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Potato chips, fried food, all junk
food, mangoes, and grapes. With diet
restrictions fasting blood sugar should
be maintained below 105mg/dl.
If the dietary management does
not control the blood sugars then
insulin is started. It is usually started
with hospitalisation to safely adjust
the dose and educate the women
on self-administration. Frequent
blood sugar estimation is required
to control the insulin dose, as urine
sugar examination is not very
informative to adjust the insulin
dosage. The insulin dosage is so
adjusted that it maintains maternal
blood glucose levels and at the same
time prevent neonatal hypoglycemia.
Oral anti diabetic medicines are not
given as they may have an adverse
effect on the foetus.
Adverse effects
To the mother:
• Uncontrolled diabetes can cause
spontaneous abortions.
• Increased incidence of excess water
in the womb.
• Increased incidence of urinary
tract infections.
• Complicated labour.
• Pre eclampsia
• Post partum hemorrhage i.e.
excessive blood loss after delivery.
• Increase chances of sepsis,
infections in the peurperium i.e.
after delivery.
• Failing lactation.
To the baby:
• Increased incidence of large over
weight baby more than 4kg. This
causes difficult or obstructed
labour, increase rate of caesarean
section.
• 3-4 folds increase in congenital
malformation specially related to
severity of diabetes affecting organ
formation in the first three months
of pregnancy.
Women with overt diabetes are more
at risk than those with GD for
Congenital malformations, foetal
deaths and stillbirths. Therefore good
control of diabetes before conception
and after reduces the incidence of
complications. During the routine
scans and ultrasounds, foetal
abnormalities can be detected and
appropriately looked into.
Delivery complications
If the patient is young, under good diabetic control and
without any obstetrical complications then the pregnancy
can be continued the expected date of delivery. Caesarean
section is done if labor is prolonged
Such babies can be more prone to neonatal complications
like jaundice, respiratory distress syndrome so special
neonatal care should be given.
If the mum is breastfeeding she is not given oral medicines
of diabetes. Recurrence of GD in subsequent pregnancy was
found in 20 women out of 30. Obese women are more likely
to develop GD again. So, pre-pregnancy counselling before
the next pregnancy is a good idea.
H
61
Apr/May 2014