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Diabetes: One of Pregnancy’s Major Roadblocks

They say that of all the rights a woman has, the best is to give birth and become a mother. Despite its numerous discomforts – having morning sickness, mood swings, swollen feet, and the feeling of carrying two sacks of rice day in and day out – I know a lot of women who’d go through it, all over again, to experience the feeling of being whole after giving birth.

Yet unfortunately for some, their pregnancy may entail a lot more complications. Diabetes may affect their pregnancy negatively, and instead of them looking forward to becoming mothers, they may get burdened thinking about their health and the future of their babies. This information will give you insights on how to take care of yourself during pregnancy and prevent the onslaught of problems diabetes may bring to you and your child.

Diabetes and Pregnancy
“There are two kinds of diabetes you encounter during pregnancy.One is the diabetic woman who’s going to get pregnant; the other one is where you determine or detect your glucose intolerance or sugar elevation during pregnancy,” explains Dr.. Josephine Carlos-Raboca, president of the Philippine Society of Endocrinology and Metabolism (PSEM). She says that the first is called pre-gestational diabetes mellitus, while the latter is known as gestational diabetes mellitus.

One may ask how these two kinds of diabetes during pregnancy may F differ in their manifestations. Here 3 are some useful information on how  to differentiate the two types of diabetes in pregnancy.

Pre-Gestational Diabetes Mellitus
It is a must that women with diabetes prepare well before pregnancy as it may cause birth defects for the baby, and trigger complications for the mother. “If you have complications, moderate to severe, it may not be wise to get pregnant. But should you get pregnant, you should have very good control prior to pregnancy,” adds Dr. Raboca. She highly recommends diabetic women to check their blood sugar four to seven times a day.

According to Dr. Rogelio Mendiola, president of the Philippine Obstetrical and Gynecological Society (POGS), “Type 1 diabetes must be controlled with a balance of diet, exercise, and insulin. Type 2 diabetes might be controlled with diet and exercise, or it might take diabetes pills or insulin or both as well as diet and exercise to get control.” If blood sugars are uncontrolled, this may lead to miscarriage and other complications, both for the mother and the unborn baby. “For instance, you’ll have complications like renal and heart complications, you may have atherosclerosis and this may affect your placental circulation, and likewise affect your baby,” says Dr. Raboca.

“Sometimes, out of control blood sugar causes a woman to make extra large amounts of amniotic fluid around the baby which might lead to preterm (early) labor”, says Dr. Mendiola. “Another problem common to a pregnant woman with uncontrolled diabetes is that her baby grows too large,” he adds. Dr. Mendiola explains that a large baby can cause serious problems during delivery for both the mother and the baby. These babies may also have low birth weight and have a higher risk of developing diabetes later in life.

Gestational Diabetes Mellitus
As defined by Dr. Raboca, gestational diabetes mellitus or GDM is diabetes that occurs during pregnancy. She says that symptoms of GDM may overlap with what pregnant women usually feel.”One of the symptoms is frequent ,urination which you may also see in pregnant women. Sugars in GDM may not be very, very high so you will not get prominent symptoms. You have to undergo screening to find out. It is best not to wait for symptoms,” she states. If you have a parent or sibling who is diabetic, you are African American, American Indian, Asian American, Hispanic/Latino or Pacific Islander, 25 years old or older, overweight, had GDM before, had at least one baby weighing over nine pounds or more and had been told of having “prediabetes”, chances of acquiring GDM is very high.

The good news is there is a low possibility of the baby having birth defects since GDM develops later in pregnancy, meaning the baby’s organs have already developed. Bad news is the mother may still experience several other complications. “She might have an extra large baby, have high blood pressure, deliver too early, or need to have a cesarean section. When the baby is delivered surgically by a cesarean section (C-section), it takes longer for the woman to recover from childbirth,” shares Dr. Mendiola. After pregnancy, sometimes the GDM goes away, but for some it stays on. Dr. Raboca says they re-evaluate mothers who had GDM four to six weeks after delivery. She adds that among women who had GDM, 50 to 60 percent may, develop type 2 diabetes after 15 years.

Breastfeeding is Still Best Even with Diabetes
Contrary to the befief of others, diabetic mothers could still breastfeed their babies. In fact, their doctors highly recommend it because it “jumpstarts and strengthens your own baby’s immune system, something formula can never do;’ says Dr. Mendiola. He believes’that regardless of being diabetic or nondiabetic, mothers must breastfeed their babies. “Breastfeeding is the first and most important step in the immunization process of children, yet it is one that is often overlooked. It truly is nature’s vaccine for the newborn;’ he emphasizes. He furthers that breast milk contains protective substances like live white cells (leukocytes and lymphocytes) that attack bacteria and viruses that protect the baby from certain illnesses. Breast milk is found to defend babies against iar infections, allergies and gastrointestinal illnesses.

Healthy Eating is a Must
Diabetic mothers should control their blood sugars to prevent complications. They should exercise and have a good diet. Ms. Imelda Cardino, Life Member of the Nutritionist-Dieticians’ Association of the Philippines (NDAP), has something to say about this. She still considers the diet of these pregnant women as a “normal” diet, although she emphasizes that foods that can raise their glucose levels must be avoided. Instead, they should take food high in fiber. “There are studies that show that the moment fiber content decreases, the glucose response rises. Fiber is also good because it increases the feeling of fullness, good bowel movement, and brings down glucose response after meals,” says Ms. Cardino.

She adds that carbohydrate content in their diet may also be increased. “For pregnant women most endocrinologists will allow 40 to 50 percent of carbohydrates in their diet. For some with type 1 diabetes they are recommended to have bedtime snacks. But for the pregnant it is mandatory to prevent starvation ketosis, a situation wherein ketones start accumulating when there is no food in the body for more than eight hours. Type 2 diabetics can forego bedtime snacks,” she explains. Ms.Cardino adds that there are only three types of artificial sweeteners allowed for these pregnant women – aspartame, sucralose, and acepotassium. However, it is only aspartame that is highly recommended by endocrinologists. With that she says that these pregnant women avoid blends, as it may contain a combination of two or more of these artificial sweeteners.

Helpful Tips
For those with pre-gestational or gestational diabetes, it is still best that you closely monitor your glucose levels to prevent complications during and after pregnancy. As previously mentioned, this will not only help the mother but the baby as well. For those whose GDM disappeared after their delivery, Dr. Mendiola recommends that you lose weight, be active for 30 minutes a day, and cut down on food rich in fat and high in calories. It is also best that you 3get checked-up for diabetes or prediabetes every one or two years. And the best advice Dr. Mendiola could leave is to breastfeed your baby as it may highly lower his or her risk of developing type 2 diabetes.

Dr. Raboca, also encourages attending PSEM’s lay fora as they have included modules on diabetes and pregnancy. They also have brochures which these women could read up on. From her end, Ms. Cardino encourages these women to eat the right kind of foods. Pregnancy can make a woman crave for a lot of things. It is wise that they weigh whether this would be beneficial to their health or not. Staying away from sweets and foods that are high in fat can make a significant difference.

Diabetes: One of Pregnancy’s Major Roadblocks

They say that of all the rights a woman has, the best is to give birth and become a mother. Despite its numerous discomforts – having morning sickness, mood

swings, swollen feet, and the feeling of carrying two sacks of rice day in and day out – I know a lot of women who’d go through it, all over again, to

experience the feeling of being whole after giving birth.

Yet unfortunately for some, their pregnancy may entail a lot more complications. Diabetes may affect their pregnancy negatively, and instead of them looking

forward to becoming mothers, they may get burdened thinking about their health and the future of their babies. This information will give you insights on how

to take care of yourself during pregnancy and prevent the onslaught of problems diabetes may bring to you and your child.

Diabetes and Pregnancy
“There are two kinds of diabetes you encounter during pregnancy.One is the diabetic woman who’s going to get pregnant; the other one is where you determine

or detect your glucose intolerance or sugar elevation during pregnancy,” explains Dr.. Josephine Carlos-Raboca, president of the Philippine Society of

Endocrinology and Metabolism (PSEM). She says that the first is called pre-gestational diabetes mellitus, while the latter is known as gestational diabetes

mellitus.

One may ask how these two kinds of diabetes during pregnancy may F differ in their manifestations. Here 3 are some useful information on how
to differentiate the two types of diabetes in pregnancy.

Pre-Gestational Diabetes Mellitus
It is a must that women with diabetes prepare well before pregnancy as it may cause birth defects for the baby, and trigger complications for the mother. “If

you have complications, moderate to severe, it may not be wise to get pregnant. But should you get pregnant, you should have very good control prior to

pregnancy,” adds Dr. Raboca. She highly recommends diabetic women to check their blood sugar four to seven times a day.

According to Dr. Rogelio Mendiola, president of the Philippine Obstetrical and Gynecological Society (POGS), “Type 1 diabetes must be controlled with a

balance of diet, exercise, and insulin. Type 2 diabetes might be controlled with diet and exercise, or it might take diabetes pills or insulin or both as

well as diet and exercise to get control.” If blood sugars are uncontrolled, this may lead to miscarriage and other complications, both for the mother and

the unborn baby. “For instance, you’ll have complications like renal and heart complications, you may have atherosclerosis and this may affect your placental

circulation, and likewise affect your baby,” says Dr. Raboca.

“Sometimes, out of control blood sugar causes a woman to make extra large amounts of amniotic fluid around the baby which might lead to preterm (early)

labor”, says Dr. Mendiola. “Another problem common to a pregnant woman with uncontrolled diabetes is that her baby grows too large,” he adds. Dr. Mendiola

explains that a large baby can cause serious problems during delivery for both the mother and the baby. These babies may also have low birth weight and have

a higher risk of developing diabetes later in life.

Gestational Diabetes Mellitus
As defined by Dr. Raboca, gestational diabetes mellitus or GDM is diabetes that occurs during pregnancy. She says that symptoms of GDM may overlap with what

pregnant women usually feel.”One of the symptoms is frequent ,urination which you may also see in pregnant women. Sugars in GDM may not be very, very high so

you will not get prominent symptoms. You have to undergo screening to find out. It is best not to wait for symptoms,” she states. If you have a parent or

sibling who is diabetic, you are African American, American Indian, Asian American, Hispanic/Latino or Pacific Islander, 25 years old or older, overweight,

had GDM before, had at least one baby weighing over nine pounds or more and had been told of having “prediabetes”, chances of acquiring GDM is very high.

The good news is there is a low possibility of the baby having birth defects since GDM develops later in pregnancy, meaning the baby’s organs have already

developed. Bad news is the mother may still experience several other complications. “She might have an extra large baby, have high blood pressure, deliver

too early, or need to have a cesarean section. When the baby is delivered surgically by a cesarean section (C-section), it takes longer for the woman to

recover from childbirth,” shares Dr. Mendiola. After pregnancy, sometimes the GDM goes away, but for some it stays on. Dr. Raboca says they re-evaluate

mothers who had GDM four to six weeks after delivery. She adds that among women who had GDM, 50 to 60 percent may, develop type 2 diabetes after 15 years.

Breastfeeding is Still Best Even with Diabetes
Contrary to the befief of others, diabetic mothers could still breastfeed their babies. In fact, their doctors highly recommend it because it “jumpstarts and

strengthens your own baby’s immune system, something formula can never do;’ says Dr. Mendiola. He believes’that regardless of being diabetic or nondiabetic,

mothers must breastfeed their babies. “Breastfeeding is the first and most important step in the immunization process of children, yet it is one that is

often overlooked. It truly is nature’s vaccine for the newborn;’ he emphasizes. He furthers that breast milk contains protective substances like live white

cells (leukocytes and lymphocytes) that attack bacteria and viruses that protect the baby from certain illnesses. Breast milk is found to defend babies

against iar infections, allergies and gastrointestinal illnesses.

Healthy Eating is a Must
Diabetic mothers should control their blood sugars to prevent complications. They should exercise and have a good diet. Ms. Imelda Cardino, Life Member of

the Nutritionist-Dieticians’ Association of the Philippines (NDAP), has something to say about this. She still considers the diet of these pregnant women as

a “normal” diet, although she emphasizes that foods that can raise their glucose levels must be avoided. Instead, they should take food high in fiber. “There

are studies that show that the moment fiber content decreases, the glucose response rises. Fiber is also good because it increases the feeling of fullness,

good bowel movement, and brings down glucose response after meals,” says Ms. Cardino.

She adds that carbohydrate content in their diet may also be increased. “For pregnant women most endocrinologists will allow 40 to 50 percent of

carbohydrates in their diet. For some with type 1 diabetes they are recommended to have bedtime snacks. But for the pregnant it is mandatory to prevent

starvation ketosis, a situation wherein ketones start accumulating when there is no food in the body for more than eight hours. Type 2 diabetics can forego

bedtime snacks,” she explains. Ms.Cardino adds that there are only three types of artificial sweeteners allowed for these pregnant women – aspartame,

sucralose, and acepotassium. However, it is only aspartame that is highly recommended by endocrinologists. With that she says that these pregnant women avoid

blends, as it may contain a combination of two or more of these artificial sweeteners.

Helpful Tips
For those with pre-gestational or gestational diabetes, it is still best that you closely monitor your glucose levels to prevent complications during and

after pregnancy. As previously mentioned, this will not only help the mother but the baby as well. For those whose GDM disappeared after their delivery, Dr.

Mendiola recommends that you lose weight, be active for 30 minutes a day, and cut down on food rich in fat and high in calories. It is also best that you

3get checked-up for diabetes or prediabetes every one or two years. And the best advice Dr. Mendiola could leave is to breastfeed your baby as it may highly

lower his or her risk of developing type 2 diabetes.

Dr. Raboca, also encourages attending PSEM’s lay fora as they have included modules on diabetes and pregnancy. They also have brochures which these women

could read up on. From her end, Ms. Cardino encourages these women to eat the right kind of foods. Pregnancy can make a woman crave for a lot of things. It

is wise that they weigh whether this would be beneficial to their health or not. Staying away from sweets and foods that are high in fat can make a

significant difference.

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