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Iqra Mazhar

Postpartum depression and anxiety are the parts of postpartum we rarely talk about. Around 8 – 10% of mothers experience PPD, which often goes unattended.

Behind The Scenes Of Postpartum Care

This article or video has been recorded by a subject / domain specialists with a proven track record of excellence in their area. 

Madeeha Syed

This article or video has been vetted and verified by Meri Sehat’s specialists. It contains citations and research from validated sources.

Your Body After Giving Birth

Overview

Post-pregnancy or postpartum is a crucial period. It&rsquo;s also known as the fourth trimester. This is when your body is <a href="https://merisehat.pk/disease/chronic-fatigue-syndrome">recovering from the fatigue</a> of pregnancy.

During pregnancy, the body goes through a lot of changes to accommodate your baby. The body eventually goes back to normal, but this can take a while.&nbsp;

Continue reading to find out more about some common changes that take place in your body, after you give birth. 
&nbsp;

Post-pregnancy or postpartum

During pregnancy, hair growth gets better and the texture of hair gets thicker. This is all thanks to the hormones that are active during that phase. However, post-delivery, this phase settles down and enters into a resting phase for about one to five months. Normal hair growth pattern usually returns six to 15 months after delivery. 
&nbsp;

Shoe surprise is pretty common after pregnancy. It is not just the midsection that gets affected. After a baby is born, your shoe size changes permanently. That is because during pregnancy women gain an average of 25-35 pounds which puts extra pressure on the feet. This pressure flattens out the arch in your feet which is the reason for extra inches in your feet. 
&nbsp;

Belly bulge is common after pregnancy. A lot of women expect that the belly will return to its normal size after birth. The upper portion of the uterus is at the level of your navel. Post-pregnancy belly returns to its normal size in about six to eight weeks. A good diet and exercise are the key to toning down your belly. Workouts focused on the core can show quick results. 
&nbsp;

A common expectation of most women is that the breast size will go up after giving birth and breastfeeding. Once you stop breastfeeding, however, the size goes back to what it was. In fact, in some cases, it goes a cup down. The main reason for the size to increase is that fat tissue in the breast is replaced by functional tissue. Once a woman stops breastfeeding, functional tissue depletes as it is no longer needed. 
&nbsp;

The first six months of the post-partum period are the recovery period. No matter how easy or smooth your pregnancy is, your body has gone through a lot of stress and trauma. It needs time to recuperate. Remember that every mom goes through a different experience and symptoms; hence, the recovery rate also changes.

Most of the symptoms, like sore nipples, backache, pain in the thigh area, etc., continue for more than a week. Other symptoms, like leaky breasts, can linger on for months.

In vaginal delivery, recovery timelines vary depending upon the kind of delivery. The soreness and perennial pain go away in three weeks. However, in the case of vaginal tear or episiotomy (incision made on the vagina to ease the delivery process), recovery can take up to six weeks.

If you have been delivered through c-section, it will take around three to four days in the hospital to recover. In about four to six weeks you can recover completely. 
&nbsp;

For the first 24 hours after birth, ice your perineum region. Sit in warm baths for 20 minutes to ease pain and avoid long periods of standing or sitting.

Ease pain and aches by taking hot showers and massages.

Do your Kegel exercises, to strengthen your pelvic muscles.

Keep up with your doctor appointments. It will help you stay on track. Your doctor can also notify you about your emotional well-being and help you with your new journey.

Ask your doctor regarding your workout plan. They can guide you about how and when can you exercise. It is a good idea to start by walking into your house and then gradually into the neighbourhood. Walking helps in recovery by improving blood circulation and toning muscles. 
&nbsp;

Bottom Line

Your diet after pregnancy shouldn&rsquo;t be very different from what you eat during pregnancy. Avoid processed foods. Focus on eating whole grains, high fibre foods, Omega-3 fatty acid-rich food, nuts, and fish.&nbsp;

<ul>
	<li>Lean Meat: Milk, cheese, and yogurt are all crucial components of a breastfeeding mother&#39;s diet. Your infant receives calcium from breastmilk for the formation of bones. Consume foods high in calcium to replenish the calcium your body has lost. Include three cups of dairy in your diet each day.</li>
	<li>Pulses: These are a good source of protein and fibre. You can cook them with different seasonings to make them tasty and easy to eat. Pulses also prevent fat from accumulating in the body.</li>
	<li>Vegetables:&nbsp;These are low-calorie healthy food. They are rich in antioxidants and aid in losing weight. Spinach and broccoli are good sources of Vitamin A which is healthy for you and your baby.</li>
</ul>

Once the baby is born, you can resume most of the food you avoided during pregnancy. Include nutrient-rich foods like legumes, proteins, fibre, citrus fruits, and vegetables. Don&rsquo;t forget to keep yourself hydrated. You may consult a dietician and your doctor in designing your diet plan.

Namwer Rao

What Happens To Your Body After Giving Birth

Giving birth is a life-changing experience. You&rsquo;ve just brought a new baby into this world, which is an incredible, miraculous feat in itself, but it also means that your body has been through quite an ordeal. You may have experienced some pain during labor and delivery, or perhaps you&rsquo;re still recovering from an episiotomy or C-section incision. No matter what kind of birth experience you had, it&rsquo;s important to take good care of yourself now so that you can heal properly. In this article, we&rsquo;ll talk about what happens to your body after giving birth and how best to care for yourself during the recovery process. 
&nbsp;

Post baby body

After giving birth, your uterus will become smaller and return to the shape it had before you became pregnant. This process can take up to six weeks, but it can happen faster if you have a cesarean section or if you have your baby naturally (vaginally). 
&nbsp;

You&rsquo;ll lose weight and muscle mass which can cause you to look different than you did before your pregnancy.

Your breasts will lose some of their volume as breast tissue shrinks. Your uterus will shrink back down to its pre-pregnant size as well.

You&rsquo;ll also notice that your stomach is flatter and less rounded than it was before delivering your baby. Your hair will likely grow back first, followed by another six months or so until any other changes are noticeable. 
&nbsp;

You may have cramping and pain. This can be uncomfortable, but it&rsquo;s a normal part of healing after delivery.

You may have a fever. This usually starts about 48 hours after birth and will go away on its own within a week or so as your body heals. It can also happen if you are breastfeeding and the baby has thrush (an infection of yeast in their mouth). If your temperature goes above 100 degrees Fahrenheit (37 degrees Celsius), <a href="https://merisehat.pk/doctor-now" target="_blank">call your doctor</a> right away!

A fever could mean that you had an infection during pregnancy or while giving birth (puerperal sepsis) and need antibiotics right away; this is highly unlikely unless you have symptoms such as chills, shaking/shivering, nausea/vomiting with diarrhea, and headaches. 
&nbsp;

This is normal and it will pass. Your body is dealing with a lot of changes, including lower blood pressure and blood sugar levels. 
&nbsp;

When you&rsquo;re ready to start exercising again, it&rsquo;s important that you consult your physician first. Many women think they can immediately resume their normal exercise routine after giving birth, but this isn&rsquo;t always the case. You need a postpartum check-up with your doctor before jumping into any rigorous workouts.

The good news is that most doctors will want to see you after just one week of rest and recovery (or sooner if there are complications). They&rsquo;ll assess how much weight you&rsquo;ve lost since giving birth, as well as take note of any pain or discomfort in your pelvic area and abdomen. If everything looks good, then they&rsquo;ll likely give the go-ahead for some light exercise like walking on flat surfaces with support from family members or friends until things feel better &mdash; and then maybe even invite some gentle stretching movements back into play! But don&rsquo;t worry too much if these tips aren&rsquo;t enough; talk with your physician about what activities would be safe for someone recovering from childbirth before getting started yourself! 
&nbsp;

The stitches will feel uncomfortable when you go to the bathroom. You can take painkillers to relieve the discomfort, but if that doesn&rsquo;t help, talk to your doctor about stronger medications.

You may also feel some discomfort from gas and bloating, which happens because of all the food your body has been absorbing in preparation for breastfeeding. In order to minimise these side effects, it&rsquo;s important not to eat anything for a few hours before feeding your baby&mdash;and make sure that whatever you do eat is high in fibre and low on fat. 
&nbsp;

Postpartum bleeding (lochia) may last for several weeks after delivery. Lochia is the normal discharge that comes from the vagina after giving birth, and it contains blood, mucus and tissue from the lining of your uterus. The amount of blood varies greatly among women, but most new mothers can expect to see some sort of discharge for six weeks or so after giving birth.

If you experience heavy bleeding more than two weeks after giving birth, contact your doctor immediately. 
&nbsp;

To avoid infection, you&rsquo;ll want to:

<ul>
	<li>Take a shower or bath</li>
	<li>Change your pads frequently, especially if they&rsquo;re not waterproof</li>
	<li>Wash and dry yourself well in the genital area after using the bathroom. If you have stitches, use medicine that has been prescribed by your doctor for cleansing stitches 
	&nbsp;</li>
</ul>

Eat healthy food that is high in protein and low in fat (a few small meals throughout the day), such as peas, beans, and fish (not red meat). Avoid junk foods like chips or chocolate bars; they won&rsquo;t give you much nutritional value.&nbsp;

Get plenty of rest so your body can repair itself from all those intense contractions during labor; don&rsquo;t worry about taking naps &mdash; it&rsquo;s okay to sleep whenever it&rsquo;s easy for you. If you feel tired during the day, try lying down on a couch instead of sitting up straight at a desk or table. 
&nbsp;

We hope you feel more prepared for what is to come. It can be overwhelming, but the best thing to remember is that your body knows what it&rsquo;s doing and will get back to normal soon enough. If you have any concerns about your health or recovery, don&rsquo;t hesitate to talk with your doctor!

Umna Salah

Humza Khizer

Baby Blues (Postpartum Depression): Is There A New Treatment?

The entire process of pregnancy is very rewarding, but what happens after you have delivered the baby? Your body that has gone through so many constant changes over the 9 months, reverses them all to get you back to normal. This process often leads to postpartum <a href="https://www.merisehat.pk/disease/depression">depression</a>.

About 11% of women in the United States suffer from postpartum depression (PPD).<a href="#accordion">[4]</a>&nbsp;PPD affects not just the life of the mother but also the infant. If left untreated, it can get worse and affect your spouse or other people close to you. So far, the treatment used for PPD has been very generic; similar to that of major depressive episode (MDE) consisting of conventional antidepressants like SSRIs, benzodiazepines, and tricyclic antidepressants. FDA has recently approved the first-ever drug targeted toward treating postpartum depression. 
&nbsp;

Understanding The Latest Treatment For Postpartum Depression

Postpartum depression is best explained as a worsened form of postpartum blues or baby blues. Baby blues are experienced a few days after delivery. Some new moms, however, experience a much more severe case of baby blues that can be classified as postpartum depression and it can go on for over a year.<a href="#accordion">[8]</a>&nbsp;PPD is characterized by:

<ul>
	<li>Feeling depressed and low</li>
	<li>Sleeping too little or too much</li>
	<li>Feeling tired all the time</li>
	<li>Doubting yourself as a mother</li>
	<li>Thinking that you do not want the baby</li>
	<li>Excessive crying</li>
	<li>Loss of appetite</li>
	<li>Anxiety and panic attacks&nbsp;</li>
	<li>Thoughts of harming yourself or the baby</li>
	<li>Unable to think clearly or make the right decisions</li>
	<li>Increased anger and irritability</li>
	<li>Overall reduced interest in everything</li>
</ul>

If you or anyone that you know are facing any of these symptoms, immediately contact your physician and get yourself screened through the Edinburg Postnatal Depression Scale (EPDS). It is one of the most common and quickest screening tools with high accuracy and allows your physician to assess the situation better through the score.&nbsp; 
&nbsp;

A lot of factors contribute to postpartum depression.The biggest factor that is not only responsible for PPD but also for the baby blues is the drastic change in hormones. During pregnancy, your estrogen and progesterone levels are very high. As soon as the baby is delivered, these levels are dropped drastically.

Since estrogen is directly linked to increasing serotonin levels in our brain&nbsp;and progesterone is known for stimulating dopamine release, the decrease in the production of these hormones coupled with some underlying mental issues or previous history of depression or anxiety becomes the most common and the biggest cause of PPD.<a href="#accordion">[2][3][7]</a> 
&nbsp;

While screening of postpartum depression can be done by several tools that are used for Major Depressive Episodes (MDE), the most universally acceptable tool targeted especially for PPD is Edinburgh Postnatal Depression Scale or EDPS. EDPS is a 10-item questionnaire with a response score of 0 to 3. If the total score is over 12, then there is a need for further in-depth assessment of the situation and severity of the condition.&nbsp;

PPD is best diagnosed by your medical practitioner through regular visits. Your doctor asks a series of questions every few days to assess your mental health and well-being. Another way to differentiate PPD from baby blues is to ensure that the patient has at least 3-5 of the symptoms that make up PPD. The generalized diagnostic criteria used for PPD are similar to the one used for Major Depressive Episode (MDE). Immediate attention is recommended to avoid any worsening of the symptoms and from transitioning of PPD to postpartum psychosis. 
&nbsp;

So far, the treatment of postpartum depression is similar to that of conventional major depressive disorder. Special attention is paid to the excretion of the drug and the concentration of the drug removed from the body through breast milk.

The following antidepressants are commonly used to treat postpartum depression due to their low levels of excretion in breast milk, making it safe for use if you are a breastfeeding mother:

<ul>
</ul>

<ul>
	<li>Fluoxetine</li>
	<li>Paroxetine</li>
	<li>Sertraline</li>
	<li>Bupropion</li>
	<li>Amitriptyline</li>
	<li>Doxepin</li>
	<li>Desipramine</li>
	<li>Tranylcypromine</li>
	<li>Trimipramine</li>
	<li>Desipramine</li>
	<li>Paroxetine</li>
	<li>Escitalopram</li>
</ul>

These antidepressants come with some common side effects that include nausea, vomiting, dizziness, sexual issues, diarrhea, blurry vision, weight gain, increased perspiration, etc.<a href="#accordion">[6]</a> 
&nbsp;

Brexanolone (under the brand name of Zulresso) got approved by the FDA as the first drug targeted toward PPD. Brexanolone is approved with a Risk Evaluation and Mitigation Strategy (REMS) which means that it is currently a controlled medicine available through a restricted distribution channel to carefully assess the conditions of the patients throughout the treatment. The program is currently known as Zulresso REMS Program.<a href="#accordion">[5]</a>&nbsp;Currently, to get Brexanolone administered to you for treating your PPD, you are required to enroll in the Zulresso REMS program.&nbsp; 
&nbsp;

<ul dir="ltr">
	<li>
	<h5>Mechanism Of Action</h5>
	</li>
</ul>

Brexanolone is a synthetic form of allopregnanolone. Allopregnanolone is a neurosteroid. Neuroactive steroids are a group of substances that change a receptor&rsquo;s response to a stimulus by binding to them.<a href="#accordion">[4]</a>&nbsp;Allopregnanolone is best understood as a metabolite of progesterone, which is a GABA-A receptor agonist. This means that progesterone is responsible for increasing GABA functions.

The exact mechanism of the drug and of allopregnanolone is still unknown. Their enhancement of the functions of GABA (Gamma-aminobutyric acid) means that it will inhibit neuronal excitability by blocking messages that are sent to our nervous system with the help of certain stimuli. This not only aids in dealing with depressive triggers but also helps with anxiety.<a href="#accordion">[1]</a> 
&nbsp;

<ul dir="ltr">
	<li>
	<h5>Dosage And Administration</h5>
	</li>
</ul>

Zulresso is administered intravenously. The dosage is determined by your doctor based on your weight and other factors. The drug is administered over a period of 2.5 days or 60 hours and requires constant monitoring due to the risk of unconsciousness.<a href="#accordion">[5]</a> 
&nbsp;

<ul dir="ltr">
	<li>
	<h5 dir="ltr">Adverse Effects</h5>
	</li>
</ul>

Since the drug is relatively new, there are a limited number of side effects reported so far. They include:

<ul>
	<li>Dry mouth</li>
	<li>Dizziness</li>
	<li>Flushed skin</li>
	<li>Losing consciousness</li>
</ul>

<h5 dir="ltr">Important!</h5>

FDA has advised to stop the treatment of Zulresso if more serious side effects occur that may include the worsening of PPD and suicidal thoughts especially in women under the age of 25. 
&nbsp;

Current research suggests that brexanolone may interact with other CNS depressants like opioids and benzodiazepines and increase the severity of the adverse effects with regard to sedation. Alcohol consumption is also not advised due to similar reasons.

During the clinical trials, patients who were taking antidepressants also showed a more severe case of sedation as compared to the ones who did not or were a part of the placebo studies. 
&nbsp;

Conclusion

Considering the rapid onset of action with brexanolone especially when compared to the long-term treatments offered by conventional antidepressants, it is believed that brexanolone can take over the go-to therapy for PPD. However, a much more convenient way of administration would be through oral pills instead of I/V. There are still many concerns left that can only be answered through long-term data in a lesser restricted environment as opposed to a clinical trial setting.&nbsp; 
&nbsp;

Key Points

<ul>
</ul>

<ul>
	<li>Current antidepressant therapies employed for PPD are based on&nbsp;long-term treatment.</li>
	<li>Brexanolone&rsquo;s onset of action is fast and has shown significant improvement in women of all ages suffering from PPD.</li>
	<li>Some women under the age of 25 were observed to experience severe side effects that even led to the worsening of their PPD.</li>
	<li>The drug is still under strict observation with the help of the REMS program.</li>
	<li>Administration coupled with the duration over which it has to be administered can make it difficult to commercialize as compared to drugs that are available in the form of oral pills.&nbsp;</li>
</ul>

[1] Allen B, Vespa PM. Antiseizure medications in critical care: An update. Curr Opin Crit Care. 2019;25(2):117-125

[2] ATP Science, 2021. HOW DOES PROGESTERONE CREATE A DOPAMINERGIC RESPONSE?. [Online] .

[3] Debra Fulghum Bruce, P., 2020. Postpartum Depression. [Online].

[4] Fala, L., 2019. Approved by the FDA Specifically for Postpartum Depression in Adults. [Online]

[5] Federal Drug Administration, 2019. FDA approves first treatment for post-partum depression. [Online]

[6] Fields, L., 2021. Which Antidepressants Treat Postpartum Depression?. [Online]

[7] Matthew Hoffman, M., 2021. Estrogen and Women's Emotions. [Online]

[8] Mayo Clinic, 2022. Postpartum depression. [Online]

Ismail Munir

Can Gestational Diabetes Be Reversed?

Introduction

The International Diabetes Federation (IDF) estimates that by 2030 an estimated 783 million adults will be living with <a href="https://www.merisehat.pk/disease/diabetes-type-1-and-2">diabetes</a>&nbsp;<a href="#accordion">[1]</a>.&nbsp;According to the latest figures, the prevalence of diabetes has steadily increased in low- and middle-income countries. With a 70% increase since 2019, Pakistan has the highest diabetes prevalence in the world<a href="#accordion">[1]</a>. Moreover, an estimated 11 million adults have Impaired Glucose Tolerance (IGT); thus, increasing their risk of <a href="https://www.merisehat.pk/disease/diabetes-type-1-and-2">type 2 diabetes</a>&nbsp;<a href="#accordion">[1]</a>. However, researchers have not only reported an increase in cases of type 2 diabetes but also gestational diabetes mellitus (GDM).&nbsp; 
&nbsp;

The true prevalence of gestational diabetes in Pakistan remains unclear due to varying risk factors and diagnostic criteria. A cross-sectional study conducted across hospitals in Karachi and Hyderabad found a prevalence of 11.9%<a href="#accordion">[2]</a>. Another study conducted at The Indus Hospital in Karachi reported a 17.7% prevalence of GDM<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

Understanding Gestational Diabetes

Gestational diabetes develops due to a combination of beta cell dysfunction and increased insulin resistance during pregnancy. The resulting hyperglycemia is detrimental to both maternal and fetal health. Complications such as neonatal hypoglycemia, stillbirth, macrosomia, shoulder dystocia, breathing difficulty, and maternal preeclampsia can occur.&nbsp; 
&nbsp;

Although maternal blood glucose levels return to normal after birth, approximately half of the women with gestational diabetes go on to develop type 2 diabetes<a href="#accordion">[4]</a>. Moreover, there&#39;s a two in three chance that Gestational Diabetes Mellitus (GDM) can return in future pregnancy<a href="#accordion">[5]</a>. However, proper antenatal and post-natal care can ensure that one&#39;s GDM stays reversed and their glucose levels remain within target.&nbsp;

&nbsp;

Gestational diabetes typically develops during the second trimester and is diagnosed between 24 to 28 weeks of pregnancy. Depending on the diagnostic criteria, doctors may conduct the following tests for diagnosing GDM: 
&nbsp;

<ul>
	<li>Initial Glucose Challenge Test - Patients drink a 50g glucose solution; after one hour, blood glucose levels are checked. Measurements &gt;140mg/dl point to a high risk of gestational diabetes. It is often followed by an oral glucose tolerance test to confirm a diagnosis of gestational diabetes. 
	&nbsp;</li>
	<li>Oral Glucose Tolerance Test (OGTT) - Patients must present in a fasting state for the test. After drinking a 100g glucose solution, samples are drawn every hour for a total of 3 hours. Diagnosis is based on blood glucose levels in fasting state, 1-hour, 2-hour, and 2-hour post glucose solution.&nbsp; 
	&nbsp;</li>
</ul>

The International Association of Diabetes and Pregnancy Study Groups (IADPSG) 2010 criteria recommends a one-step approach<a href="#reference" target="_blank">6</a>. Blood samples are drawn in a fasting state, and then 1- and 2-hours after drinking a 75g glucose solution (OGTT). While most women are screened during the second trimester, those at high risk may undergo screening at their first prenatal visit.&nbsp; 
&nbsp;

Non-modifiable risk factors of GDM include a family history of diabetes, increasing maternal age (&gt;25years), and a history of GDM. Although these cannot be controlled, several modifiable risk factors also exist for gestational diabetes. These include obesity, polycystic ovary syndrome, prediabetes, diet, and physical activity.&nbsp; 
&nbsp;

Antenatal interventions are aimed at making women aware of the risks associated with gestational diabetes and ways to control the modifiable risk factors of the disease. Moreover, they should be made aware of their blood glucose level targets. 
&nbsp;

<h5>Blood Glucose Monitoring</h5>

Using a glucose meter or sensor, pregnant women with GDM should daily test their fasting, pre-meal, 1-hour postprandial, and bedtime glucose levels. According to the American Diabetes Association (ADA), pregnant women with gestational diabetes should maintain their blood glucose levels within the following range<a href="#accordion">[7].</a>

<ul>
	<li>Fasting plasma glucose levels: less than 95mg/dl</li>
	<li>1-hour postprandial glucose levels: less than 140mg/dl</li>
	<li>2-hour postprandial glucose levels: less than 120mg/dl 
	&nbsp;</li>
</ul>

<h5>Dietary Changes</h5>

A certified dietician can help ensure that the mother reaches her caloric requirements and achieves a healthy weight gain during pregnancy. Women are mostly advised to eat 3 small-sized meals and three to four healthy snacks during the day. Moreover, a bedtime snack is recommended to help keep fasting blood glucose levels within range.&nbsp; 
&nbsp;

The recommended nutrition plan for women with GDM should contain a minimum of 175 g of carbohydrate, a minimum of 71 g of protein, and 28 g of fiber. Sugar and saturated fats are mostly limited.&nbsp; 
&nbsp;

<h5>Physical Activity</h5>

Regular exercise can help keep blood glucose levels within normal and combat insulin resistance. Recommended physical activity for pregnant women includes aerobic exercises like walking and swimming. 30 minutes of exercise for 3-5 days a week is often considered adequate. However, one should consult their doctor before starting any form of exercise during pregnancy.

&nbsp;

<h5>Insulin</h5>

If dietary changes and physical activity are unable to maintain blood glucose levels, doctors may prescribe insulin injections to pregnant women. Insulin is the first choice in gestational diabetes due to its safety profile and inability to cross the placenta. Metformin and sulfonylureas are contraindicated due to adverse outcomes in the fetus. However, with daily insulin injections, it is important that women are made aware of the risks of hypoglycemia.&nbsp;

&nbsp;

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Since blood glucose levels and insulin resistance decrease drastically after birth, it is important to re-evaluate a woman&#39;s insulin requirement. Most women do not require further treatment with insulin. However, blood glucose levels are checked the day after birth.&nbsp; 
&nbsp;

The American Diabetes Association recommends the following for postpartum care of gestational diabetes<a href="#accordion">[7]</a>.

<ul>
	<li>Using the 75g oral glucose tolerance test, screen women at 4-12 weeks postpartum</li>
	<li>Lifelong screening for type 2 diabetes or prediabetes every 1 to 3 years</li>
	<li>If women are found to have prediabetes, they should seek an experienced diabetologist that can advise lifestyle interventions and any diabetes medicines if needed.</li>
	<li>Psychosocial assessment of women should also be included in postpartum care 
	&nbsp;</li>
</ul>

According to research, diets consisting of &#39;high refined grains, fats, oils and fruit juice&#39;, &#39;high nuts, seeds, fat and soybean; low milk and cheese&#39;, and &#39;high added sugar and organ meats; low fruits, vegetables and seafood&#39; is associated with an increased risk of gestational diabetes<a href="#accordion">[8]</a>. Therefore, women with GDM are advised to continue with a healthy diet plan following birth. This will reduce their risk of developing gestational diabetes in future pregnancies. 
&nbsp;

Moreover, women with a history of GDM have a 10-fold higher risk of developing type 2 diabetes mellitus than non-GDM women<a href="#accordion">[9]</a>. Lifestyle interventions such as weight loss, healthy diet, daily exercise and/or metformin use can help reduce the progression of the disease. These modifications can further reduce the risk of cardiovascular complications in women with a history of GDM. 
&nbsp;

&nbsp;

The lack of awareness among the general population combined with limited healthcare access is a barrier to the prevention and management of gestational diabetes in low and middle income countries. Moreover, there is no universal consensus on GDM screening. However, multiple diagnostic criteria are available for diagnosing gestational diabetes. Therefore, there is a need for not only general awareness programs but also effective screening tests that can diagnose the condition early on. Preconception diabetes screening can help prevent GDM-related complications and congenital abnormalities. 
&nbsp;

Gestational diabetes can be quite a distressing state for a mother. It is important that family members are involved in providing emotional support to the mother. Psychological counselling might also be beneficial. Moreover, a healthcare professional should review contraceptive options as part of postpartum care as unplanned pregnancies can further increase the risk of complications.&nbsp; 
&nbsp;

<ul>
	<li>Gestational Diabetes Mellitus (GDM) is the most common metabolic disorder of pregnancy and affects both maternal and neonatal health. Common complications include neonatal hypoglycemia, macrosomia, obstructed labor, stillbirth, preterm delivery, increased risk of shoulder dystocia, maternal preeclampsia, and increased risk of type 2 diabetes in both mother and child.&nbsp;</li>
	<li>In women with GDM, blood glucose levels return to normal shortly after birth. However, 50% of women are at risk of developing type 2 diabetes in the future, and 2 in 3 women have a risk of developing GDM in a future pregnancy.</li>
	<li>A healthy and balanced diet, regular physical activity, blood glucose monitoring, and the use of insulin can help maintain blood glucose levels within the normal range in pregnant women with GDM. The American Diabetes Association (ADA) recommends fasting blood glucose levels &lt;95mg/dl, 1-hour postprandial levels &lt;140mg/dl, and 2-hour postprandial levels &lt;120mg/dl during pregnancy.</li>
	<li>4-12 weeks postpartum, women with GDM should undergo testing with 75g-OGTT. Moreover, they should be tested every 1-3 years for risk of type 2 diabetes.&nbsp; 
	&nbsp;</li>
</ul>

[1].International Diabetes Federation, 2021. With 1 in 4 adults living with diabetes, Pakistan has highest diabetes prevalence in the world. s.l.:s.n.

[2].Riaz, M. et al., 2019. Frequency of gestational diabetes mellitus using DIPSI criteria, a study from Pakistan. Clinical Epidemiology and Global Health, 7(2), pp. 218-221

[3].Wali, A. S. et al., 2020. High proportion of overt diabetes mellitus in pregnancy and missed opportunity for early detection of diabetes at a tertiary care centre in Pakistan. Pakistan journal of medical sciences, 36(1), pp. 38-43.

[4].CDC, 2021. Gestational Diabetes. [Online]

[5].American Diabetes Association, n.d. Gestational Diabetes - Treatment & Perspective.

[6].Rani, P. R. & Begum, J., 2016. Screening and Diagnosis of Gestational Diabetes Mellitus, Where Do We Stand. Journal of Clinical and Diagnostic Research, 10(4).

[7].American Diabetes Association, 2021. Management of Diabetes in Pregnancy. In: Standards of Medical Care in Diabetes. s.l.:s.n.

[8].Shin, D., Lee, K. W. & Song, W. O., 2015. Dietary Patterns during Pregnancy Are Associated with Risk of Gestational Diabetes Mellitus. Nutrients, 7(11).

[9].Vounzoulaki, E. et al., 2020. Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis. BMJ, Volume 13

Nimrah H. Sattar

Getting Back To Working Out After Giving Birth

The weeks after one&rsquo;s delivery can be as stressful as they are joyous. Newborn babies need constant attention and it&rsquo;s difficult to take out time to care for oneself. When the baby is down for a nap, it&rsquo;s our chance to get some sleep too or catch up on chores. Naturally, there&rsquo;s very little time or mental space for fitness and physical activity. Plus, there&rsquo;s the physical exhaustion that comes with long nights and breastfeeding. 
However, taking care of our bodies is essential to recovering quickly from pregnancy and childbirth. Taking time out for fitness enables us to better manage the stressors that come with a newborn baby, both physically and emotionally. This, in turn, ensures that we are able to enjoy the joys of new motherhood as well.

<div>&nbsp;</div>

time to recover body

As a new mother, it&rsquo;s important to ensure that you are consuming all of the nutrients that are essential to your health and recovery. If you are breastfeeding, it is even more important that you consume a nutritious diet.&nbsp;

Try to include a good amount of protein in your diet, as well as good fats and essential fatty acids. Eating a sufficient amount of carbs will give you the energy you need to keep up with your baby. Make sure to include fruits and nutrients in your diet as they are an important source of <a href="https://merisehat.pk/article/a-guide-to-essential-vitamins-and-micronutrients-and-should-you-be-taking-them">micronutrients and fibre</a>.&nbsp;

If you have a straightforward vaginal delivery, you can start with gentle movement in the form of short walks as soon as the day you deliver; however, you will have to wait till your epidural has been taken out. If you delivered via a caesarean or faced postpartum complications, you may have to wait a few extra days to give your body time to recover.&nbsp; 
&nbsp;

<h5>Moderate Walking</h5>

Easy to moderate walking is the best way to start moving after childbirth. You can start with just 20 minutes a day and gently build up to half an hour over the course of four to six weeks. Consider breaking up your walks into several walks a day to avoid tiring yourself out and being able to fit them in more easily into your newborn&rsquo;s routine. You could start with two 10-minute walks a day, build that up to two 12-minute walks after a few days and so on. Walking burns calories, while also strengthening muscles and joints, and improving blood circulation. 
&nbsp;

<h5>Postpartum Exercises</h5>

Incorporate gentle postpartum exercises and stretches into your routine in the first few weeks after a delivery. There is a lot of information online about safe postpartum exercises. You can look some up and aim to do them for five minutes a day. YouTube videos focused on postpartum exercises can also be easy to follow along, and if you&rsquo;d like the opportunity to get out of the house, a postpartum exercise or yoga class might just be the thing for you. As with walking, start with just a few minutes a day and slowly build up as your body adjusts.

Your pelvic floor and core tend to be particularly weak after childbirth. Before you move onto high-impact exercises, it is important to build some strength in these parts of the body. You can start doing gentle pelvic exercises, like kegels and pelvic tilts in the first week after your delivery. Aim to do them for about five minutes at a time, up to three times a day. Again, there&rsquo;s no need to do long sessions and tire yourself out. Fitting in smaller movement sessions throughout the day will ensure that you are able to be consistent and don&rsquo;t end up pushing yourself too much.

About a month after childbirth, you can start exercising core exercises into your routine. Again, this also depends on what kind of delivery you&rsquo;ve had and whether you faced any complications during or after. Once again, incorporate a few minutes of core work into your daily movement sessions and break it up into two to three sessions a day.&nbsp; 
&nbsp;

<h5>As A Rule Of Thumb</h5>

You should wait at least six weeks after childbirth to get into high-impact exercises. It&rsquo;s important to prepare your body in the preceding weeks and to also take it slow when you do start with higher impact movement. Make sure to consult your doctor and get their okay beforehand. Even at this stage, start slowly and listen to your body. There&rsquo;s no need to push forward from the get go. What&rsquo;s important is that you maintain consistency and build up in a manner that is doable for you. 
&nbsp;

It&rsquo;s easy to forget to take care of ourselves in the first few months after childbirth. But we need to remember that we need as much love and care as our newborn babies do. Being kind to yourself and patient with your body is especially important after a delivery. Remember, the healthier you feel, the better you&rsquo;ll be able to enjoy the time you get with your newborn!

Ayesha Binte Rashid

The Foot Care Guide For Diabetic Patients

Diabetes foot problems are quite common as, according to the American Diabetes Association, 1 in 5 people with diabetes seek hospital care for it<a href="#accordion">[1]</a>. However, that doesn&#39;t mean everyone with diabetes has diabetic feet. 
&nbsp;

You won&#39;t succumb to diabetic feet if you give your feet all the attention they deserve. It&rsquo;s all the more imperative if your blood sugar levels are continually out of range.&nbsp; 
&nbsp;

In short you need to be proactive while taking care of your feet to avoid diabetic foot or any other complications. 
&nbsp;

Understanding the Foot Care for Diabetic Patients

To understand the correlation between diabetes and foot problems, you first need to have a clear idea about what diabetes really is.&nbsp; 
&nbsp;

<h5>Understanding Diabetes&nbsp;</h5>

Diabetes mellitus, or diabetes for short, is a metabolic disorder that causes high blood sugar levels, which is referred to as hyperglycemia.&nbsp; 
&nbsp;

The reason for diabetes is either absolute or relative deficiency of insulin, or&nbsp; insulin resistance. Insulin is the hormone released by pancreas that helps to maintain a normal level of the blood glucose levels by ensuring glucose uptake in the liver and muscles after a meal.&nbsp; 
&nbsp;

There are 3 different types of diabetes:

1. Type 1 Diabetes Mellitus: This type of diabetes has an autoimmune basis, which means that the body&#39;s own immune cells start attacking the pancreas resulting in absolute deficiency of insulin. The reason behind this autoimmune destruction of cells in the pancreas that produce insulin remains unclear<a href="#reference" target="_blank">2</a>. This type of diabetes affects both children and young adults.

2. Type 2 Diabetes Mellitus: Almost 90-95% of individuals with diabetes have this type of diabetes. It occurs when cells in the body become unresponsive to insulin and the sugar levels peak in the blood resulting in hyperglycemia<a href="#accordion">[2]</a>. 
&nbsp;

3. <a href="https://merisehat.pk/disease/diabetes-gestational">Gestational Diabetes</a>: Some women experience this type of diabetes during pregnancy. Their placenta makes hormones that block insulin from functioning<a href="#accordion">[2]</a>.&nbsp; 
&nbsp;

If left untreated, all three types of diabetes result in blood sugar levels beyond the normal range, which ultimately damages multiple sites in the body like the kidneys, eyes, nerves, and other organs<a href="#accordion">[2]</a>.&nbsp; 
&nbsp;

Some common symptoms of diabetes include<a href="#accordion">[2][3]</a>: 
&nbsp;

<ul>
	<li>Increase in thirst&nbsp;</li>
	<li>Increase in hunger&nbsp;</li>
	<li>Increase in frequency of urination&nbsp;&nbsp;</li>
	<li>Weight loss (individuals with gestational diabetes would have increased weight gain during pregnancy)</li>
	<li>Blurry vision&nbsp;</li>
	<li>Sores that heal slowly or do not heal&nbsp;</li>
	<li>Fatigue&nbsp;</li>
	<li>Numbness or tingling in hand or feet&nbsp;</li>
	<li>Dry or itchy skin 
	&nbsp;</li>
</ul>

Now back to the initial question: how can diabetes cause foot problems? So, diabetes damages the nerves, a condition called diabetic neuropathy. As a result, you may experience pain, tingling, and burning sensation in your affected foot. If the nerve damage is extensive, you may feel nothing at all.&nbsp; 
&nbsp;

While the idea of having an area of skin being pain free may sound great, not being able to have any sensation in any region of your body is far from great. The dangers associated with not being able to sense anything are so serious that it can even cost you losing the affected part through amputation, that is, surgically removing the affected limb. 
&nbsp;

As an individual with diabetic neuropathy, you may not feel a stone or pebble underneath your sole; you won&rsquo;t even feel a blister or if your foot&rsquo;s sore. When these lesions are not treated early on, they can either become the portal of entry for bacteria and other microorganisms causing infection or they can result in ulcer formation due to delayed healing of the skin<a href="#accordion">[4]</a>. 
&nbsp;

Slow healing in diabetic individuals is because the blood vessels supplying the periphery become very narrow which reduces the amount of blood flowing in the leg and foot. This impedes the healing process and infections of the feet often take too long to heal or at times may not heal at all. When an infection doesn&#39;t resolve, it progresses to gangrene (death of a body tissue due to inadequate blood perfusion or due to a serious bacterial infection)<a href="#accordion">[4]</a>.&nbsp; 
&nbsp;

Once gangrene or ulcers form in the foot, treatment&nbsp; options include removing the dead tissue and treating existing infections. In extreme cases amputation of the involved part, such as the toe, foot, or part of the leg is the only option<a href="#accordion">[4]</a>.

Therefore, in order to prevent the loss of a part of your limb, precautions should be taken and foot care needs to be maximized. Controlling blood sugar levels is the only way to prevent diabetic foot<a href="#accordion">[4]</a>. In case a foot problem develops, a foot specialist or a podiatrist needs to be consulted immediately<a href="#accordion">[4]</a>. 
&nbsp;

Nerve damage eventually leads to diabetic foot if not treated. The following risk factors increase the risk of developing diabetic neuropathy<a href="#accordion">[3]</a>: 
&nbsp;

<ul>
	<li>High blood sugar levels that are difficult to manage</li>
	<li>Having a long history of diabetes with blood sugar levels beyond normal ranges</li>
	<li>Being overweight</li>
	<li>Having hypertension (increased blood pressure</li>
	<li>Having high levels of cholesterol</li>
	<li>Being more than 40 years of age 
	&nbsp;</li>
</ul>

There are some measures that you can take to prevent nerve damage<a href="#accordion">[3]</a>:&nbsp;

<ul>
	<li>Maintain healthy blood sugar levels&nbsp;</li>
	<li>Quit smoking since smoking reduces the blood perfusion to the feet</li>
	<li>Use medications as prescribed by the doctor&nbsp;</li>
	<li>Become physically active&nbsp; 
	&nbsp;</li>
</ul>

You need to be consistent with your foot care regimen as it is the only way to prevent foot problems in diabetes. There&#39;s no denying that managing diabetes can get quite overwhelming with trying to maintain your blood sugar levels, going for doctor&#39;s appointments, taking medications, staying active along with eating healthy; and there is a chance that your feet get neglected in the process. 
&nbsp;

However, incorporating foot care into your daily routine will help reduce the risk of developing diabetic feet<a href="#accordion">[3]</a>. Remember, persistence is the key!&nbsp;

Here&#39;s a list of tips that you can follow to ensure that your feet stay healthy: 
&nbsp;

<ul>
	<li>
	<h5>Inspect Your Feet Daily</h5>
	</li>
</ul>

You need to regularly check your feet for any signs of bruises, scar marks, blisters, swelling, sores, calluses, or any change in color of the skin or nail. You can use a mirror to inspect the part of your feet that isn&#39;t visible to you or, if you don&#39;t find it convenient, ask a family member to help you or consult a doctor<a href="#accordion">[3]</a>. The earlier you detect any sore or blister, the easier it is to treat and vice versa.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Don&#39;t Walk Barefoot&nbsp;</h5>
	</li>
</ul>

Always wear slippers at home and shoes outdoors and never walk barefoot even in your house. This is to prevent injuries to the feet. Moreover, make sure that your shoes have no pebbles or any other object that can cause any injury to your feet<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Wash Your Feet Daily With Warm Water&nbsp;</h5>
	</li>
</ul>

Do not use hot water to wash your feet as it will cause skin&nbsp; dryness; instead, use warm water. Also, don&#39;t soak your feet. Just wash them properly and dry them right after<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Moisturize Your Feet</h5>
	</li>
</ul>

Diabetic individuals, especially those who have dry feet, are no strangers to cracks on their feet. The trick is to keep your feet moistened. However, make sure not to apply lotion or moisturizing cream between the toes as it can result in infection<a href="#accordion">[3]</a>&nbsp;and keep the application limited to the heel of the foot.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Choose The Right Shoes&nbsp;</h5>
	</li>
</ul>

Wear shoes that are the right size, not too tight or too loose. It would not only be difficult to walk, but would also increase the chances of developing foot problems. Most importantly, make it a habit to wear socks with your shoes<a href="#accordion">[3]</a>. 
&nbsp;

<ul>
	<li>
	<h5>Properly Trim Toenails</h5>
	</li>
</ul>

Try to cut your nails gently straight across and smooth them with a nail file. Avoid cutting your nails too deep as it may cause a break in the skin and become a space for an infection to set in<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Keep The Blood Flowing&nbsp;</h5>
	</li>
</ul>

To maintain perfusion in the feet, put your feet up while sitting and don&#39;t stand or hang your legs for too long. This is also for women with gestational diabetes as they need proper perfusion in their lower limbs (leg area). Wiggle your toes multiple times in a day to maintain perfusion<a href="#accordion">[3]</a>. 
&nbsp;

<ul>
	<li>
	<h5>Do Not Miss Your Doctor&#39;s Visit&nbsp;</h5>
	</li>
</ul>

Visit your doctor every year or as scheduled for your diabetes. Get your feet properly examined by a feet specialist, more so if your healthcare provider is suspecting diabetic neuropathy. 
&nbsp;

Stay vigilant and if you notice any of the symptoms listed below, consult a healthcare provider immediately to either treat or prevent diabetic foot<a href="#accordion">[3]</a>: 
&nbsp;

<ul>
	<li>Pain in the legs and cramping in the thighs and calves during physical activity&nbsp;</li>
	<li>Inability to sense temperature, pain, or touch over the skin of your foot&nbsp;</li>
	<li>Tingling, painful, and burning sensation in your feet&nbsp;</li>
	<li>Dry skin with cracks</li>
	<li>Thick, yellow toenails&nbsp;</li>
	<li>Signs of fungal infection, such as athlete&#39;s foot&nbsp;</li>
	<li>Any sign of sore, blister, or ulcer anywhere on the foot 
	&nbsp;</li>
</ul>

Diabetes is a very common metabolic disorder and it is associated with a constellation of signs and symptoms. Moreover, the damage caused by diabetes is also widespread as it involves many organs of the body. Diabetic neuropathy affecting the foot is another dreaded complication of diabetes that can cause the diabetic individual to lose sensation over the affected area. It can progress to diabetic foot, which can result in amputation and loss of limb. Optimization of feet care and maintenance of healthy blood sugar levels can prevent the development of this condition.&nbsp; 
&nbsp;

<ul>
	<li>Diabetic foot is one of the common complications of diabetes yet the most dreaded.</li>
	<li>Diabetes causes nerve damage in the peripheries and this is often due to high blood sugar levels that are not managed.</li>
	<li>Nerve damage causes the foot to lose sensation, and blisters, sores, or minor injuries go unnoticed; it&rsquo;s dangerous because these points can become the site of entry for bacteria and result in infection.&nbsp;</li>
	<li>Infection in diabetic foot is often difficult to treat which then progresses to gangrene and ulceration</li>
	<li>Amputation remains the last resort to protect the infection from progressing throughout the body.</li>
	<li>Maintaining normal blood sugar levels and adopting a healthy foot care regimen are the only ways to prevent diabetic foot.&nbsp;</li>
</ul>

[1] Diabetes Foot Care. WebMD. es/caring-feet. Published 2022.

[2] Watson S. Diabetes: Symptoms, Causes, Treatment, Prevention, and More. Healthline.

[3] CDC.

[4] Problems D, Health N. Diabetes & Foot Problems | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases.

Nawal Adnan

A Basic Skincare Guide For Men

Basic skincare is gender neutral: cleanse, exfoliate, and moisturise. But since men have more testosterone in their bodies, male skin tends to be thicker and oilier. This texture slows down the appearance of fine lines and wrinkles, which means that men have a reduced need to apply <a href="https://merisehat.pk/article/collagen-the-secret-to-healthy-skin-hair-and-bones">collagen synthesisers</a>, such as retinol, but an increased need to exfoliate and cleanse. 
&nbsp;

Skincare Guide for Men

The primary form of skincare for men is actually hygiene maintenance.&nbsp;

<ul>
	<li>A good quality cleanser will clean up the top layer of the skin;&nbsp;</li>
	<li>An exfoliator will scoop out dead skin cells, excess oil, and dirt from the pores;&nbsp;</li>
	<li>A moisturiser will restore any essential oil that&rsquo;s been accidentally washed down the drain.&nbsp;</li>
	<li>But since the under-eye area is thinner in texture, men notice the first signs of aging here. This makes under-eye creams and serums a good investment.&nbsp; 
	&nbsp;</li>
</ul>

<h5>What About The Beard?</h5>

Another important aspect of male skincare is the presence or absence of facial hair. People who shave typically use an antiseptic substance, known as aftershave, immediately after. This closes up the pores and kills off any harmful bacteria that might invade the exposed epidermis (top layer of the skin).&nbsp;&nbsp;

However, experts believe that there&rsquo;s actually no real need to apply an aftershave because the same germ and bacteria can be killed with a good splash of soapy water. The same experts also believe that alcohol-based aftershaves are detrimental in the long-term, not to mention painful to use, as they will strip the skin of essential oils.&nbsp;

If needed, natural bactericides, such as coconut and jojoba oil, can be a good alternative to the infamous sting.&nbsp; 
&nbsp;

<h5>Beard Dandruff (Seborrheic Dermatitis)</h5>

If you don&rsquo;t shave at all, you&rsquo;d want to work harder at cleaning out dead skin and dirt from underneath the beard. Otherwise, you&rsquo;d end up with seborrheic dermatitis, which sounds like a terrible disease, but is actually just another name for pesky beard dandruff. One way to prevent this is to apply steam (through a hot shower or a warm, wet washcloth); it softens the skin underneath the beard and makes it easier to exfoliate and cleanse 
&nbsp;

<h5>Gender Neutrality And The Essential Difference</h5>

At the end of the day, basic skincare is extremely gender neutral and revolves around maintaining a good hygiene and delaying premature aging due to UV rays. The idea that skincare is a feminine enterprise is dated and was rooted simply in the aforementioned texture.&nbsp;

The perennial &ldquo;lesser effort&rdquo; in maintaining male skin exists only in one direction - moisturizing and inducing collagen production-, and the other one (keeping it clean) requires twice as much work, especially with the presence of facial hair.&nbsp;

Additionally, since male skin has larger pores, due to the aforementioned sebaceous glands, men who prefer to reduce their appearance can and should use serums for enlarged pores. Everyone has a right to optimise their physical appearance without being shamed for it, especially with something as basic as this. The best way to do it, however, is to understand the science &mdash; or inner workings &mdash; of our respective skin types and address whatever problem naturally occurs.

Zuha Malik

Insulin And Postpartum

The postpartum period refers to the time after you give birth. Your hormonal levels will be fluctuating as your body recovers from the physical and emotional toll of the pregnancy. You&rsquo;ll probably be overwhelmed by all sorts of emotions during this period.

Besides mood, these changes can affect your blood sugar regulation, particularly if you had <a href="https://merisehat.pk/disease/diabetes-gestational">gestational diabetes</a>. However, you can have postpartum diabetes even if you did not have gestational diabetes. 
&nbsp;

Around 2-10% of all pregnant women in the US have gestational diabetes<a href="#accordion">[1]</a>. The condition often shows up during the middle of pregnancy when the placenta produces hormones that prevent the body from efficiently using insulin. Consequently, glucose concentrates in the blood rather than being absorbed by the cells.

The best thing to do after the diagnosis of gestational diabetes is to look after yourself as much as possible. It&rsquo;s crucial to monitor blood glucose during labor and birth. While eating healthy and staying active during pregnancy can help control blood sugar levels, you may need to take insulin as well to control your blood sugar levels and avoid complications, like preeclampsia and birth defects, for you and your baby. 
&nbsp;

Insulin can be injected via pen or syringe and it&rsquo;s generally safe to use as prescribed by your doctor. Using too much insulin or skipping a meal, however, may cause hypoglycemia which can be dangerous for both you and your baby.

Note: If you have type 1 or type 2 diabetes, refer to a professional doctor before getting pregnant as uncontrolled gestational diabetes is not safe for your baby. Moreover, several diabetes tablets are not safe to be taken during pregnancy so your doctor can guide you regarding insulin injections<a href="#accordion">[2]</a>. 
&nbsp;

Understanding the importance of insulin in pregnancy

If you were diagnosed with gestational diabetes, it&rsquo;s important that you get tested for diabetes after delivery. Your doctor will order regular glucose checking for a few days after delivery, usually before breakfast and two hours after meals, to ensure your glucose levels are within the normal range. An oral glucose tolerance test is recommended 6-12 weeks after birth<a href="#accordion">[2]</a>. 
&nbsp;

If your blood glucose level is:

<ul>
	<li>Normal &ndash; Get checked every three years</li>
	<li>Pre-Diabetes &ndash; Get checked every year; talk to your doctor about minimizing your risk of diabetes</li>
	<li>Diabetes &ndash; Consult your doctor and set up a treatment plan 
	&nbsp;</li>
</ul>

The symptoms of gestational diabetes usually disappear in the postpartum period as blood sugar levels return to normal after labor and any medications, including insulin, will be stopped after your baby is born. But it&rsquo;s also possible that it progresses to type 2 diabetes. Around 50% of women with gestational diabetes develop type 2 diabetes<a href="#accordion">[1]</a>. 
&nbsp;

Getting checked helps because type 2 diabetes presents few symptoms during the early stages of the disease. With a timely diagnosis, you can prevent or delay the development of type 2 diabetes by continuing with your treatment, eating healthily, and avoiding a sedentary lifestyle.

Note: For future pregnancies, make sure to inform your healthcare team about your history of gestational diabetes. 
&nbsp;

According to the American Diabetes Association, breastfeeding can help you manage your diabetes<a href="#accordion">[3]</a>.

For the baby, breastfeeding for the first six months at least means a reduced risk of developing type 1 diabetes, obesity leading to type 2 diabetes, and other health issues like eczema and respiratory disease. For the mother, benefits include a lower risk of developing health conditions like breast and ovarian cancers and type 2 diabetes in addition to a quicker recovery after birth. 
&nbsp;

That said, is it safe to take insulin while breastfeeding your newborn? Yes, it is<a href="#accordion">[3]</a>. This is because insulin molecules are large enough to not pass through the breast milk to the baby.

However, the dose needs to be adjusted accordingly after the pregnancy and, again, during breastfeeding. Ideally, the blood sugar level while breastfeeding should be between 90 and 180 mg/dL.

These levels may drop during breastfeeding, a condition known as hypoglycemia, so you should eat before each session to keep the glucose levels stable. And check your blood glucose levels every time before and after nursing. 
&nbsp;

<ul>
	<li>Gestational diabetes goes away soon after birth in the majority of cases. This is because of a drop in pregnancy hormones and the insulin resistance associated with them.</li>
	<li>If you have had gestational diabetes or are at risk of postpartum diabetes, you should monitor your blood sugar regularly during the postpartum period.</li>
	<li>Breastfeeding may help reduce insulin and blood sugar levels after birth.</li>
	<li>If you started taking insulin during pregnancy, it may be stopped after childbirth. But, depending on your blood glucose levels, you may have to restart insulin again.</li>
	<li>If you were taking insulin before pregnancy, you will most probably continue to do so. However, the dosage and the type of insulin may be reviewed by your doctor.</li>
	<li>Lifestyle recommendations may further help prevent developing type 2 diabetes. 
	&nbsp;</li>
</ul>

[1] Gestational diabetes. Centers for Disease Control and Prevention.

[2] Department of Health &amp; Human Services. Diabetes - gestational. Better Health Channel.

[3] Diabetes and breastfeeding. Diabetes and Breastfeeding | ADA

Shermeen Zuberi

Does Postpartum Hypertension Go Away?

Bringing a new life into the world is an incredible journey, but sometimes unexpected challenges can pop up, like postpartum hypertension.

In simple words, postpartum hypertension is high <a href="merisehat.pk/disease/blood-pressure">blood pressure</a> that shows up after you give birth. 
&nbsp;

Understanding postpartum hypertension

However, it doesn&#39;t stick around forever. It&#39;s like the body&#39;s way of saying, &quot;Hang on, I need a little more time to get back to normal.&quot;

The duration and severity of postpartum hypertension varies from woman to woman. Factors such as pre-existing health conditions and the presence of risk factors may influence the resolution of postpartum hypertension.

A recent study found that the condition was more commonly present in mothers who smoked, had delivered via C-section, were aged 35 and above, and were Black Americans.<a href="#accordion">[1]</a> 
&nbsp;

Other risk factors include:<a href="#accordion">[2]</a>

<ul>
	<li>Obesity</li>
	<li>Family or individual history of preeclampsia</li>
	<li>High blood pressure during pregnancy</li>
	<li>Multiple births</li>
	<li>Diabetes</li>
	<li>Autoimmune conditions 
	&nbsp;</li>
</ul>

High blood pressure usually peaks within 48 hours after delivery, which is when most women leave the hospital.

Call your doctor immediately if you have a reading of 140/90 mm Hg or higher or postpartum hypertension symptoms, such as changes in vision, shortness of breath, persisting and severe headache, abdominal pain, nausea or vomiting, and decreased urination.

Delayed treatment can lead to serious complications, including pulmonary edema, seizures, strokes, blood clots, and even death. 
&nbsp;

For a new mom, postpartum hypertension can be scary. Will it go away on its own? Will I need medications?

Postpartum hypertension treatment often revolves around a healthy lifestyle. Eating well, staying active, and catching those precious zzz&#39;s all contribute to your body&#39;s speedy recovery.

Regular check-ups with your healthcare provider ensure that any lingering high blood pressure is noticed and managed. Sometimes, they may prescribe blood pressure medicine, antiseizure medicine, and anticoagulant medications to treat it.

It could take several days to a few weeks for the blood pressure to return to a safe or manageable level. Remember, you&rsquo;ll also be recovering from childbirth itself during this time, too. So, you may experience physical and emotional changes, such as fatigue, tender breasts, cramping or vaginal discharge, and mood swings. 
&nbsp;

Your body has this remarkable ability to self-regulate and heal, ensuring that postpartum hypertension often resolves on its own. However, regular monitoring and doctor check-ups during this period can further help with a smooth transition back to pre-pregnancy blood pressure levels. 
&nbsp;

Key Takeaways

<ul>
	<li>Postpartum hypertension, or high blood pressure after giving birth, is a rare condition that affects some women during the weeks or months following delivery.</li>
	<li>Postpartum is a healing period for the body, and as it recovers from the stress of childbirth, blood pressure levels often return to normal.</li>
	<li>However, it&#39;s important to monitor postpartum hypertension through regular check-ups with a healthcare provider to ensure that it does not persist or lead to complications.</li>
	<li>Maintaining a healthy lifestyle, including a balanced diet, regular physical activity, and sufficient rest, helps blood pressure levels return to normal.</li>
	<li>In some cases, medical intervention, such as medication, may be required to manage postpartum hypertension.</li>
</ul>

[1] Sullivan K, Rauf D, Welch A, et al. New moms at risk of developing high blood pressure 6 weeks after childbirth, study finds. EverydayHealth.com. Accessed January 26, 2024.

[2] Postpartum preeclampsia: Causes, symptoms & treatment. Cleveland Clinic. Accessed January 26, 2024

A Guide To Basic Foot Care

The feet undergo a lot of daily wear and tear. They are the body part that are worked on and overburdened the most. What&rsquo;s worse is that many people fail to take care of their feet properly and frequently ignore their foot health. Other than being unhygienic,&nbsp;this can lead to various foot diseases and restrict your overall mobility and impairment.

Your feet are constantly stressed for most of the day. We can help you by giving some of the tips that can keep your feet in the best condition. 
&nbsp;

Tips To Basic Foot Care

Your feet are significantly more exposed to dirt and dust than other parts of your body because they are so close to the ground. Additionally, they sweat a lot since socks and shoes keep them covered for&nbsp;several of hours each day.

As a result, be sure to thoroughly wash them at least twice a day with lukewarm water and a mild or antibacterial detergent. While the soap helps get rid of any signs of sweat, filth, and bacteria, the mild heat of the water will assist loosen the dead skin that has built up on the feet.

After bathing, remove any moisture from your feet, especially in the space in between your toes, by letting them air dry or dabbing them with a fresh towel.&nbsp;

Athlete&rsquo;s feet and other bacterial and fungal illnesses can develop on damp skin.&nbsp; 
&nbsp;

As you move about, your feet are bearing the weight of your body and rubbing against the ground and your shoes. Your feet skin gets damaged and brittle as a result.

Such repeated stress gradually thickens or hardens the skin in the weight-bearing or high-friction areas, leading to the development of unevenly raised patches known as calluses or small spherical lumps known as corns. For this reason, it is important to exfoliate twice a week to remove dead skin and cells to prevent corns and calluses. 
&nbsp;

Here is an easy-to-prepare exfoliator at home:

<ul>
	<li>&frac12; cup of sugar</li>
	<li>Almond oil, one tablespoon</li>
	<li>1/4 cup of honey</li>
	<li>Tea tree oil, 2 to 3 drops 
	&nbsp;</li>
</ul>

<h4>Directions</h4>

<ul>
	<li>To create a paste, combine all the ingredients in a bowl.</li>
	<li>To soften the skin, soak your feet in lukewarm water for 8 to 10 minutes.</li>
	<li>Use this thick mixture to massage your feet for at least five minutes.</li>
	<li>Dry your feet with a soft towel after rinsing the substance off with cool water. 
	&nbsp;</li>
</ul>

Your feet&#39; skin may become dry as they frequently come in contact with the surface. During winter, the chances of wear and tear are even greater. Dry skin is more likely to lose its elasticity. The soles of the feet are particularly vulnerable to this type of skin injury, which frequently manifests as cracked heels because they are constantly in contact with the ground. Therefore, it&rsquo;s crucial to thoroughly moisturize your feet at least once a day to keep them hydrated and supple.&nbsp;

You can apply a moisturizer before going to bed and wear socks on top. This is to ensure that it is properly absorbed and not wiped off from the bed sheets.&nbsp; 
&nbsp;

You can also make your own moisturizer.

Ingredients

<ul>
	<li>1/4 cup cocoa butter</li>
	<li>Coconut oil, 1/2 tbsp</li>
	<li>Almond oil, 1/2 tbsp</li>
	<li>2-3 glycerine drops</li>
	<li>Tea tree oil, 2 to 3 drops 
	&nbsp;</li>
</ul>

In addition to gathering dirt, overgrown toenails are also more likely to break. Therefore, it&rsquo;s important to routinely trim your toenails with a nail clipper rather than a pair of scissors.

Scissors are not shaped properly to follow the curvature of your nails; they can only cut straight lines. After cutting, smooth the rough edges of the nails using a nail file or emery board.

Avoid trimming your nails too short since this can damage the nail bed and cause severe pain, especially when walking. Additionally, to avoid ingrown nails, trim them at an angle along their curve rather than straight across. If you do develop an ingrown nail, go to the doctor rather than trying to treat it yourself.&nbsp;

Last but not least, avoid cutting or plucking your cuticles because doing so can be painful and expose your nail bed to infections. Use a stick or pen made for this reason to gently push your cuticle back in if it is protruding. 
&nbsp;

Fortunately, feet require very little care, and keeping them healthy is crucial for the comfort of walking. To ensure they are at their best, moisturise and clean them often. If you detect any persistent swelling, skin rashes, or peeling on your feet, which could be an indication of an allergic response, see a <a href="https://merisehat.pk/doctor-now" target="_blank">doctor immediately</a>.

Your body has endured the most rigorous and remarkable changes to do something extraordinary: give birth to another human being. For 9 months, you took the necessary precautions, went to the best doctors to receive top-notch medical care, and followed all maternity books to ensure your baby finds its new abode comfortable.&nbsp;

&nbsp;

9 months and a healthy baby later, you are enveloped with maternal joy. What worries you now is natal development. While your concern is justified, it is necessary to remember that you need rest as well. For 9 months you were completely selfless and now, for the 12 weeks following the delivery, you must direct your time and energy to recuperate, heal, and recover.&nbsp;

<div>&nbsp;</div>

Understanding The Importance of Postpartum Care

There may have been unprecedented or unanticipated events during delivery. The delivery might have been riddled with complications or it might have been traditionally simple. You might have undergone a cesarean birth (C-section) or the doctor might have suggested a vaginal delivery. Your labor might have lasted for a couple of hours or even a day. Regardless of what your delivery situation resembled, your body has had to deal with an outstanding and remarkable trauma, and consequently, it needs to compensate for it with the appropriate time to recover and heal.&nbsp;

&nbsp;

Your postpartum journey could be by the book or it could be unique. But, at the end of the day, your hormones will fluctuate, and so will your body. You will feel puzzled and bewildered, confused and alone. It&rsquo;s easy to be excited yet intimidated. All these emotions are justified and appropriate.&nbsp;

&nbsp;

Remember, you should never hesitate to <a href="https://merisehat.pk/doctor-now">reach out to a doctor</a> for a safe consultation and to update them on your situation. Finding refuge and comfort with friends and family is also encouraged.

<div>&nbsp;</div>

So, you assumed labor was difficult? Well, think again. Postpartum changes after vaginal delivery necessitate conversations with your OB/GYN before delivery, so that you can have a relatively well-organized recovery. Some changes that you can expect include the following:

&nbsp;

<h5>Vaginal Soreness</h5>

Vaginal tears during labor are medically known as perineal lacerations (episiotomy) or just tears. It can occur in either of the two circumstances: (a) the child&#39;s head is getting through the vaginal opening and is excessively huge for the vagina to dilate around; or (b) the head is a typical size, but the vagina is unable to fully extend. These sorts of tears are normal and are made between the vagina and the anus<a href="#accordion">[6]</a>.&nbsp;

&nbsp;

Post-delivery, these tears heal at a gradual pace and, therefore, cause vaginal soreness and discomfort. To ease and cope with the pain, an individual could try different home remedies and medications, such as:

i) Placing an ice pack on the tear or sitting on a padded pillow.

ii) Use warm water while washing the area, to ensure the prevention of any infection of the wound. Cool water can also be used if an individual finds it to be more soothing.

iii) Investing in a witch hazel pad sanitary napkin, cool for a while before placing it on the tear, which is usually localized between the vaginal opening and anus (perineum)<a href="#accordion">[5]</a>.

iv) Consult the doctor for painkillers and laxatives to help you deal with painful stools or constipation.

&nbsp;

During the postpartum visit to the doctor, inform them of every symptom, as any slight development could be an indication of an infection. 
&nbsp;

<h5>Vaginal Discharge</h5>

Vaginal discharge postpartum is called Lochia and contains a mix of&nbsp; uterine tissue, blood and mucus. The discharge is dark colored and released in copious amounts&nbsp; for the first couple of days, and later it becomes paler and the amount of discharge reduces<a href="#accordion">[4]</a>.&nbsp;

&nbsp;

To be on the safe side,&nbsp; doctors advise against the use of tampons or vaginal douching until 4-6 weeks in the postpartum period. The involvement of such items&nbsp; in the early postpartum period increases the risk for uterine infection.&nbsp;

&nbsp;

If your vaginal discharge is putrid or pungent, refrain from using heavily scented vaginal cleansers and inform your doctor to avoid future complications. If you are experiencing heavy vaginal bleeding, such that the sanitary pad is soaked in a matter of hours then you must contact your primary care physician<a href="#accordion">[4]</a>. 
&nbsp;

<h5>Incontinence</h5>

Pregnancy and consequently labor has been associated with the stretching of the pelvic floor muscles, which bolster the uterus, bladder, and rectum<a href="#accordion">[4]</a>. This stretching can weaken the pelvic floor muscles leading to a possibility of incontinence or the lack of bladder control. For instance, urine might leak when you laugh, sneeze, or cough.&nbsp;

&nbsp;

While incontinence decreases after a few weeks, it is incredibly frustrating and embarrassing, especially in public. To avoid any unfortunate incidents, you could try wearing protective pads or diapers and exercising to tone the pelvic floor muscles. A specific set of exercises called Kegel (also known as pelvic floor muscle training) can be practiced thrice a day. Sit on a stable and flat surface and tighten the pelvic floor muscles as if you&rsquo;re stopping yourself from going to the toilet. Begin with tightening and quickly releasing the muscles. After some time, you can hold a contraction for at least 5 seconds. Try doing 8 squeezes for each set<a href="#accordion">[6]</a>. 
&nbsp;

<h5>Hemorrhoids</h5>

If you feel discomfort during bowel movements and there&#39;s swelling near your anus, then you might have a case of hemorrhoids. It is a swelling of veins in the rectum, which is usually caused during your pregnancy. If not, you might have gotten them from the excessive strain and forceful pushing at the time of your delivery. Hemorrhoids are extremely painful, and cause itching and bleeding after defecation<a href="#accordion">[2]</a>.

&nbsp;

Here are a few things you can try to ease the pain:

i) Use a topical hemorrhoid cream that is easily accessible at pharmacies or any cream containing hydrocortisone.

ii) Opt for pads that are made of witch hazel to soothe the affected area.

iii) Go for a Sitz bath i.e. Soaking the hips and buttocks in warm water for around 10-15 minutes twice or thrice a day. Sitz baths help in reducing swelling.&nbsp; &nbsp;

iv) If you are avoiding defecation due to hemorrhoids and if the situation has been aggravated due to constipation after delivery, then it is suggested to consult a doctor for laxatives. Also, make sure you have a diet rich in fiber and you&rsquo;re staying hydrated. 
&nbsp;

<h5>Tender Breasts</h5>

It is common for breasts to fill up with milk after delivery for lactation. They become firm, tender, and sore; this is called breast engorgement<a href="#accordion">[2]</a>. It is suggested to alternate between breasts or even try alternating feeding positions during breastfeeding to minimize engorgement.&nbsp;

&nbsp;

If your breasts remain engorged for a prolonged period, then it would be difficult for the baby to latch on to the nipple. To help the baby while feeding, you might rely on hand compressions or a breast pump. Additionally, to relieve yourself of pain, you could try easily accessible pain killers, take long warm showers before breastfeeding, and place cold damp cloths on your breasts during feeding<a href="#accordion">[5]</a>. 
&nbsp;

<h5>Hair Loss And Skin Changes&nbsp;</h5>

Physical changes after delivery do not just involve weight gain or weight loss. As the body is producing an abundance of hormones, hair is also produced at a faster rate than it sheds, therefore you may experience substantial hair loss, too.&nbsp;

&nbsp;

And in addition to the permanent stretch marks that transition from red to silver as they start to fade, you might witness scaly, irritated skin. This would disappear as well, but for the time being, it&rsquo;s going to be more prone to acne.&nbsp;

&nbsp;

Consulting an endocrinologist and a dermatologist after delivery could help with the management of such symptoms. These are primarily due to the hormonal changes and thus could be accompanied by other side effects such as mood swings and excessive perspiration<a href="#accordion">[5]</a>.

&nbsp;

A postpartum visit to the doctor follows a personal objective. Your doctor would discuss your symptoms in detail, such as the inconsistent contractions or uncomfortable vaginal soreness and help you find solutions to relieve your pain. Furthermore, the discussion could also involve future birth spacing, contraception, and your emotional well-being.&nbsp;

&nbsp;

The doctor would also perform a physical examination. This includes&nbsp; a thorough examination of the abdomen, vagina, cervix, and uterus to ensure there is no physical scarring or post-delivery injuries.&nbsp;

&nbsp;

This is a terrific opportunity to discuss any worries you have, including continuing sexual activity and how you are adjusting back to routine with a child, while maintaining a healthy sleep cycle and nourishing your body with sufficient nutrients. 
&nbsp;

During a C section, most individuals are conscious and are only provided local anesthesia during their surgery. Afterwards, the patient is kept under observation at the hospital for a day or two to monitor vitals and gauge any abnormal behavior of the body. This might exclude the usual grogginess and nausea after surgery, which is easily managed through prescriptions.&nbsp;

&nbsp;

While most of the changes will be similar to vaginal birth, if you are delivering your baby via a C-section, please note there would be some additional circumstances which require different care. 
&nbsp;

<h5>Rest</h5>

A cesarean is an intense surgery that drains an individual. While normally an individual is admitted for only a couple of days after a cesarean, complications might persist for a couple of weeks. It is important to soak in as much rest (both physical and mental) as you can. This is quite difficult as the individual might have to care for a demanding newborn child or there could be numerous unexpected visitors to deal with. But it&rsquo;s important that you prioritize yourself.

&nbsp;

Organize and plan for effective postpartum care before delivery. This includes hiring help, constructing a workable timetable, and asking friends and family to pitch in. Moreover, you can be happy that everyone&rsquo;s coming to meet your new bundle of joy and, at the same, excuse yourself from gatherings for some alone time to recover faster<a href="#accordion">[3]</a>.

 
&nbsp;

<h5>Minimal Activity</h5>

While moving around could help with the prevention of blood clots, most doctors advise against participating in strenuous activities such as driving, competitive swimming, vigorous exercise, and handling heavy objects.&nbsp;

&nbsp;

Take things slowly and gradually. It would take 4-8 four to eight weeks after surgery before you have enough stamina to rejoin usual activities. Listen to your gut; your body will tire easily reminding you to take a break and just rest<a href="#accordion">[2]</a>.&nbsp; 
&nbsp;

<h5>Incision Care</h5>

The region where the incision was made, is naturally covered after surgery. Consult the doctor to know when it is safe to remove the bandage. Until then, keep the incision covered. Once you receive the green signal from the doctor, remove it and clean the region with saline water regularly to protect it from infection<a href="#accordion">[2]</a>. 
&nbsp;

Postpartum depression is a type of clinical depression experienced by women after delivery<a href="#accordion">[1]</a>. It is often trivialized and misconceived. A common blunder is how frequently it&rsquo;s used interchangeably with &lsquo;baby blues&rsquo; when it&rsquo;s so much more distressing and can also worsen.&nbsp;

&nbsp;

It is characterized by a prolonged and complicated mix of emotions, where the individual frequently feels severe anxiety, despair, dejection, fear of the unknown, and gut-wrenching guilt.&nbsp;

&nbsp;

If you experience such emotions and think about harming yourself or the child, then it is extremely important to inform relevant authorities for the necessary help.&nbsp;

&nbsp;

Moreover, if partners, friends, and family members observe concerning signs and symptoms then they must consult a therapist before anyone gets hurt<a href="#accordion">[1]</a>. 
&nbsp;

Your post-pregnancy or postpartum care will not be the same as an 8-hour long sleep after a tiring day at work. Complete recovery from pregnancy, labor, and any other complication can take several months. While numerous individuals begin to feel better and invigorated after 12 weeks, it might take more time to feel like your pre-pregnancy self.&nbsp;

&nbsp;

While your concerns are totally real, however, there&rsquo;s no need to rush the healing stage. Postpartum is not a race. Do not challenge or tire or exhaust yourself to reach a weight goal, or to go back to your corporate life. During this time, you might feel like your body has betrayed you. Do whatever it takes to not get disappointed with your progress. Look for ways you can reassure yourself that your body is recovering at its own pace.&nbsp; The smartest option for you is to rest, eat well, and enjoy some well-earned respite.

<div>&nbsp;</div>

<ul><li>Postpartum care refers to the period of recovery after delivery.&nbsp;</li><li>It involves physical and mental healing.</li><li>Changes and symptoms differ according to the type of delivery - vaginal or cesarean.&nbsp;</li><li>Individuals should rest, focus on their diet, and consult a doctor for better and personalized guidance.</li><li>Postpartum depression is a condition of prolonged grief and anxiousness after delivery. Individuals should reach out for professional help if they experience symptoms of Postpartum depression. </li></ul>