A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

کیا حمل کے دوران ہونے والی ذیابیطس ختم ہو سکتی ہے ؟

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

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Saad Ullah Siddiqui

Please Don't Sugar Coat It, I Am Diabetic!

Introduction

The chronic metabolic disease is characterized by an inability of the pancreatic cells to produce insulin, or the body&#39;s inability to use the produced insulin. This results in elevated blood glucose levels (hyperglycemia) that can cause complications, such as vascular damage, stroke, cardiovascular disease, <a href="https://www.merisehat.pk/disease/chronic-kidney-disease">chronic kidney disease</a>, neuropathy, and hypertension.

&nbsp;

As per the International Diabetes Federation&#39;s (IDF) latest figures, approximately 537 million adults worldwide are suffering from diabetes<a href="#accordion">[1]</a>. This translates to roughly 1 in 10 people. In Pakistan, the figures have risen 70% since 2019, with diabetes accounting for 400,000 deaths in 2021. The increasing disease prevalence is blamed on rising levels of obesity and the lack of physical activity among Pakistanis.&nbsp; 
&nbsp;

Diabetes management strategies which includes self-care practices such as eating healthy, self-monitoring blood glucose, staying compliant with prescribed medications, and exercising regularly can help maintain glucose levels within range. Furthermore, this can prevent the development of complications and improve the overall quality of life. 
&nbsp;

However, in Pakistan, people face several barriers to the implementation of these self-care practices. Poor knowledge about diabetes, its complications, diet planning, and hypoglycemia management contributes to poor diabetes control<a href="#accordion">[2]</a>.&nbsp;

&nbsp;

Understanding diet plans for Type 2 diabetic patients

Glucose is a form of sugar that the cells use for fuel. However, in diabetes the cells are unable to use the glucose, causing it to build up in the blood. The resulting hyperglycemia is damaging to the vessels and organs. Therefore, keeping the blood glucose levels within a normal range is important.&nbsp; 
&nbsp;

Carbohydrates are a main source of glucose and form a major part of the food we eat. Therefore, doctors recommend limiting carbs when making meal plans for diabetics. Moreover, other food groups such as fats, proteins, and fiber are also taken into consideration when creating diet plans for diabetics. 
&nbsp;

According to the American Diabetes Association (ADA)<a href="#accordion">[3]</a>.&nbsp;the following are the goals of nutrition therapy for adults with diabetics: 
&nbsp;

1. To promote and support healthful eating patterns, emphasizing a variety of nutrient-dense foods in appropriate portion sizes to improve overall health and: 
&nbsp;

<ul>
	<li>achieve and maintain body weight goals</li>
	<li>attain individualized glycemic, blood pressure, and lipid goals</li>
	<li>delay or prevent the complications of diabetes 
	&nbsp;</li>
</ul>

2. To address individual nutrition needs based on personal and cultural preferences, health literacy and numeracy, access to healthful foods, willingness, and ability to make behavioural changes, and existing barriers to change 
&nbsp;

3. To maintain the pleasure of eating by providing nonjudgmental messages about food choices, while limiting food choices only when indicated by scientific evidence 
&nbsp;

4. To provide diabetics with the practical tools for developing healthy eating patterns rather than focusing on individual macronutrients, micronutrients, or single foods

&nbsp;

Typically, diabetics should consume 5-6 small meals, spaced evenly throughout the day. The meals should contain: 
&nbsp;

<ul>
	<li>Non-starchy vegetables (broccoli, carrots, cauliflower, mushrooms, and greens such as cabbage, spinach, and rocket)</li>
	<li>High-fiber fruits (apples) and cereals (porridge)</li>
	<li>Whole grains such as brown rice, whole wheat chappati, brown pasta, whole wheat bread, quinoa, and oatmeal</li>
	<li>Lean protein sources such as eggs, fish, skinless chicken, turkey, lentils, and beans</li>
	<li>Dairy products such as low-fat milk, yoghurt, low-fat cheese</li>
	<li>Healthy fats such as olive oil, nuts, avocados 
	&nbsp;</li>
</ul>

While non-starchy vegetables can be eaten in unlimited quantities, lentils, beans, and chickpeas are often advised to be taken in a serving size of 3/4 cup cooked. For grains such as rice, corn, noodles, and porridge, a 1/2 cup is recommended. Whereas, for chapati or brown bread, 1 is the preferred serving size.&nbsp; 
&nbsp;

The following methods are often employed to create meal plans for diabetics: 
&nbsp;

1. Counting Carbs - For type 2 diabetics, limiting carbs ensures that their blood glucose levels remain within range. Moreover, it can help overweight individuals lose weight and contribute to better health outcomes. Whereas in type 1 diabetics, since they are on insulin therapy, the risk of hypoglycemia needs to be avoided. A registered dietician can help teach individuals to measure food portions through food labels and calculate the carbohydrate content. Moreover, people can then learn to calculate the carbs in each meal and snack, and adjust their insulin dose accordingly. 
&nbsp;

2. Glycemic Index (GI) - Glycemic index assigns carbohydrate-containing foods a number depending on how much it increases one&#39;s blood sugar. Diabetics opt for foods or meals with a low GI. 
&nbsp;

The three categories of GI values are:

<ul>
	<li>Low GI: 1 to 55</li>
	<li>Medium GI: 56 to 69</li>
	<li>High GI: 70 and higher 
	&nbsp;</li>
</ul>

Examples of low GI foods include carrots (GI=47), apples (GI=38), and peas (GI=48). White bread (GI=70) and white rice (GI=58) are considered high GI foods. Therefore, they are avoided by diabetics. However, GI values are not indicative of a food&#39;s nutritional value. For example, 1 cup of whole milk has a low GI value, but high-fat content, which isn&#39;t recommended for diabetes. 
&nbsp;

3. Diabetes Plate Method - Calculating carbs for every meal is not always feasible. Therefore, some people follow the plate method to reach their nutrition goals. The plate method ensures that one gets enough protein, vegetables, and fruits, while limiting the carb intake.&nbsp; 
&nbsp;

A 9-inch dinner plate is divided as follows:

<ul>
	<li>Half of the plate is filled with non-starchy vegetables.&nbsp;</li>
	<li>One-quarter of the plate is filled with lean protein such as eggs, tofu, turkey, lentils, or chicken.</li>
	<li>One quarter is filled with high-carb foods such as rice, pasta, potatoes, fruit, and grains.</li>
</ul>

Moreover, with the meal, people can go for water or a low-calorie drink.&nbsp; 
&nbsp;

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<ul>
	<li>Both type 1 and type 2 diabetics should avoid or limit the following foods:</li>
	<li>packaged and processed foods</li>
	<li>refined grains such as rice, white bread, pasta</li>
	<li>fried foods</li>
	<li>sugary foods such as candies, bakery products, cakes</li>
	<li>alcoholic beverages and sugary drinks such as sodas</li>
	<li>sweetened products</li>
	<li>salty food such as chips, canned soups</li>
</ul>

&nbsp;

Serving size varies for different foods. For example, for diabetics, the recommended serving size for chicken, meat, and fish is 1 ounce. Moreover, 1/2 cup of grains such as rice and corn are recommended. However, when using cups as a measuring size, it is important to stick to a standard measuring cup.&nbsp; 
&nbsp;

Since measuring cups or spoons are not always available, there is an easier guide to estimate the serving size using fingers and hands<a href="#accordion">[4]</a>.&nbsp;

Fist = 1 cup or 1 medium fruit

The palm of hand (no fingers) = 3 ounces of lean protein such as fish, meat, or chicken

Cupped hand = 1-2 ounces of nuts or pretzels

Thumb (tip to base) = 1 ounce of meat or cheese

Thumb tip (tip to 1st joint) = 1 tablespoon (mostly for fats)

Fingertip (tip to 1st joint) = 1 teaspoon

&nbsp;

The following is a sample menu and is meant for general information. It is not a replacement for expert opinion. A dietician or diabetologist should always be consulted for a diet plan to ensure adequate disease management and calorie intake. 
&nbsp;

<h5>Breakfast:</h5>

1/2 cup high fiber cereal/porridge with low-fat milk

or

1 slice of brown bread/chapati with 2 egg white/1 boiled egg

1 cup unsweetened tea or coffee

&nbsp;

<h5>Lunch:&nbsp;</h5>

1 whole wheat chapati/brown bread/1/2 cup rice

vegetables/salad

1-ounce lean meat/lentils

1 medium fruit

1 cup green tea or unsweetened tea/coffee

&nbsp;

<h5>Dinner:&nbsp;</h5>

1 whole wheat chapati/brown bread/1/2 cup rice

vegetables/salad

1-ounce lean meat/lentils

1 medium fruit

1 cup green tea or unsweetened tea/coffee

&nbsp;

<h5>Snack options:&nbsp;</h5>

1-ounce low-fat cheese

4 whole grain crackers

1 medium fruit

1 cup of low-fat milk

4 tbsp peanut butter

1/2 cup corn

&nbsp;

<h5>Fruit Juice Intake: Is it Allowed?</h5>

There has been a lot of debate on whether fruits are better than fruit juices for diabetics. As a rule, fruits are preferred over fruit juice, as it has higher fructose (sugar) and low fiber content. And also, a greater number of calories.&nbsp; 
&nbsp;

As 2014 study assessed the intake of fruit juice and its effect on the risk of type 2 diabetes. Although sugar-sweetened fruit juice increased the risk of type 2 diabetes, 100% fruit juice did not cause the same effects<a href="#accordion">[5]</a>. However, diabetics should practice caution and consult with a nutritionist before adding fruit juices to their diet plans.&nbsp;

&nbsp;

Conclusion

There is no diabetes-specific diet. Instead, several methods can be employed to ensure adequate calorie intake and prevent disease progression. These include counting carbs, focusing on the glycemic index, and the plate method. When creating meal plans, it is important to take into consideration a person&#39;s individual needs and be culturally sensitive to the food practices practised in the area.&nbsp; 
&nbsp;

Lifestyle changes such as dietary habits are a major aspect of improving patients&#39; disease knowledge and disease management. Therefore, it is important to educate patients on food practices that can help them manage their disease better.&nbsp; 
&nbsp;

Key Points

<ul>
	<li>Diabetes is characterized by elevated blood glucose levels that can be damaging to the body&#39;s vessels and organs. The resulting hyperglycemia can cause complications such as stroke, cardiovascular disease, recurrent infections, hypertension, and vision loss.</li>
	<li>A healthy and balanced diet can help maintain blood glucose levels within the normal range and prevent complications of diabetes.</li>
	<li>For diabetics, a healthy meal consists of lean proteins, whole grains, non-starchy vegetables, fruits, and low-fat foods. 5-6 small meals, spaced out over a day, should be consumed daily.&nbsp;</li>
	<li>An experienced dietician and diabetologist should be sought for diabetic meal plans. They may recommend carb counting, glycemic index diet, or the plate method.</li>
</ul>

&nbsp;

[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].Bukhsh, A. et al., 2020. Type 2 Diabetes Patients' Perspectives, Experiences, and Barriers Toward Diabetes-Related Self-Care: A Qualitative Study From Pakistan. Frontiers in endocrinology, Volume 11.

[3].American Diabetes Association, 2021. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes. Diabetes Care, 44(1).

[4].Canadian Diabetes Association, 2014. Handy portion guide.

[5].Xi, B. et al., 2014. Intake of fruit juice and incidence of type 2 diabetes: a systematic review and meta-analysis. PLoS One, 9(3).

Nimrah H. Sattar

Ismail Munir

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

Can Gestational Diabetes Be Reversed?

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>

[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

Iqra Mazhar

Is Your Asthma Due To Your Mother’s Gestational Weight Gain?

Gestational weight gain and high BMI (body mass index) affects a majority of pregnant women. There are various factors such as social factors, environmental factors, maternal factors, and energy balance that could contribute to weight gain <a href="https://merisehat.pk/disease/lets-talk-about-sex-during-pregnancy">during pregnancy</a>.&nbsp; 
&nbsp;

Although gestational weight gain (GWG) is a natural response to accommodate a growing fetus, GWG that is either too high or too low contributes to long-term or short-term health complications. This specifically applies for women whose BMI is greater than 25 at the time of their pregnancy. 
&nbsp;

The number of women who experience excessive gestational weight gain while they are pregnant is increasing, irrespective of their socio-economic status. Institute of Medicine, USA, has worked on identifying optimal gestational weight, so healthcare providers can advise pregnant women accordingly<a href="#accordion">[1]</a>.

&nbsp;

Understanding The Impact Of Pregnancy Weight Gain On Childhood Asthma

Extreme gestational weight gain has a significant impact on pregnant women and their health. It increases risk of birth complications, and leads to long-term maternal obesity. 
&nbsp;

Additionally, excessive gestational weight gain is harmful for the child, especially because of increased risk of childhood obesity<a href="#accordion">[2]</a>. There is also enough evidence to link maternal obesity with childhood obstructive lung diseases, e.g., asthma<a href="#accordion">[3]</a>. 
&nbsp;

<h5>GWG And Asthma&nbsp;</h5>

Obesity during pregnancy is directly related to adverse outcomes in children, e.g., higher probability of developing asthma&nbsp; 
&nbsp;

The mechanism to identify this connection is fetal programming. It describes the in-utero exposure that influences gene expression and chronic diseases during childhood. The disease originates from metabolic and psychological adaptations, which are made by the fetus in response to in-utero exposures during critically sensitive developmental phases. Moreover, environmental and genetic factors also play a role in the immune modulatory effects. 
&nbsp;

<h5>The Effects Of BMI</h5>

It&rsquo;s difficult to gauge the effects of the mother&rsquo;s and the child&rsquo;s BMI on childhood asthma. Researchers have investigated the mediating effects of BMI by adding childhood body mass index to their variable models with two or more quantities, and further describing what would reduce the risk. 
&nbsp;

Some studies concluded that birth weight of babies and BMI at the age of eight partially affected childhood asthma due to gestational weight gain. However, other studies found minimal effects on childhood BMI<a href="#accordion">[4]</a>. 
&nbsp;

Another research studied the relationship between maternal pre-pregnancy BMI, gestational diabetes, weight gain, and the risk of wheezing in preschool offspring. The focus was on the growth, infection, and atopic mechanism. 
&nbsp;

The age group of the children in the study was 1-4 years and it was observed that mothers who had a history of asthma, atopy, and pre-pregnancy obesity, had kids at risk of pre-school wheezing.&nbsp; 
&nbsp;

Moreover, whenever the standard gestational weight gain deviated, it increased the risk of preschool wheezing. The results were independent of pre-pregnancy BMI and no difference was seen in mothers with history of atopy or asthma<a href="#accordion">[5]</a>. Additionally, child growth or eczema did not change the results either. 
&nbsp;

An overall higher risk of pre-school wheezing was seen in offspring of mothers with obesity before pregnancy, history of atopy, asthma, and gestational weight gain. Neither of these could be explained by infectious or atopic mechanisms. However, further research might be able to identify what the underlying mechanisms are.

&nbsp;

Childhood asthma is one of the most common chronic respiratory diseases. Considering that the death rate of children by asthma is 0-0.7 per 100,000 around the world, it is a cause for global concern. Moreover, the annual prevalence of asthma in children is 9.5%, which is higher compared to the 7.7% seen in adults<a href="#accordion">[6]</a>. Therefore, new tools have been developed to target preventive strategies, and improve health. 
&nbsp;

Studies suggest that asthma in children is associated with maternal weight gain before and during pregnancy. Moreover, pre-pregnancy weight gain is a global issue; it jumped from 13% to 22% within a decade (1993-2003). Overall, it indicates an increase of 69%.&nbsp; 
&nbsp;

Unfortunately, numerous studies have examined the link between GWG and pre-pregnancy obesity with childhood asthma, and the results remain inconclusive.&nbsp;

&nbsp;

A healthy and balanced diet can help the baby get the required nutrients for a healthy growth. However, the question that is commonly asked is how much extra calories are even normal? Extra calories are helpful and required in some cases, but eating for two is not recommended.&nbsp; 
&nbsp;

However it is important to note that the below caloric add-ons are applicable if a woman&rsquo;s weight is within a normal range and is moderately active. In this case, the recommended daily intake before pregnancy would be about 2,000 calories a day.&nbsp;&nbsp; 
&nbsp;

The caloric intake in pregnant women depends on the time of the pregnancy. For example, slight increase is good enough for the first trimester, which then needs to increase to an additional 300 to 350 calories per day during the second trimester. In the third trimester, an additional 450 to 500 calories per day are needed. If you&#39;re carrying multiple pregnancies, you could need an additional 300 calories per day for each baby. 
&nbsp;&nbsp;

Pregnant women need to consult their healthcare providers to know how much weight they can gain. Women who have the ideal weight according to their BMI should be able to gain 25-35 pounds during pregnancy, whereas underweight women have a margin for 28-40 pounds. Overweight women can gain only 15-25 pounds when pregnant<a href="#accordion">[7]</a>. 
&nbsp;

So, the general rule is that women can gain 2-4 pounds in their first trimester and 1 pound per week for the remaining pregnancy. Besides, women who are expecting twins can gain 35-45 pounds, which makes it an average of 1.5 pounds per week after the usual first trimester weight gain. It is very important for women with twin pregnancy to gain the right weight.&nbsp;

&nbsp;

It is advised that prenatal healthcare providers evaluate maternal weight at every visit. They should also monitor weight goals and provide counselling accordingly. More than 50% of women tend to exceed their weight gain goals and become overweight, which is a serious health hazard. It leads to low birth weight, failure to produce breast milk, cesarean deliveries, and postpartum weight retention. Furthermore, the offspring can also be overweight and suffer from macrosomia. 
&nbsp;

Although gestational weight gain is potentially threatening to women and the offspring, it is a modifiable risk factor. Diet and exercise during pregnancy helps in reducing the extra weight. However, these interventions have not improved neonatal outcomes significantly, and the effects on obese women are also limited. Thus, indicating that its best to achieve a healthy BMI prior to conception.

&nbsp;

[1] Rogozińska, E., Zamora, J., Marlin, N., Betrán, A.P., Astrup, A., Bogaerts, A., Cecatti, J.G., Dodd, J.M., Facchinetti, F., Geiker, N.R. and Haakstad, L.A., 2019. Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes: analysis using individual participant data from randomised trials. BMC pregnancy and childbirth, 19(1), pp.1-12.

[2] Kominiarek, M.A. and Peaceman, A.M., 2017. Gestational weight gain. American journal of obstetrics and gynecology, 217(6), pp.642-651.

[3] Rusconi, F. and Popovic, M., 2017. Maternal obesity and childhood wheezing and asthma. Paediatric respiratory reviews, 22, pp.66-71.

[4] Harskamp-van Ginkel, M.W., London, S.J., Magnus, M.C., Gademan, M.G. and Vrijkotte, T.G., 2015. A study on mediation by offspring BMI in the association between maternal obesity and child respiratory outcomes in the amsterdam born and their development study cohort. PLoS One, 10(10), p.e0140641.

[5] Leermakers, E.T., Sonnenschein-van der Voort, A.M., Gaillard, R., Hofman, A., de Jongste, J.C., Jaddoe, V.W. and Duijts, L., 2013. Maternal weight, gestational weight gain and preschool wheezing: the Generation R Study. European Respiratory Journal, 42(5), pp.1234-1243.

[6] Liu, S., Zhou, B., Wang, Y., Wang, K., Zhang, Z. and Niu, W., 2020. Pre-pregnancy maternal weight and gestational weight gain increase the risk for childhood asthma and wheeze: an updated meta-analysis. Frontiers in pediatrics, 8, p.134.

[7] National Research Council, 2010. Weight gain during pregnancy: reexamining the guidelines.

Staff Writer

Is Gestational Diabetes Treatable

This condition can lead to complications for both the mother and the baby if left untreated. However, with proper management and treatment, women with gestational diabetes can experience a healthy pregnancy and give birth to a healthy baby. 
&nbsp;

<h5>What Is Gestational Diabetes?</h5>

Gestational diabetes is a form of diabetes that occurs during pregnancy when the body cannot produce enough insulin to meet the increased demands. Insulin is essential for regulating blood sugar levels, and during pregnancy, hormonal changes can make it harder for the body to utilize insulin effectively. 
&nbsp;

Certain factors increase the risk of developing gestational diabetes, such as being overweight or obese, having a family history of diabetes, being over the age of 25, or having previously given birth to a large baby.

Early detection of gestational diabetes is crucial for proper management and treatment. Pregnant women are typically screened for gestational diabetes between the 24th and 28th weeks of pregnancy. Early diagnosis allows healthcare providers to implement the necessary interventions to maintain blood sugar levels within a healthy range<a href="#accordion">[1]</a>. 
&nbsp;

<h5>Treating Gestational Diabetes</h5>

Gestational diabetes treatment focuses on managing blood sugar levels to keep them in a safe range for both the mother and the baby. The treatment plan may involve several components:

A balanced and healthy diet is essential for managing gestational diabetes. Women with GDM may be advised to follow a meal plan that controls carbohydrate intake while ensuring they receive adequate nutrients for a healthy pregnancy. 
&nbsp;

Regular physical activity can help improve insulin sensitivity and assist in maintaining healthy blood sugar levels. It is important for pregnant women to engage in safe and suitable exercises as recommended by their healthcare provider.

In some cases, diet and exercise alone may not be sufficient to manage gestational diabetes. Healthcare providers may prescribe medication or insulin therapy to help control blood sugar levels. 
&nbsp;

<h5>First Trimester</h5>

During the first trimester, the focus is on early detection and lifestyle adjustments. Healthcare providers will monitor blood sugar levels and recommend dietary changes and physical activity. 
&nbsp;

<h5>Second Trimester</h5>

As the pregnancy progresses, the treatment plan may be adjusted to accommodate the changing needs of the mother and the baby. Medication or insulin therapy may be initiated if blood sugar levels remain elevated. 
&nbsp;

<h5>Third Trimester</h5>

In the third trimester, close monitoring becomes even more critical. Healthcare providers will ensure that the treatment plan is effective and make any necessary changes to promote a healthy delivery<a href="#accordion">[4]</a>. 
&nbsp;

<h5>Meal Planning And Healthy Eating</h5>

Following a well-balanced meal plan can help stabilize blood sugar levels. Opting for nutritious foods and controlling portion sizes are essential components of managing GDM. 
&nbsp;

<h5>Staying Active During Pregnancy</h5>

Regular physical activity can contribute to better blood sugar control and overall well-being during pregnancy. It is essential to engage in exercises that are safe and suitable for pregnant women. 
&nbsp;

<h5>Coping With Stress</h5>

Stress can affect blood sugar levels, so finding ways to manage stress is crucial. Techniques like meditation, deep breathing, or prenatal yoga can be helpful. 
&nbsp;

<h5>Regular Medical Check-Ups</h5>

Attending all scheduled medical appointments is vital for monitoring the progress of the pregnancy and the effectiveness of the treatment plan<a href="#accordion">[2]</a>. 
&nbsp;

<ul>
	<li>
	<h5>Risks To The Mother</h5>
	</li>
</ul>

Untreated gestational diabetes can lead to high blood pressure, preeclampsia, and an increased risk of developing type 2 diabetes later in life. 
&nbsp;

<ul>
	<li>
	<h5>Risks To The Baby</h5>
	</li>
</ul>

Uncontrolled gestational diabetes can cause respiratory distress syndrome, hypoglycemia, and electrolyte imbalance. It can also lead to macrosomia (a large baby), which can cause birth injuries during delivery. It may also increase the baby&#39;s risk of developing obesity and type 2 diabetes later in life<a href="#accordion">[3]</a>. 
&nbsp;

Gestational diabetes is a treatable condition that requires careful management throughout pregnancy. By following a comprehensive treatment plan, including a balanced diet, regular exercise, and close monitoring of blood sugar levels, women with gestational diabetes can have a healthy pregnancy and deliver a healthy baby. Early detection and intervention are crucial in ensuring the best possible outcomes for both the mother and the child. 
&nbsp;

Key Takeaways

<ul>
	<li>Gestational diabetes (GDM) is a type of diabetes that develops during pregnancy due to hormonal changes affecting insulin production and usage.</li>
	<li>Early detection of GDM is essential for proper management and treatment to ensure a healthy pregnancy and delivery.</li>
	<li>GDM treatment involves a multi-faceted approach, including diet and nutrition, exercise, blood sugar monitoring, and, if necessary, medication or insulin therapy.</li>
	<li>During the first trimester, the focus is on early detection and lifestyle adjustments, such as dietary changes and physical activity.</li>
	<li>In the second trimester, treatment may be adjusted based on the changing needs of the mother and baby, and medication or insulin therapy may be initiated.</li>
	<li>The third trimester requires close monitoring and adjustments to the treatment plan to promote a healthy delivery.</li>
	<li>Tips for managing GDM include following a well-balanced meal plan, engaging in safe physical activity, managing stress, and attending regular medical check-ups.</li>
	<li>Untreated GDM can lead to complications for both the mother, such as high blood pressure and an increased risk of type 2 diabetes, and the baby, such as macrosomia and a higher risk of obesity and type 2 diabetes later in life.</li>
</ul>

[1] Gestational diabetes - Treatment. (n.d.). HSE.

[2] TUROK, D. K., RATCLIFFE, S. D., & BAXLEY, E. G. (n.d.). Management of Gestational Diabetes Mellitus. Management of Gestational Diabetes Mellitus | AAFP

[3] C. (2022, July 14). Gestational Diabetes and Pregnancy | CDC. Centers for Disease Control and Prevention.

[4] Current Management of Gestational Diabetes Mellitus.

Syeda Qurat-ul-Ain

Back Pain In Pregnancy? Here’s What You Should Do!

Pregnancy can be an exciting and magical time for expectant mothers, filled with anticipation and wonder as they prepare to bring a new life into the world. However, along with all the joys of pregnancy come a few not-so-pleasant side effects, including morning sickness, fatigue, and of course, the dreaded back pain. 

While back pain may not be the most glamorous topic, it&#39;s one that many pregnant women are all too familiar with. So, let&#39;s take a closer look at the science behind this common complaint and explore some tips and tricks for managing back pain during pregnancy. 
&nbsp;

Yes, it is normal for women to experience back pain during pregnancy. In fact, back pain is a common complaint among pregnant women, affecting around 50-80% of all pregnancies<a href="#accordion">[2]</a>. 

The extra weight and changes in body posture during pregnancy put excessive strain on the muscles and ligaments in the back, leading to discomfort and pain. Additionally, hormonal changes during pregnancy can also affect the ligaments and muscles in the back, making them more prone to strain and injury. 

Note: If the pain is severe or persistent, it&#39;s important to talk to your doctor to rule out any underlying conditions or complications. 
&nbsp;

Back pain during pregnancy can occur at any time. However, most pregnant women tend to start experiencing back pain during the second half of their pregnancy, typically between the fifth and seventh months. This is because the uterus expands to accommodate the growing fetus and it shifts the center of gravity forward, which naturally puts a strain on the back. 

Additionally, when the ligaments in the pelvic area become too flexible due to hormonal changes during pregnancy, it can also end up contributing to back pain. 
&nbsp;

Understanding Back Pain During Pregnancy

There are several causes of back pain in pregnancy, including: 
&nbsp;

Weight Gain: A healthy growing fetus can put a lot of pressure on the lower back muscles and spine, leading to pain and discomfort.

Hormonal Changes: The body releases progesterone, which helps to loosen the ligaments and joints in the pelvic area to prepare for childbirth. However, this can also affect the ligaments and muscles in the back, making them more prone to strain and injury.

Poor Posture: The changing shape of the body and the weight gain during pregnancy cause women to adopt a poor posture, which puts additional strain on the back muscles.

Stress And Anxiety: Pregnancy can be a stressful time, so much so that it can cause muscle tension and trigger back pain.

Existing Back Problems: Women with previous back injuries or problems are more likely to experience back pain during pregnancy.

Muscle Separation: During pregnancy, the uterus expands and causes a separation between two parallel sheets of muscles (known as the rectus abdominis muscles) that run from the rib cage to the pubic bone. This separation can worsen back pain. 
&nbsp;

While back pain is common during pregnancy, there are some situations where you should seek medical help<a href="#accordion">[3]</a>: 
&nbsp;

Severe Pain: If you experience severe or persistent back pain for more than two weeks, especially if it is accompanied by other symptoms such as fever or numbness, it is important to contact your healthcare provider. They can tell whether medication such as paracetamol (Panadol) or other treatment is feasible in your condition.

Vaginal Bleeding Or Fluid Leakage: If you experience vaginal bleeding or fluid leakage along with back pain, it can be a sign of a serious problem and you should seek medical help right away.

Contractions: If you experience regular contractions along with back pain, it might be an indication of preterm labor. Contact your healthcare provider immediately.

History Of Back Problems: Inform your doctor if you have a history of back problems, such as herniated discs or sciatica. They will recommend additional monitoring or treatment to help prevent or manage back pain during pregnancy. 
&nbsp;

There are several safe and effective treatments for back pain during pregnancy: 
&nbsp;

Exercise: Regular exercises, such as prenatal yoga or walking, help strengthen muscles and improve posture, ultimately reducing back pain.

Heat Or Cold Therapy: You can use a heating pad or ice pack for 15-20 minutes at a time to reduce pain and inflammation.

Massage: Gentle massage can help to reduce tension and relieve back pain. Choose a massage therapist who is experienced in working with pregnant women.

Maternity Support Belts: Maternity support belts provide additional support to your back and belly, which can help reduce back pain.

Acupuncture: Acupuncture is considered a safe and effective treatment for back pain for most women during pregnancy, and it can also help to reduce stress and promote relaxation. Consult your doctor before trying it out!

Medications: Several over-the-counter pain relievers, such as paracetamol, are safe to use during pregnancy. However, over-the-counter anti-inflammatory drugs, such as ibuprofen and aspirin, should be avoided during pregnancy. Consult your healthcare provider before taking any medication during pregnancy<a href="#accordion">[4]</a>!

Physical Therapy: If your back pain is severe or persistent, your healthcare provider may also recommend physical therapy. A physical therapist can provide exercises and techniques to help reduce pain and improve your mobility.

 
Note: It is important to remember that not all treatments are safe for pregnancy. Always consult your gynecologist before trying any new treatment or medication. 
&nbsp;

There are several steps you can take to avoid back pain during pregnancy: 
&nbsp;

Maintain Good Posture: A good posture is key to reducing the strain on your back. Always stand up straight with your shoulders back and your pelvis in a neutral position.

Exercise Regularly: Regular exercise strengthens your muscles and improves your posture, reducing your risk of back pain. Low-impact activities, such as walking, swimming, and prenatal yoga, are all excellent options.

Wear Comfortable Shoes: Choose comfortable, supportive shoes with good arch support. Avoid high heels as they put a strain on your back and increase your risk of falls, too.

Lift Correctly: When lifting, bend your knees only; keep your back straight. Twisting or bending at the waist strains your back.

Sleep On Your Side: Sleeping on your side, particularly on your left side, can reduce pressure on your back and improve circulation to your baby.

Use Proper Support: Use a pregnancy pillow or support belt to support your back and belly. When seated, use a lumbar pillow for good back support.

Stay Hydrated: Drinking plenty of water keeps your muscles hydrated and prevents cramping. 
&nbsp;

Note: If you experience back pain during pregnancy despite taking these measures, consult your healthcare provider for advice on safe and effective pain relief options. Do NOT start any exercise program without first consulting your doctor. 
&nbsp;

Back pain is a common problem during pregnancy, but it&rsquo;s possible to prevent or reduce it by maintaining good posture, exercising regularly, wearing comfortable shoes, and staying hydrated. 

If you experience back pain during pregnancy despite these measures, safe and effective treatments, including heat or cold therapy, acupuncture, and medications (with caution) can help. 

Enjoy a comfortable and healthy pregnancy with proper care and management. 
&nbsp;

<ul>
	<li>Back pain is a common complaint among pregnant women, affecting around 50-80% of all pregnancies. </li>
	<li>Hormonal changes, weight gain, and changes in posture can contribute to back pain during pregnancy.</li>
	<li>Sleeping on your side, using proper support, and wearing comfortable shoes can help to reduce back pain.</li>
	<li>Consult your doctor if you experience severe pain, vaginal bleeding or fluid leakage, contractions, or if your pain interferes with your daily activities.</li>
</ul>

[1] Back pain during pregnancy. ACOG.

[2] Back pain during pregnancy - spineuniverse.

[3] Back pain during pregnancy: 7 tips for relief. Mayo Clinic.

[4] Back pain during pregnancy: Causes and treatments. WebMD.

[5] Back pain in pregnancy. Back Pain in Pregnancy | Johns Hopkins Medicine.

[6] Timmons J. First trimester pregnancy back pain: Causes, treatments and more. Healthline.

Sarah Mhowwala

تعارف

۔حمل کے دوران ذیابیطس ہونے کا سب سے اہم سبب بیٹا خلیات کا غیر فعال ہو جانا اور حمل کے دوران انسولین کے خلاف مزاحمت ہے بین الاقوامی ذیابیطس فیڈریشن (آئی ڈی ایف) کے مطابق تقریبا دنیا میں 2030 تک 783 ملین افراد ذيابیطس کی بیماری کے ساتھ زندگی گزار رہے ہوں گے ۔ (1)۔ تازہ ترین اعداد و شمار کے مطابق ، ذيابیطس کی بیماری کا پھیلاؤ غریب اور درمیانی آمدنی رکھنے والے ممالک میں زيادہ تیزی سے ہو رہا ہے ۔&nbsp; سال 2019 میں 70٪ اضافے کے ساتھ ، پاکستان میں دنیا بھر کے مقابلے میں ذیابیطس کے پھیلاؤ کی شرح سب سے زيادہ ہے ۔ (1)۔ کم و بیش 11 ملین افراد گلوکوز کی عدم برداشت کی بیماری (آئی جی ٹی ) کا شکار ہیں جن کے ٹائپ ٹو ذيابیطس میں مبتلا ہونے کا خطرہ بہت زيادہ ہے (1)۔ ماہرین کے مطابق صرف ٹائپ 2 ذيابیطس کے کیسز میں اضافہ نہیں ہوا ، بلکہ حمل کے دوران ہونے والی ذيابیطس (جی ڈی ایم )کی شرح میں بھی اضافہ دیکھنے میں آیا ہے ۔&nbsp;حمل کے دوران ہونے والی ذیابیطس کے پھیلاؤ کی حقیقی شرح پاکستان میں اب تک ناکافی تشخیص کے طریقہ کار کے سبب غیر واضح ہے ۔ کراچی اور حیدرآباد کے ہسپتالوں میں کی جانے والی ایک تحقیق کے مطابق پھیلاؤ کی یہ شرح 11.9% تک ہے (2)۔ جب کہ کراچی کے انڈس ہسپتال میں کیۓ گۓ ایک سروے کی رپورٹ کے مطابق یہ شرح 17.7% ہے (3)

حمل کے دوران  ذیابیطس کے ہونے کی وضاحت

حمل کے دوران ذیابیطس ہونے کا سب سے اہم سبب بیٹا خلیات کا غیر فعال ہو جانا اور حمل کے دوران انسولین کے خلاف مزاحمت ہے ۔ جس کی وجہ سے حاملہ عورت اور اس کی کوکھ میں پلتے بـچے کو ہائپر گلاسیمیا یا خون میں گلوکوز کی بلند شرح کا سامنا کرنا پڑ سکتا ہے ۔ اس کے سبب ہونے والی پیچیدگیوں میں مردہ بچے کی پیدائش ، میکروسومیا ، سانس لینے میں مشکل ، بچے کی پیدائش کے وقت دردوں کا کم ہو جانا یا حمل کے دوران حاملہ عورت کو صحت کے مسائل شامل ہیں ۔&nbsp;اگرچہ بچے کی پیدائش کے بعد ماں کے خون میں گلوکوز کی شرح دوبارہ سے نارمل حالت میں آجاتی ہے ، لیکن تقریبا 50 ٪ خواتین میں حمل کے دوران ہونے والی ذيابیطس وقت گزرنے کے ساتھ ٹائپ 2 ذيابیطس میں تبدیل ہو جاتی ہے ۔ (4)۔ کم و بیش تین میں سے ہر دو عورتوں میں حمل کے دوران ہونے والی ذيابیطس اگلے حمل میں بھی ظاہر ہو جانے کا امکان ہوتا ہے ۔ (5)۔ مگر حمل کے دوران اور اس کے بعد کی جانے والی مناسب دیکھ بھال اور احتیاط سے یہ ممکن بنایا جا سکتا ہے کہ ڈلیوری کے بعد خون میں شوگر کا لیول نارمل ہو جاۓ اور دوبارہ نہ بڑھے ۔

حمل کے دوران ذيابیطس کا مرض عام طور پر دوسری ٹری میسٹر یعنی چھٹے مہینے سے ہوتا ہے ۔ اس کی تشخیص عام طور پر 24 سے 28 ہفتوں کے دوران ہوتا ہے ۔ اس کی تشخیص کے لیۓ ڈاکٹر ان طریقہ کار کا استعمال کر سکتا ہے ؛&nbsp;<ul><li style="text-align: right;">ابتدائی گلوکوز چیلنج ٹیسٹ : مریض کو 50 گرام گلوکوز کا ایک محلول پلایا جاتا ہے ، جس کے ایک گھنٹے کے بعد مریض کے خون میں گلوکوز لیول کو چیک کیا جاتا ہے ۔ اگر اس کا لیول اگر 140 mg/dl&nbsp; &lt; ہو تو مریضہ حمل کے دوران ہونے والی ذيابیطس کے شدید خطرے سے دوچار ہے ۔ اس ٹیسٹ کے بعد اورل گلوکوز کی برداشت کا بھی ایک ٹیسٹ کنفرم کرنے کے لیۓ کیا جاتا ہے ۔&nbsp;</li><li style="text-align: right;">اورل گلوکوز برداشت کا ٹیسٹ (او جی ٹی ٹی ): اس ٹیسٹ کے لیۓ مریض کا خالی پیٹ ہونا ضروری ہے ۔ 100 گرام تک کا محلول پینے کے بعد ہر ایک گھنٹے بعد کل خون کے تین سیمپل تین گھنٹوں تک لیۓ جاتے ہیں ۔ تشخیص کا انحصار خالی پیٹ لیۓ جانے والے سیمپل اور اس کے بعد ہر ایک گھنٹے کے بعد لیۓ گۓ خون کے سیمپل میں گلوکوز کی شرح پر ہوتا ہے&nbsp;</li></ul>ذيابیطس اور حمل کی بین الاقوامی ایسوسی ایشن کے اسٹڈی گروپ 2010&nbsp; &nbsp;صرف ایک مرحلہ اپروچ اپنانے کی تجویز دیتی ہے (6)۔ جس کے مطابق خالی پیٹ اور 75 گرام تک گلوکوز کا محلول پلانے کے بعد ایک اور دو گھنٹوں کے بعد خون کے سیمپل لیۓ جائيں ۔ یہ ٹیسٹ عام طور پر دوسرے ٹریمسٹر میں کرنا چاہیۓ مگر جو خواتین شواہد کی بنا پر ذيابیطس کے خطرے کا شکار ہوں ان کا یہ ٹیسٹ پہلے معائنے کے دوران بھی کیا جا سکتا ہے&nbsp;حمل کے دوران ہونے والی ذيابیطس کے ہونے کے دوسرے عوامل کچھ اس طرح سے ہو سکتے ہیں ۔ خاندان میں ذيابیطس کی ہسٹری ، ماں کا 25 سال سے زائد عمر کا ہونا یا ماضی میں حمل کے دوران ذيابیطس کا ہونا اس کے عام عوامل ہو سکتے ہیں ۔ اگرچہ ان عوامل کو روکا نہیں جا سکتا ہے ، مگر ان کے علاوہ&nbsp; کچھ دیگر عوامل بھی ہو سکتے ہیں جن میں موٹاپا ، پولی سسٹک اووری سنڈروم ، پری ڈائبیٹیس ، کھانے پینے کی عادات وغیرہ شامل ہیں ۔&nbsp;قبل از پیدائش دیکھ بھال کرنے والے میڈیکل ماہرین کا مقصد یہ ہے کہ وہ حمل کے دوران ہونے والی ذیابیطس کے حوالے سے خواتین کو آگاہ کریں ۔ اور ان کو اس کو کنٹرول کرنے کے طریقے بھی بتائيں تاکہ بیماری کے خطرے سے بچا جا سکے ۔ اور ان کو خون میں گلوکوز کے لیول اور اس کی شرح کے بارے میں بھی بتائيں ۔&nbsp;خون میں گلو کوز کی مانیٹرنگ&nbsp;گلوکومیٹر یا سینسر کی مدد سے ذيابیطس کا شکار حاملہ عورت، روزانہ خالی پیٹ اور کھانے کے ایک گھنٹے بعد ،اپنے خون میں گلوکوز کا لیول چیک کر سکتی ہے ۔ امریکن ڈائيبیٹک ایسوسی ایشن کے مطابق حاملہ خواتین کو ذیابیطس کی صورت میں اس رینج کے مطابق برقرار رکھنا چاہیے۔(7)<ul><li style="text-align: right;">خالی پیٹ پلازما گلوکوز لیول : 95mg/dl&nbsp; سے کم ہونا چاہیے&nbsp;</li><li style="text-align: right;">کھانےکے ایک گھنٹے بعد گلوکوز لیول :&nbsp; &nbsp;140 mg/dl سے کم ہونا چاہیۓ&nbsp;</li><li style="text-align: right;">کھانے کے دو گھنٹوں بعد گلوکوز لیول : 120 mg/dl سے کم ہونا چاہیۓ&nbsp;</li></ul>غذائی تبدیلیاں&nbsp;ایک مستند غذائی ماہر اس حوالے سے مدد کر سکتا ہے کہ حاملہ عورت کی کیلوری کی ضرورت بھی پوری ہو رہی ہو اور اس کے وزن میں بھی صحت مند اضافہ ہو رہا ہو۔ حاملہ خواتین کو دن بھر میں 3 بار کھانا کھانے اور تین سے چار بار ہلکے پھلکے اسنیکس لینے کا مشورہ دیا جاتا ہے ۔ جب کہ سونے سے قبل ایسے اسنیکس لینے کا مشورہ دیا جاتا ہے جو خون میں گلوکوز کے لیول کو بڑھانے کا باعث نہ بن سکیں ۔غذائی ماہر کی جانب سے ذيابیطس کا شکار حاملہ عورت کے لیۓ کم سے کم 175 گرام کاربوہائيڈریٹ ، کم سے کم 71 گرام پروٹین اور 28 گرام فائبر پر مشتمل ہو سکتا ہے ۔ چینی اور چکنائی کو کم ہی استعمال کرنے کا مشورہ دیا جاتا ہے۔جسمانی سرگرمیباقاعدگی سے ورزش کرنے سے خون میں گلوکوز کے لیول کو نارمل رکھنے میں مدد مل سکتی ہے۔اور انسولین کی مزاحمت میں بھی کمی لائی جا سکتی ہے۔ حاملہ خواتین کے لیۓ تجویز کردہ جسمانی ورزشوں میں ایروبک ورزشیں شامل ہیں جن میں چہل قدمی اور تیراکی شامل ہے۔ ہفتے کے 3 سے 5 دنوں میں آدھے گھنٹے کی ورزش کافی سمجھی جا سکتی ہے ۔ مگر حمل کے دوران کسی بھی قسم کی جسمانی سرگرمی کو شروع کرنے سے قبل اپنی ڈاکٹر سے ضرور مشورہ کر لیں ۔انسولین&nbsp;&nbsp;اگر غذائی تبدیلیاں اور جسمانی سرگرمیاں بھی خون میں گلوکوز لیول کو نارمل کرنے میں کامیاب نہ ہو سکیں۔ ایسی صورت میں حاملہ عورت کے لیۓ ڈاکٹر انسولین کے انجکشن تجویز کرتے ہیں ۔ حمل کے دوران ہونے والی ذيابیطس کے علاج کے لیۓ انسولین ڈاکٹرز کے نزدیک سب سے محفوظ طریقہ ہے جس سے گلوکوز کا لیول بھی کنٹرول ہو سکتا ہے اور اس سے ماں کے رحم میں موجود بچے کو بھی کوئی نقصان نہیں ہوتا ہے ۔ میٹافورمین اور سلفونائلیریس کو بھی اس کے ساتھ تجویز کیا جاتا ہے تاکہ بچے پر کسی قسم کے اثرات نہ ہو سکیں ۔ جب کہ روزانہ انسولین لگانے کے سبب حاملہ عورت کو ہائپوگلاسیمیا (خون میں گلوکوز کے لیول کا کم ہونا ) کے خطرے سے بھی آگاہ ہونا چاہیے۔ &nbsp;

اگرچہ خون میں گلوکوز کا لیول اور انسولین کے خلاف مزاحمت بچے کی پیدائش کے بعد خود بخود نارمل ہوجاتا ہے ۔ مگر یہ ضروری ہے کہ خواتین میں انسولین کی ضرورت کو چیک کیا جاتا رہے ۔ اکثر خواتین کو مذید انسولین لگانے کی ضرورت ڈلیوری کے بعد نہیں رہتی ہے ۔ مگر اس کے باوجود خون میں گلوکوز کے لیول کو چیک کرتے رہنا چاہیۓ ۔&nbsp;ایسی خواتین کے لیۓ امریکن ڈائبیٹیس ایسوسی ایشن بعد از پیدائش دیکھ بھال کے لیۓ ان اقدامات کو اپنائيں (7)؛<ul><li style="text-align: right;">بچے کی پیدائش کے 4 سے 12 ہفتوں کے بعد خاتون کا 75 گرام کا گلوکوز کی برداشت کا ٹیسٹ کروائيں۔&nbsp;</li><li style="text-align: right;">ہر ایک سے تین سال کے بعد ٹائپ 2 ذيابیطس کو چیک کروانا چاہیۓ&nbsp;</li><li style="text-align: right;">اگر خواتین پری ڈائبیٹیس ہو ، تو اس کو کسی ماہر ذیابیطس سے رابطہ کر کے اپنے طرز زندگی میں تبدیلی کرنی چاہیۓ اور ضرورت پڑنے پر ادویات کا بھی استعمال کرنا چاہیے ۔&nbsp;</li><li style="text-align: right;">بچے کی پیدائش کے بعد عورت کو نفسیاتی مدد کی بھی ضرورت پڑ سکتی ہے ۔&nbsp;</li></ul>تحقیقات کے مطابق ، ایسی غذا جو سفید آٹا ، چکنائی اور پھلوں کے رس، مغزیات ، بیجوں ، سویابین ، پنیر ، گوشت&nbsp; پر مشتمل ہو یہ خواتین میں حمل کے دوران ذيابیطس میں مبتلا ہونے کے خطرے کو بڑھا سکتے ہیں ۔ (8)۔ اس وجہ سے ایسی خواتین کو بچے کی پیدائش کے بعد بھی صحت مند غذائی آیات کو اپنانے کا مشورہ دیا جاتا ہے ۔ جس سے مستقبل میں حمل کے دوران ذیابیطس کے خطرے سے بچا جا سکتا ہے ۔&nbsp;حمل کے دوران ذيابیطس کا شکار ہونے والی خواتین میں ٹائپ 2 ذیابیطس میں مبتلا ہونے کا خطرہ دس گنا زيادہ ہوتا ہے (9)۔ طرز زندگی میں تبدیلی جیسے وزن میں کمی ، صحت مندغذائی عادات ، روزانہ ورزش اس بیماری کے خطرے کو کم کر دیتی ہے ۔&nbsp;

خلاصہ

کم آمدنی والے ممالک میں حمل کے دوران ہونے والی ذیابیطس کے حوالے سے کم آگاہی اور صحت کی ناکافی سہولیات کے سبب اس کے پھیلاؤ کو روکنے کی راہ میں ایک بڑی رکاوٹ ہے ۔ اس کے علاوہ اس کی اسکریننگ پر کوئی عالمی اتفاق راۓ بھی موجود نہیں ہے ۔ اس وجہ سے اس کی تشخیص کے لیۓ مختلف طریقے اختیار کیۓ جا رہے ہیں ۔ اس وجہ سے اس بیماری کے حوالے سے آگاہی بڑھانے کے ساتھ ساتھ اس کی اسکریننگ کے طریقے کو بھی بڑھانا ضروری ہے۔ اس کی بروقت تشخیص سے اس کے سبب ہونے والی پیچیدگیوں اور بچے کے اندر ایب نارمیلیٹیز کو روکا جا سکتا ہے۔

یہ بیماری کسی بھی عورت کے لیۓ انتبہائی مایوس کن ہو سکتی ہے۔ لہذا خاندان کے لوگوں کے لیۓ ضروری ہے کہ اس کو جزباتی سہارا فراہم کریں ۔ نفسیاتی کونسلنگ بھی مددگار ثابت ہو سکتی ہے ۔ اس کے علاوہ ماہرین کو مانع حمل طریقوں کے بارے میں بھی آگاہی دینی چاہیۓ کیوں کہ بغیر پلاننگ کے حمل اس کے خطرے کو بڑھا سکتا ہے۔

اہم نکات

<ul><li style="text-align: right;">حمل کے دوران ذیابیطس حاملہ خواتین میں ہونے والی ایک میٹا بولک خرابی ہے ۔ اور ماں اور بچے دونوں پر اثرات مرتب کرتے ہیں۔ اس کے سبب ہونے والی کچھ پیچیدگیوں میں نیونیٹل ہائپوگلا ئسیمیا ، میکروسومیا ، حمل کے دوران درد کا رک جانا ، مردہ بچے کی پیدائش، قبل از وقت پیدائش ، اور ماں اور بچے میں ٹائپ 2 ذیابیطس کا خطرہ بھی بڑھ جاتا ہے ۔</li><li style="text-align: right;">صحت مند اور متوازن غذا ، باقاعدگی سے ورزش ، خون میں گلوکوز کی نگرانی ، اور انسولین کا استعمال خون میں گلوکوز کے لیول کو برقرار رکھنے میں مدد دیتے ہیں۔ امریکن ڈائيبیٹیس ایسوسی ایشن کے مطابق خالی پیٹ خون میں گلوکوز کا لیول &lt;95mg/dl , اور کھانےکے دو گھنٹے بعد &lt;120 mg/dl&nbsp; حمل کے دوران نارمل تصور کیا جاتا ہے۔&nbsp;</li><li style="text-align: right;">بچے کی پیدائش کے 4 سے 12 ہفتوں کے بعد حمل کے دوران ذیابیطس میں مبتلا خواتین کو 75 گرام – او جی ٹی ٹی کا ٹیسٹ کروانا چاہیے ۔ اس کے علاوہ ہر تین سال بعد ٹائپ 2 ذیابیطس کا ٹیسٹ بھی کروانا چاہیے&nbsp; </li></ul>

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

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.

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.