Saturday, March 06, 2010

Diabetic? Also Pregnant?

diabetes kit, wpcontent.answers.com

Remain Alert About Congenital Complications

Imagine the surprise on the face of the primi-gravida - the first-time pregnant woman - upon being told that her blood samples have revealed high levels of glucose. Gestational diabetes mellitus (GDM) is a medical condition that has the element of surprise inherent in it. People don't know they have it till they come for regular screening in the early days of the pregnancy.

image by memoossa, sxc.hu

For the woman, the implication of having contracted GDM is that she has a higher-than-moderate chance of developing type 2 diabetes mellitus going forward. The why behind GDM is unknown; but it has been observed that older women (above 35), smokers, those with diabetes in family history, and those with specific ethnic backgrounds (African-American, Afro-Caribbean, Native American, Hispanic, Pacific-Islander, as well as from the Indian subcontinent) are especially prone. About 7% of all pregnancies are affected by GDM.

image by rotorhead, sxc.hu

The how behind GDM is fairly clear: secretion of diabetogenic hormones at the placental level takes place, coupled with the deposition of maternal adipose, lack of exercise and increased caloric intake, all together bring about a host of physiological changes to such an extent that the pancreatic islet function falls short. The consequence is the impaired tolerance to glucose, which is what GDM is.

image by rotorhead, sxc.hu

It has also been observed that obese gravida have higher chance of experiencing GDM than do the non-obese. The risk of GDM is directly proportional to one's BMI.

image by mzacha, sxc.hu

The neonate too doesn't escape from the aftermath of the GDM. Macrosomia (abnormally large size of the body, or "large-for-gestational-age" (LGA) fetus), hypoglycemia, hypocalcemia, polycythemia and hyperbilirubinemia are some of the complications that afflict up to 25% of such offspring. Congenital malformations are the most common cause of perinatal death among these infants.

image from Wikimedia.org

Given these complications, it is no wonder then that, as late as the early 1980s, physicians used to advice diabetic women against pregnancy. Recent studies have attempted to create subgroups of pregnant women who can be administered different therapeutic / control interventions depending on various factors, in order to reduce the risks to congenital anomalies. According to one such study, women with adequate weight, diagnosed with two 100-g OGTT (oral glucose tolerance test) abnormal values, and without anybody in the immediately family having been diagnosed with diabetes, form a low-risk group. This group may be administered one level of insulin therapy. On the other end of the spectrum is the subgroup of obese women, diagnosed with four abnormal 100-g OGTT values and at least one of whose kith and kin is diabetic. This is a high-risk group, and needs to be administered another level of insulin therapy.

image by pzado, sxc.hu

If you or anybody in your circle is planning pregnancy, it might do a lot of good if the appropriate tests are undergone to determine diabetes - and especially GDM - susceptibility, and assess the level of risk involved beforehand. Correct intervention at the right stage will reduce the randomness involved in the delivery of a healthy progeny.

image by ddrlfoto, sxc.hu

[While this was a very clinical discussion on the subject of diabetes, for a more philosophical approach to this medical condition, click on: "Diabetes - Silent Killer? Or Awakener?".]

image by missmilano, sxc.hu

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