dates, custard apple,
Cold drinks & alcoholic drinks,
Non-veg food stuffs,
All nuts & oil.
Yoga practices
Hands in & out Breathing
Hands stretch breathing
Ankle stretch breathing with wall support
Side twist breathing
Instant relaxation technique [IRT]
Yoga practices
Leg raise breathing
Hip raise breathing
Spine & abdominal stretch breathing
Cycling in the supine pose
Tiger breathing
Yoga practices
Ankle rotation
Kneecap contraction
Yoga practices
Eye exercises
Alternate nostril breathing
Shavasana in left lateral position.
AvoidJogging
Suryanamaskar
Kapalabhathi & Bhastrika
Ankle Stretch Hands In & Out
Group practice
Tiger Stretch Side Stretch
Loosening Exercises
Backward Bending Forward Bending
Sitting Postures
Vajrasana Ardha Matsyendrasana
Badha Konasana Squatting
Uphavista Konasana
Sasankasana
Supine Postures
Viparita Karani
Viparita Karani with
Wall Support
1. Mastery over Prana – Slowing of breath – Awareness of breathing – Balance between the two
nostrils.
2. There is intimate connection between mind and Prana.
Pranayama
Cooling Pranayamas
Sitkari (Folded – up – Tongue Pranayama)
Sitali (Beak – Tongue Pranayama)
Sadanta (Suck – through – Teeth Pranayama
Relaxation Techniques
Instant Relaxation Technique (IRT)
Quick Relaxation Technique (QRT)
Deep Relaxation Technique (DRT)
Meditation
Omkar Meditation
Mudra
Aswini Mudra
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