DIABETES MELLITUS (DM) IN PREGNANT WOMEN

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DIABETES MELLITUS (DM) IN PREGNANT WOMEN
How yoga helps?

• Dr. Shamanthakamani Narendran
• MD (Pead), PhD (Yoga Science)

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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.

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• 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.

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• 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.

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Women and diabetes

• Diabetes no longer means
• Abstinence
• Amenorrhea
• Inability to conceive
• Inability to deliver healthy children
• Death during pregnancy

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Diabetes and fertility

• Delayed menarche in T1
• Menstrual abnormalities
• Premature Ovarian Failure
• PCOD

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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

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Fetal morbidity in GDM

• Miscarriages
• Growth restriction
• Fetal macrosomia

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Newborn complications

• Birth defects
• Birth injury
• Polycythemia
• Hypoglycemia
• Hypocalcemia
• Hyperbilirubinemia
• Respiratory problems

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Maternal morbidity

• Diabetic retinopathy
• Renal complications
• Chronic hypertension
• Preeclampsia

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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

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Screening for GDM

• 1 hr GCT
• 140 mg
• 130 mg
• 75 g GTT
• 2 h 155 mg

• 100 g GTT
• 1 h 180 mg
• 2 h 155 mg
• 3 h 140 mg

Any time of day No regards to meals
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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 In any two or more values are elevated, the glucose tolerance test result must be considered abnormal In any two or more values are elevated, the glucose tolerance test result must be considered abnormal
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Criteria for diagnosis of impaired glucose
tolerance and diabetes with 75 gm (WHO) oral
glucose
Time Normal Impaired glucose tolerance Diabetes
Fasting lt105 105 to lt140 gt/ 140
2 hours post glucose lt 160 160 to lt200 gt/ 200
Venous whole blood values are 15 less than the plasma m mol/L mg x 0.0555 Venous whole blood values are 15 less than the plasma m mol/L mg x 0.0555 Venous whole blood values are 15 less than the plasma m mol/L mg x 0.0555 Venous whole blood values are 15 less than the plasma m mol/L mg x 0.0555
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Management

• Dietary therapy
• Glucose monitoring
• Insulin therapy
• Oral hypoglycemic agents Metformin
• Timing of delivery

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Management of delivery

• Referred to well equipped hospital to prevent
  maternal and fetal complications.

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DIET
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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 gt 27

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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.

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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.

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Food Selection Pyramid

• Prefer
• Bajra,
• Jowar,
• Wheat flour mixed with black channa flour whole,
• Split sprouted pulses,
• Green leafy vegetables fresh fruits,
• Skimmed milk curd,
• Light tea,
• Vegetable juices.

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Food Selection Pyramid

• Limit
• Rice,
• Biscuts,
• Naan food prepared with maida,
• Roots tubers potato, arbi jimikand sweet
  potato,
• Whole milk,
• Tea coffee

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Food Selection Pyramid

• Avoid
• Fat,
• Sweets,
• Pastries,
• Fruits like mango, grape, banana, chiku dates,
  custard apple,
• Cold drinks alcoholic drinks,
• Non-veg food stuffs,
• All nuts oil.

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Yoga practices

• Hands in out Breathing
• Hands stretch breathing
• Ankle stretch breathing with wall support
• Side twist breathing
• Instant relaxation technique IRT

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Yoga practices

• Leg raise breathing
• Hip raise breathing
• Spine abdominal stretch breathing
• Cycling in the supine pose
• Tiger breathing

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Yoga practices

• Ankle rotation
• Kneecap contraction

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Yoga practices

• Eye exercises
• Alternate nostril breathing
• Shavasana in left lateral position.

Avoid

• Jogging
• Suryanamaskar
• Kapalabhathi Bhastrika

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Group practice
Hands In Out
Ankle Stretch
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Tiger Stretch
Side Stretch
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Loosening Exercises
Forward Bending
Backward Bending
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Sitting Postures
Vajrasana
Ardha Matsyendrasana
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Badha Konasana
Squatting
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Uphavista Konasana
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Sasankasana
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Supine Postures
Viparita Karani
Viparita Karani with Wall Support
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Pranayama

• Mastery over Prana
• Slowing of breath
• Awareness of breathing
• Balance between the two
  nostrils.
• 2. There is intimate connection between mind and
  Prana.

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Cooling Pranayamas

• Sitkari (Folded up Tongue Pranayama)
• Sitali (Beak Tongue Pranayama)
• Sadanta (Suck through Teeth Pranayama

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Relaxation Techniques

• Instant Relaxation Technique (IRT)
• Quick Relaxation Technique (QRT)
• Deep Relaxation Technique (DRT)

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Meditation
Omkar Meditation
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Mudra
Aswini Mudra
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