Diabetes mellitus, commonly called diabetes, is derived from the Greek word diabetes, meaning syphon- to pass through and the Latin word mellitus meaning sweet. As per literature the term diabetes was first used by Apollonius of Memphis around 250 BC. Later as the ancient Greek, Chinese, Indian, and Egyptian civilizations discovered the sweet nature of urine in this condition, the word Diabetes Mellitus came into being. Passage of urine in large amounts being one of its most common symptoms, the 17th century English physician Thomas Willis named it as ‘The pissing evil’. Gradually its pathogenesis became clear and accordingly various effective treatment modalities including insulin therapy got developed. But unfortunately, till now globally diabetes is one of the most common chronic diseases prevailing.
Pregnancy is a state where the mothers body changes all its physiology to accommodate the foetus and to support its growth and development. As the foetus is totally dependent on the mother for its energy requirement, the maternal system ensures a continuous supply of glucose to the foetus. Thus, physiologically an insulin resistance is developed in pregnant mothers under the influence of pregnancy hormones like human placental lactogen, oestrogen, progesterone, prolactin, cortisol which prevents the maternal utilisation of entire glucose. This phenomenon reaches its maximum during the second trimester and there will always be postprandial hyperglycemia followed by diversion of glucose to the foetus. Though these hyperglycaemic changes are happening in mothers’ bodies, normally it does not cross the diabetic threshold. But in a lady who is already having insulin resistance or is diabetic, it will result in the condition diabetes in pregnancy.
Insulin resistance:
Insulin is a hormone released by the pancreas which regulates the utilisation of glucose from the bloodstream into the body’s cells. Insulin resistance is the impaired insulin sensitivity and the body’s cells do not respond normally to insulin. This results in building up of glucose in the blood as it cannot be utilised by the tissues. As a result, the pancreas produces more and more insulin to overcome these increasing blood glucose levels resulting in hyperinsulinemia. In addition to diabetes, insulin resistance is also associated with obesity, polycystic ovarian syndrome, non-alcoholic fatty liver diseases, metabolic syndrome, and many similar other conditions. It can be temporary or chronic. Temporarily insulin resistance develops from excess body fat, physical inactivity, high carbohydrate diet and certain medications like steroids.
Who all are at risk of diabetes in pregnancy??
- Obese women
- Family history of diabetes mellitus
- History of diabetes in previous pregnancy
- History of previous stillbirth, difficult delivery due to big baby
- Ethnicity; Indian population is prone to diabetes
Types:
Diabetes in pregnancy is of two types based on when it gets developed and diagnosed: the gestational diabetes and pregestational or overt diabetes.
If the woman is getting diagnosed with diabetes for the first-time during pregnancy and which usually develops during the second trimester around the fifth month it is gestational diabetes. This condition is not usually associated with much risk of abortion or foetal anomalies and following delivery the woman gets back to normal glucose levels in her body. But if a diabetic woman is getting pregnant, she is a case of overt diabetes and she is at increased risk of abortions and various foetal anomalies. These risks can be reduced if the condition is detected early and managed well.
Screening for diabetes in pregnancy:
Different countries follow different guidelines for screening diabetes in pregnancy. In India under the DIPSI guidelines, a universal screening is done where all pregnant ladies are screened for diabetes as early as possible in the first antenatal visit. This is because Indians as an ethnic group are already at risk for developing diabetes. This one step test called Oral Glucose Tolerance Test (OGTT) is repeated at 24 to 28 weeks of pregnancy. Various other countries like the US follow a two step method where they first do screening at 24 weeks by Glucose Challenge Test (GCT) followed by Glucose Tolerance Test (GTT) if screening becomes positive.
Management:
Once diagnosed with gestational diabetes, start with diet modifications under the guidance of a registered medical practitioner or dietician. Thirty minutes aerobic exercise is also advised 5 days a week. Diet and exercise alone might not always help in controlling your blood sugar levels. In such unresponsive conditions or if one is having blood sugars in the overt range (FBS>126 mg/dl or RBS >200 mg/dl or 2-hour OGTT >200 mg/dl) that patient should be started with insulin therapy.
Prevention:
Planning of pregnancy and taking preconception health care under an expert can improve chances of having a healthy pregnancy.
Garbha Sanskar; The Preparation for a lifetime:
Garbha Sanskar is a comprehensive approach of maternal care based on the science of Ayurveda covering everything from planning of a pregnancy to delivery of a healthy baby. It aims at begetting a Sreyasipraja (superior progeny with all the qualities desired by the couple) and it incorporates two of the 16 Samskaras; the Garbhadana Samskara; planning of pregnancy and the Pumsavana Samskara; lifestyle modification and therapies performed with the aim of achieving a pregnancy, maintaining it healthy and getting a progeny of desired sex. Garbha Sanskar is performed based on the principle that a person’s mental, behavioural, spiritual development starts in the womb and it can be influenced by modifying the food, habits, and thoughts of the pregnant mother. So based on the detailed history and desires of the couple planning for pregnancy, a customised plan of treatments and lifestyle modifications under GarbhaSanskar may be developed for each of them under the principle the future consequences are inevitably shaped by present actions.
