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Type 2 Diabetes And Pregnancy Complications

Maternal Complications Of Gdm

Maternal Complications Of Gdm

Gestational diabetes mellitus (GDM) is defined as any carbohydrate intolerance first diagnosed during pregnancy. It is associated with adverse outcome not only for the mother, but also for the child, whether as a fetus, a neonate, a child or an adult. Maternal consequences include increased rate of operative and cesarean delivery, hypertensive disorders during pregnancy and future risk for type 2 diabetes mellitus as well as other aspects of the metabolic syndrome, such as obesity, cardiovascular morbidities and recurrent GDM. Also, there are maternal implications secondary to a delivery of a macrosomic or a large for gestational age fetus, such as an increased rate of cesarean delivery, postpartum hemorrhage, birth trauma and shoulder dystocia. In this entry we shall review maternal complications of gestational diabetes mellitus, during and following gestation: hypertensive disorders in pregnancy, increased risk of cesarean and operative deliveries, postpartum type 2 diabetes mellitus and macrosomia related complications Hypertensive disorders during pregnancy Gestational diabetes mellitus (GDM) is defined as any carbohydrate intolerance first diagnosed during pregnancy[1]. Women with GDM are at an increased risk for hypertensive disorders during pregnancy compared to those without GDM. A portion of this risk is related to co-existing mutual risk factors, such as obesity, increased maternal age and family history. However, it is evident from several studies that GDM per se is an independent risk factor for hypertensive disorders during pregnancy, with an increased relative risk ranging from 1.4 to 2.5[2][3][4]. What is the role of insulin resistance? Insulin resistance plays an important role in the pathogenesis of hypertensive disorders during pregnancy. Available dat Continue reading >>

Diabetes Symptoms And Warning Signs In Women

Diabetes Symptoms And Warning Signs In Women

Diabetes can happen at any age, though type 2 diabetes is more common in those over 45 years of age. Many of the risks for diabetes are the same between men and women, but there are some differences. The risk of developing diabetes is higher for people who: Are overweight or obese Are do not lead active lives Have high levels of fats called triglycerides, low levels of "good" cholesterol, or both Are a member of a high-risk race or ethnicity Have a history of high blood sugar Have a first-degree relative with diabetes Have conditions that are associated with the body not using insulin effectively (insulin resistance) Contents of this article: Women and diabetes One condition that is unique to women and linked to the body not using insulin effectively (insulin resistance) is polycystic ovarian syndrome. In this condition, the ovaries become enlarged and are unable to release eggs properly. Other unique risk factors include a history of gestational diabetes or having given birth to a baby weighing over 9 pounds. According to the National Institutes of Heath (NIH), close to one-third of women with diabetes do not know they have the disease. It is recommended that screening for adults of both genders be done in those over the age of 45 who are overweight or obese and who have one of the risk factors listed above. On the other hand, men are more likely to develop type 2 diabetes than women. The exact reasons why are unclear, however. One possible reason could be that men tend to carry their weight in the belly area more often than women, which can increase insulin resistance. Men are also more likely than women to develop heart disease as a result of their diabetes. The risks become relatively similar between the sexes once women reach menopause. Complications of diabetes fo Continue reading >>

Risks To Infants Of Diabetic Mothers

Risks To Infants Of Diabetic Mothers

A fetus growing inside a woman who has diabetes may be exposed to high levels of blood glucose during the pregnancy if the diabetes is not well controlled. There are two types of diabetes that may put a baby at risk during pregnancy, namely, gestational diabetes and pre-gestational diabetes. Gestational diabetes is a condition that develops during pregnancy in women who did not previously have diabetes. Pre-gestational diabetes refers to type 1 or type 2 diabetes that a woman already had prior to becoming pregnant and requires blood sugar lowering medications or insulin to treat it. It is important to ensure that the diabetes is well controlled during pregnancy, otherwise the baby will be exposed to excess blood sugar levels that can affect it during pregnancy, during birth and after birth. When the diabetes is not properly controlled, the excess blood glucose is transferred to the fetus during pregnancy, which causes the baby to produce excess amounts of insulin. The infant is then at risk of various complications including hypoglycemia, excessive birth weight, pre-term birth, respiratory distress syndrome, and birth injury. If a woman has insulin-dependent diabetes, there is also an increased risk of birth defects that affect the formation of the heart, spinal cord, brain gastrointestinal system, and urinary tract. Unlike insulin-dependent diabetes, in gestational diabetes, the blood glucose levels are generally normal throughout the critical first three months of pregnancy, when the baby’s organs are forming. Risks to the Baby Some of the complications that diabetes can lead to if it is not carefully managed during pregnancy are described in more detail below. Excessive birth weight If there is an excess of glucose in the maternal blood, it crosses the placenta and Continue reading >>

Type 2 Diabetes

Type 2 Diabetes

Introduction Diabetes is a lifelong condition that causes a person's blood sugar level to become too high. The hormone insulin – produced by the pancreas – is responsible for controlling the amount of glucose in the blood There are two main types of diabetes: type 1 – where the pancreas doesn't produce any insulin type 2 – where the pancreas doesn't produce enough insulin or the body's cells don't react to insulin This topic is about type 2 diabetes. Read more about type 1 diabetes Another type of diabetes, known as gestational diabetes, occurs in some pregnant women and tends to disappear after birth. Symptoms of diabetes The symptoms of diabetes occur because the lack of insulin means glucose stays in the blood and isn't used as fuel for energy. Your body tries to reduce blood glucose levels by getting rid of the excess glucose in your urine. Typical symptoms include: feeling very thirsty passing urine more often than usual, particularly at night feeling very tired weight loss and loss of muscle bulk Read more about the symptoms of type 2 diabetes It's very important for diabetes to be diagnosed as soon as possible as it will get progressively worse if left untreated. Causes of type 2 diabetes Type 2 diabetes occurs when the body doesn't produce enough insulin to function properly, or the body's cells don't react to insulin. This means glucose stays in the blood and isn't used as fuel for energy. Type 2 diabetes is often associated with obesity and tends to be diagnosed in older people. It's far more common than type 1 diabetes. Read about the causes and risk factors for type 2 diabetes Treating type 2 diabetes As type 2 diabetes usually gets worse, you may eventually need medication – usually tablets – to keep your blood glucose at normal levels. Read mor Continue reading >>

Pcos Pregnancy And Delivery Complications

Pcos Pregnancy And Delivery Complications

Women with PCOS are at higher risk for pregnancy and delivery complications. These include a three-fold increase in miscarriage risk in early pregnancy compared to women without PCOS, gestational diabetes (diabetes during pregnancy) which can lead to large babies, preeclampsia which is characterized by sudden elevated blood pressure and body swelling after the 20th week of pregnancy, preterm birth, and C-section delivery. Diabetes during pregnancy is a concern many women with PCOS must face. The following information is published with permission from the Hormone Health Network, the public education arm of the Endocrine Society. It has been extracted from the Diabetes and Pregnancy patient guide. What care do you need during pregnancy? Blood glucose. While pregnant, you will probably need to check your blood sugar more often than before pregnancy. Check your blood sugar as often as your doctor recommends. You should probably test it before meals, one or two hours after a meal, at bedtime, and during the night. Ask your doctor what your blood glucose numbers should be. Most pregnant women with diabetes should aim for these blood sugar levels as long as they do not cause low blood sugar: Before meals (fasting blood glucose) One hour after the start of a meal: 140 mg/dL or less Two hours after the start of a meal: 120 mg/dL or less Insulin. If you were already using an insulin pump before pregnancy, you should keep using it. You probably should not start using an insulin pump for the first time during pregnancy. But if other types of insulin treatment do not control your blood sugar, your doctor may want you to switch to an insulin pump. Medical nutrition therapy. You should see a dietitian for nutrition therapy. This healthy eating plan, tailored to you, helps make sure yo Continue reading >>

Gestational Diabetes

Gestational Diabetes

Overview Gestational diabetes develops during pregnancy (gestation). Like other types of diabetes, gestational diabetes affects how your cells use sugar (glucose). Gestational diabetes causes high blood sugar that can affect your pregnancy and your baby's health. Any pregnancy complication is concerning, but there's good news. Expectant women can help control gestational diabetes by eating healthy foods, exercising and, if necessary, taking medication. Controlling blood sugar can prevent a difficult birth and keep you and your baby healthy. In gestational diabetes, blood sugar usually returns to normal soon after delivery. But if you've had gestational diabetes, you're at risk for type 2 diabetes. You'll continue working with your health care team to monitor and manage your blood sugar. Symptoms For most women, gestational diabetes doesn't cause noticeable signs or symptoms. When to see a doctor If possible, seek health care early — when you first think about trying to get pregnant — so your doctor can evaluate your risk of gestational diabetes as part of your overall childbearing wellness plan. Once you're pregnant, your doctor will check you for gestational diabetes as part of your prenatal care. If you develop gestational diabetes, you may need more-frequent checkups. These are most likely to occur during the last three months of pregnancy, when your doctor will monitor your blood sugar level and your baby's health. Your doctor may refer you to additional health professionals who specialize in diabetes, such as an endocrinologist, a registered dietitian or a diabetes educator. They can help you learn to manage your blood sugar level during your pregnancy. To make sure your blood sugar level has returned to normal after your baby is born, your health care team wil Continue reading >>

Diabetes During Pregnancy

Diabetes During Pregnancy

What is diabetes? Diabetes is a condition in which the body can't make enough insulin, or can't use insulin normally. Insulin is a hormone. It helps sugar (glucose) in the blood get into cells of the body to be used as fuel. When glucose can’t enter the cells, it builds up in the blood. This is called high blood sugar (hyperglycemia). High blood sugar can cause problems all over the body. It can damage blood vessels and nerves. It can harm the eyes, kidneys, and heart. In early pregnancy, high blood sugar can lead to birth defects in a growing baby. There are 3 types of diabetes: Type 1 diabetes. Type 1 diabetes is an autoimmune disorder. The body's immune system damages the cells in the pancreas that make insulin. Type 2 diabetes. This is when the body can’t make enough insulin or use it normally. It’s not an autoimmune disease. Gestational diabetes. This is a condition in which the blood glucose level goes up and other diabetic symptoms appear during pregnancy in a woman who has not been diagnosed with diabetes before. It happens in about 3 in 100 to 9 in 100 pregnant women. What causes diabetes during pregnancy? Some women have diabetes before they get pregnant. This is called pregestational diabetes. Other women may get a type of diabetes that only happens in pregnancy. This is called gestational diabetes. Pregnancy can change how a woman's body uses glucose. This can make diabetes worse, or lead to gestational diabetes. During pregnancy, an organ called the placenta gives a growing baby nutrients and oxygen. The placenta also makes hormones. In late pregnancy, the hormones estrogen, cortisol, and human placental lactogen can block insulin. When insulin is blocked, it’s called insulin resistance. Glucose can't go into the body’s cells. The glucose stays in Continue reading >>

Adverse Pregnancy Outcomes In Women With Diabetes

Adverse Pregnancy Outcomes In Women With Diabetes

Abstract Pregnancy affects both the maternal and fetal metabolism and even in nondiabetic women exerts a diabetogenic effect. Among pregnant women, 2 to 17.8% develop gestational diabetes. Pregnancy can also occur in women with preexisting diabetes, that can predispose the fetus to many alterations in organogenesis, growth restriction and the mother to some diabetes-related complications like retinopathy and nephropathy or accelerate the course of these complications if they are already present. Women with gestational diabetes generally start their treatment with diet and lifestyle modification; when these changes fail in keeping an optimal glycemic control, then insulin therapy must be considered. Women with type 2 diabetes in use of oral hypoglycemic agents are advised to change to insulin therapy. Those with preexisting type 1 diabetes must start an intensive glycemic control, preferably before conception. All these procedures are performed aiming to keep glycemic levels normal or near-normal as possible to avoid the occurrence of adverse perinatal outcomes to the mother and to the fetus. The aim of this review is to reinforce the need to improve the knowledge on reproductive health of women with diabetes during gestation and to understand what are the reasons for them failing to attend for prepregnancy care programs, and to understand the underlying mechanisms of adverse fetal and maternal outcomes, which in turn may lead to strategies for its prevention. Background Pregnancy affects both the maternal and fetal metabolism and even in nondiabetic women exerts a diabetogenic effect. As normal pregnancy progresses insulin resistance increases and pancreatic β-cells reserve is stressed aiming to maintain glycemia within normal ranges; gestational diabetes results when Continue reading >>

Diabetes Mellitus And Pregnancy

Diabetes Mellitus And Pregnancy

Practice Essentials Gestational diabetes mellitus (GDM) is defined as glucose intolerance of variable degree with onset or first recognition during pregnancy. A study by Stuebe et al found this condition to be associated with persistent metabolic dysfunction in women at 3 years after delivery, separate from other clinical risk factors. [1] Infants of mothers with preexisting diabetes mellitus experience double the risk of serious injury at birth, triple the likelihood of cesarean delivery, and quadruple the incidence of newborn intensive care unit (NICU) admission. Gestational diabetes mellitus accounts for 90% of cases of diabetes mellitus in pregnancy, while preexisting type 2 diabetes accounts for 8% of such cases. Screening for diabetes mellitus during pregnancy Gestational diabetes The following 2-step screening system for gestational diabetes is currently recommended in the United States: Alternatively, for high-risk women or in areas in which the prevalence of insulin resistance is 5% or higher (eg, the southwestern and southeastern United States), a 1-step approach can be used by proceeding directly to the 100-g, 3-hour OGTT. The US Preventive Services Task Force (USPSTF) recommends screening for gestational diabetes mellitus after 24 weeks of pregnancy. The recommendation applies to asymptomatic women with no previous diagnosis of type 1 or type 2 diabetes mellitus. [2, 3] The recommendation does not specify whether the 1-step or 2-step screening approach would be preferable. Type 1 diabetes The disease is typically diagnosed during an episode of hyperglycemia, ketosis, and dehydration It is most commonly diagnosed in childhood or adolescence; the disease is rarely diagnosed during pregnancy Patients diagnosed during pregnancy most often present with unexpected Continue reading >>

Gestational Diabetes Mellitus And Risk Of Type 2 Diabetes 10 Years After The Index Pregnancy In Sri Lankan Women—a Community Based Retrospective Cohort Study

Gestational Diabetes Mellitus And Risk Of Type 2 Diabetes 10 Years After The Index Pregnancy In Sri Lankan Women—a Community Based Retrospective Cohort Study

Abstract Women with a history of gestational diabetes mellitus (GDM) have an increased risk of type 2 diabetes mellitus (T2DM) later in life compared to women with no GDM. This study was aimed to determine the risk of developing T2DM 10 years after GDM in Sri Lankan women. A retrospective cohort study was conducted in the Colombo district, Sri Lanka. 7205 women who delivered a child in 2005 were identified through Public Health Midwives in the field. Women with antenatal records were interviewed and relevant data were extracted from medical records to identify potential participants. One hundred and nineteen women who had GDM and 240 women who did not have GDM were recruited. Current diagnosis of diabetes was based on history, relevant medical records and blood reports within the past 1 year. Results The mean duration of follow up was 10.9 (SD = 0.35) years in the GDM group and 10.8 (SD = 0.31) years in the non-GDM group. The incidence density of diabetes in the GDM group was 56.3 per 1000 person years compared to 5.4 per 1000 person years in non GDM group giving a rate ratio of 10.42 (95% CI: 6.01–19.12). A woman having GDM in the index pregnancy was 10.6 times more likely to develop diabetes within 10 years compared to women with no GDM after controlling for other confounding variables. Delivering a child after 30 years, being treated with insulin during the pregnancy and delivering a baby weighing more than 3.5 Kg were significant predictors of development of T2DM after controlling for family history of diabetes mellitus (DM), GDM in previous pregnancies, parity and gestational age at delivery. Women with GDM had a 10-fold higher risk of developing T2DM during a 10-year follow up period as compared to women with no GDM after controlling for other confounding variab Continue reading >>

Pregnancy Complications

Pregnancy Complications

While most pregnancies are smooth sailing, some women have a tougher time than others Anaemia Anaemia is a condition in which mums-to-be have less than the usual number of red blood cells in her blood. It can occur during pregnancy and is most often caused by the increased iron demands of the baby and the necessity for the pregnant women to expand her blood volume. If you are anaemic, you may feel tired and are less able to cope with any loss of blood when you give birth. If routine blood tests during pregnancy show that you are anaemic, the doctor may prescribe iron and folic acid tablets. Sometimes anaemia occurs due to excessive blood loss e.g. bleeding piles or gastric ulcers. Do let your doctor know if you have any of these symptoms. Related: Low In Energy? You Could Be Low In Iron Antenatal Depression Depression during pregnancy can occur when changes experienced by the mum-to-be are overwhelming. Symptoms include low mood, irritability, loss of interest, poor appetite, poor concentration, excessive self-blame or guilt, and feeling that life is meaningless. If these symptoms continue for two weeks or more, and/or affect your work and the people around you, talk to your doctor. With proper care and management, you can still enjoy the journey to parenthood and reduce the chances of developing postnatal depression. Related: Myths and Misconceptions about Depression Gestational Diabetes Due to the hormonal changes in pregnancy, some women may become diabetic during pregnancy. If it clears up after delivery, it is merely gestational diabetes. This means they are diabetic only when pregnant but it also means they are at risk of becoming diabetic later in life. Risk factors for gestational diabetes are first-degree family history of diabetes (i.e. parents and siblings), Continue reading >>

How Does Gestational Diabetes Affect The Developing Fetus?

How Does Gestational Diabetes Affect The Developing Fetus?

Usually, Gestational Diabetes goes away as soon as your baby is born. But, if it left uncontrolled, it can risk you and your baby. The Risks for your baby: Hypoglycemia: The blood sugar of the baby is low. You need to breastfeed to get the glucose out of the baby’s system. Macrosomia: The body of the baby is larger than normal. Your baby can weight 9 pounds or more. Jaundice: The skin of the baby is yellow while the eyes may appear a little color change. Low Magnesium and Calcium levels: The baby may develop a condition causing feet and hand spasms or cramping muscles. Respiratory Distress syndrome. There is breathing trouble in the baby and it may require oxygen for breathing in case there are respiratory issues. Continue reading >>

Gestational Diabetes: What You Need To Know

Gestational Diabetes: What You Need To Know

This pregnancy complication is more common than you might think. Learn who's at risk for it, how it's detected, and what can be done to treat it. For years, doctors believed that gestational diabetes affected three to five percent of all pregnancies, but new, more rigorous diagnostic criteria puts the number closer to 18 percent. The condition, which can strike any pregnant woman, usually develops in the second trimester, between weeks 24 and 28, and typically resolves after baby is born. If gestational diabetes is treated and well-managed throughout your pregnancy, "There's no reason you can't deliver a very healthy baby," says Patricia Devine, M.D., perinatologist at New York-Presbyterian Hospital in New York City. But gestational diabetes that goes untreated, or isn't carefully monitored, can be harmful for both mother and baby. Consult our guide for risk factors, signs of gestational diabetes, and treatment options. What is gestational diabetes? Gestational diabetes, or diabetes that is diagnosed during pregnancy in a woman who previously did not have diabetes, occurs when the pancreas fails to produce enough insulin to regulate blood sugar efficiently. "A hormone produced by the placenta makes a woman essentially resistant to her own insulin," Dr. Devine explains. How does gestational diabetes differ from type 1 or 2 diabetes? Gestational diabetes affects only pregnant women. People who have type 1 diabetes, sometimes referred to as juvenile diabetes, are generally born with it. Type 2 diabetes accounts for 95 percent of all cases of diabetes in the U.S.; it occurs in adulthood, and is triggered by lifestyle factors such as obesity and lack of physical activity. What causes it? It's unclear why some women develop gestational diabetes while others do not. Doctors th Continue reading >>

Type 1 Diabetes More Risky For Moms, Babies

Type 1 Diabetes More Risky For Moms, Babies

U. ROCHESTER (US) — Pregnant women with type 2 diabetes have a better chance for a good outcome than those with type 1, particularly if they receive proper care before and during their pregnancy. A new study published in the Journal of Reproductive Medicine shows the importance of separating type 1 diabetes from type 2 when considering treatment. Historically, research on diabetes during pregnancy did not differentiate between the two types. “With the rapid rise of type 2 diabetes in reproductive-age women, it is important to look at it separate from type 1 so we know how best to support and care for type 2 diabetics to promote the best possible outcomes in pregnancy,” says Eva K. Pressman, professor of obstetrics and gynecology and head of the division of maternal fetal medicine at the University of Rochester Medical Center. [sources] Type 1 diabetics in the study had a higher incidence of complications and of poor outcomes than the type 2 and non-diabetic women. For example, 20 percent of the type 1 diabetics had preeclampsia, a condition marked by elevated blood pressure and protein in the urine, compared with 14 percent of type 2 and 1 percent of non-diabetics. Type 1 mothers who had never had a cesarean delivery had a 50 percent cesarean-section rate, compared with 27 percent for type 2 and 13 percent for non-diabetics. Babies of type 2 diabetics in the study had a higher incidence of being large for their gestational age, at 38 percent, versus 23 percent for type 1 mothers and just 3 percent for non-diabetic moms. Eighty-five percent of babies born to type 1 moms required admission to the neonatal intensive care unit, compared with 71 percent born to type 2 moms and 11 percent of non-diabetic moms. Pressman, who co-authored the study with colleagues Loralei Continue reading >>

Symptoms Of Gestational Diabetes

Symptoms Of Gestational Diabetes

While the real symptom of gestational diabetes is elevated blood sugar, there are some serious complications that can stem from the condition. Women with poorly controlled diabetes, and their infants, have an increased risk for the following conditions during pregnancy and childbirth: Birth defects. Women who have high glucose levels during the first six to eight weeks of pregnancy are most likely to bear children with birth defects. During that time, a baby's major organs are forming. High glucose levels can interfere with healthy development and damage the fetus's heart and spinal cord, as well as bones, kidneys, and gastrointestinal system. One study found that women who failed to attain good glucose control before getting pregnant were ten times more likely to bear a child with a birth defect. Jaundice. For some reason, babies born to women with diabetes sometimes have this yellow discoloration of the skin and eyes. Jaundice occurs when the blood contains too much bilirubin, a by-product made when red blood cells break down. Although jaundice is usually harmless and fades after a few days, a physician must monitor the condition. Macrosomia. This condition is also known as gigantism and large-for-gestational-age infant, but you can just think of it as Really Big Baby Syndrome. Plainly stated, women with poorly controlled glucose during pregnancy often give birth to immense infants. How big? By one definition, a baby is considered abnormally large if it weighs more than 9 or 10 pounds or tips the scales at a weight higher than 90 percent of other newborns. Apart from the fact that a large newborn can't squeeze into the darling little outfit you knitted for him (and boys are more likely to be plus size than girls), what's the big deal? Plenty. Continue to the next sect Continue reading >>

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