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Pregnancy and Diabetes

เบาหวานเป็นภาวะที่ก่อให้เกิดระดับกลูโคสในเลือดสูง (กลูโคส คือ น้ำตาลที่เป็นแหล่งพลังงานหลักของร่างกาย) โดยร่างกายที่มีกลูโคสสูงสามารถก่อให้เกิดปัญหาอื่นๆ ทางสุขภาพตามมาได้ เบาหวานสามารถเกิดขึ้นได้ทั้งก่อนตั้งครรภ์หรือระหว่างการตั้งครรภ์ ทั้งสองสภาวะล้วนจำเป็นต้องได้รับการดูแลรักษาอย่างใกล้ชิด

Diabetes before Pregnancy
Diabetes is a condition that arises from an abnormality of the carbohydrate metabolism system, causing high levels of sugar in the blood. Diabetes is caused by a problem with “insulin.” Insulin carries glucose out from the blood and into various cells, where is it transformed into energy. When the body cannot produce adequate insulin or does not respond appropriately to that insulin, glucose cannot be absorbed into the cells of the body and remains in the bloodstream. A high level of glucose in the blood is called hyperglycemia. With time this high level of glucose will destroy the body and lead to various problems, such as heart disease, eye conditions (including blindness) and kidney disease.
 
There are four types of diabetes.
  • Diabetes type 1 – the body produces too little insulin or none at all. This type of diabetes occurs when a person is young and can be managed by injecting insulin. Eating appropriate foods and exercising regularly help maintain the level of glucose in the blood.
  • Diabetes type 2 – the body produces insulin, but it does not respond to the insulin that is produced and stores it in the bloodstream instead. This type of diabetes occurs when a person is older. The risk factors for this type of diabetes are obesity and a family history of diabetes. It can be managed by losing weight, eating appropriate foods, and exercising regularly to maintain a healthy weight. It may sometimes be necessary to take insulin orally or through injections.
  • Other types of diabetes caused by various factors, such as genetic abnormality of the pancreas, the adverse effects of insulin, thyroid conditions, medications, chemicals, or infections. Women with diabetes should undergo regular health check-ups and control the levels of sugar in their blood.
  • Gestational diabetes - Gestational diabetes is a health complication that is most often discovered during pregnancy as the body undergoes hormonal changes that leads to insulin resistance. This causes gestational diabetes, particularly among Asians.
 
Gestational diabetes is divided into two categories:
  1. Diabetes that is discovered before pregnancy, which refers to a woman who has diabetes before she becomes pregnant or the level of glucose in the blood after fasting is higher than 25 milligrams per deciliter, combined with other symptoms of diabetes. Treatment includes controlling food, exercising and possibly injecting insulin if the blood sugar level cannot be controlled.
  2. Diabetes that is discovered during pregnancy, which refers to a woman who did not have diabetes before she became pregnant or blood sugar levels were normal when tested before pregnancy, but the condition is found during pregnancy. If the blood sugar level is not too high, the diabetes often resolves on its own after childbirth.
 
High Risk Factors for Gestational Diabetes
  • Obesity, with body mass index (BMI) higher or equal to 30
  • Immediate family with type 2 diabetes
  • History of gestational diabetes (in previous pregnancy)
  • Sugar is detected in the urine
Women with high risk factors should be tested for blood sugar levels at the beginning of their pregnancies and again during weeks 24-28 of their pregnancies.
 
Moderate Risk Factors for Diabetes
  • Age over 25 years
  • Overweight before pregnancy
  • Large fetus
  • Problems with previous pregnancy, such as miscarriage, stillbirth, or toxemia
  • Previous baby’s birth weight was over 4,500 grams
Women with moderate risk factors should be tested for glucose levels during weeks 24-28 of their pregnancies.
 
Glucose Tolerance Testing
A patient drinks 50 grams of glucose and blood sugar levels are then measured one hour afterwards. If the level is higher than 140 milligrams per deciliter, there is a tendency of developing gestational diabetes, which will then be further explored by drinking 100 grams of glucose.
 
 
Effects on Pregnancy
Effects on the Mother
Diabetes may cause blood sugar levels to be too high or too low, high blood pressure, and deterioration of the nerve endings of the kidneys, eyes, and blood vessels. It can also make a pregnant woman prone to infections, cause an abnormally high amount of amniotic fluid, and increases the chances of a Cesarean delivery.
Effects on the Fetus
Diabetes is a risk factor for miscarriage, stillbirth, and congenital defects. The baby may have a high birth weight, resulting in a difficult birth, including shoulder dystocia. Furthermore, after birth the baby may have low blood sugar or jaundice.

Controlling Diabetes
Both types of diabetes can be controlled during pregnancy by maintaining blood sugar levels to be as close to normal as possible. Methods for controlling blood sugar include eating the right foods and exercising regularly. If the sugar levels cannot be controlled through these methods alone, it is necessary to use insulin. Whether you have diabetes before becoming pregnant or develop it during pregnancy, you should always come to all your doctor’s appointments.

 
All pregnant women, especially those with diabetes, should exercise. Physical activity helps lower blood glucose levels. You and your doctor should work together on selecting the exercises most appropriate for you and how often and how long they should be done. Generally it is recommended to do 30 minutes of exercise each day. Do not overdo it.
Women with gestational diabetes should test their bloods to monitor glucose levels on a daily basis. This is extremely important. For best results, follow the testing schedule determined by your doctor, carefully and correctly record all results and inform your doctor of the results at every antenatal visit.
     ** If the blood glucose level is not in the normal range of 70-99 milligrams per deciliter while fasting for many hours, such as in preparation of Cesarean section or other procedures, please contact the hospital for further instructions. **
 
Eating Healthy Foods
Eating healthy foods is important during pregnancy. The fetus will receive the nutrients from the foods consumed by the mother for their growth and development in utero. Eating inappropriate foods will cause blood glucose levels to be too high or too low so pregnant women should reduce intake of carbohydrates (sugar or flour) and eat more proteins (meats and fat-free milk) and vegetables.
Women who are at a healthy weight should consume 3,000 to 3,200 calories each day, while overweight women should restrict their caloric intake to 2,500 calories a day. Consult a nutritionist for individualized advice in maintaining the healthiest blood sugar levels during pregnancy.
In the case that blood sugar levels cannot be controlled, it will become necessary to use medications, which include those taken orally and those injected.
  • Insulin is a medication that is injected to control the levels of sugar in the blood. It is safe for use during pregnancy. It is injected under the skin, according to the amount and schedule specified by your doctor. Insulin is used in this case only if diet and exercise cannot adequately control blood sugar levels, and these levels must be continuously monitored while the insulin is taken.
  • Oral medications that have been reviewed and researched further include glyburide and metformin, which are used to control diabetes in pregnant women. No risk to the baby or mother has been found, but these medications are not allowed in some countries as gestational diabetes affects the health of both the mother and baby.
Correct diagnosis and appropriate management from the start can help restrict or reduce the risk of serious complications of diabetes to the mother than baby. It is very important that women with diabetes consult their doctors before and during their pregnancies and strictly attend all appointments for the health of themselves and their unborn babies.

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