Ayurveda And Diabetes During Pregnancy (Gestational Diabetes)


                                            Today is World Diabetes Day 

                                     DIABETES : PROTECT OUR FUTURE

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Diabetes is the most common medical complication of pregnancy and it has increased about 40% . The increasing prevalence of Type 2 Diabetes in general and younger people in particular has led to an increasing number of pregnancies with this complication .

Women can be separated into :

–  those who were known to have Diabetes before pregnancy –                         Pregestational or Overt 

–  those diagnosed during pregnancy – Gestational .

There is keen interest in events that precedes Diabetes which includes the mini environment of the uterus , where it is believed that early imprinting can have effects later in life ( Saudek 2002) . For example in utero exposure to maternal hyperglycemia leads to fetal hyperinsulinemia , causing an increase in fetal fat cells, which leads to obesity and insulin resistance in childhood . This in turn leads to impaired glucose tolerance and Diabetes in adulthood . Thus a cycle of fetal exposure to Diabetes leading to childhood obesity and glucose intolerance is set in motion .

gestational-diabetes

GESTATIONAL DIABETES MELLITUS :

Gestational Diabetes Mellitus is defined as carbohydrate intolerance of variable severity with onset or first recognition during the present pregnancy . An alternative explanation is that Gestational Diabetes is Type 2 Diabetes unmasked or discovered during pregnancy .

Risk Factors :

a)      Positive family history of Diabetes

b)      Having a previous birth of an overweight baby of 4 kg or more

c)       Previous stillbirth

d)      Unexplained perinatal loss

e)      Presence of polyhydramnios ( excessive amniotic fluid ) or recurrent vaginal infection in present pregnancy

f)       Persistent glycosuria

g)      Age over 30 years

h)      Obesity

i)        Ethnic groups ( East Asian , Pacific Island)

Screening :

The method employed is by using 50 gm oral glucose challenge test without regard to time of day or last meal , between 24 – 28 weeks of pregnancy . A plasma glucose value of 140 mg percent or that of whole blood of 130 mg percent at 1 hour is considered as cut off point for consideration of a 100 gm ( WHO – 75 gm ) glucose tolerance test .

Complications :

a)      Increased perinatal loss is associated with fasting hyperglycemia . Fetal anomalies are not increased due to the absence of metabolic disturbance during organogenesis in early pregnancy.

b)      Increased incidence of Macrosomia ( Fetal Macrosomia is defined as infants whose birth weight exceeds 4500 gm) .

c)       Polyhydramnios

d)      Birth trauma

e)      Recurrence of GDM in subsequent pregnancies is about 50 %

OVERT DIABETES :

A patient with symptoms of Diabetes Mellitus ( increased urination , increased thirst , weight loss ) and random plasma glucose concentration of 200 mg / dl or more is considered overt diabetic  . The condition may be pre existing or detected for the first time during present pregnancy .

According to American Diabetic Association , diagnosis is positive if

a)      The fasting plasma glucose exceeds 126 mg / dl

b)      The 2 hour post glucose ( 75 gm ) value exceeds 200 mg / dl

Patients with poor glycemic control and vascular disease are at increased risk of complication of IUD , IUGR , Pre eclampsia and Ketoacidosis .

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Complications :

MATERNAL :

During Pregnancy :

  • Abortion

  • Preterm Labour ( 20% )

  • Infection – Urinary tract infection and vulvo vaginitis

  • Increased incidence of Pre eclampsia ( 25 % )

  • Polyhydramnios ( 25 – 50% )

  • Maternal distress

  • Diabetic Retinopathy

  • Diabetic Nephropathy

  • Ketoacidosis

During Labour :

  • Prolongation of labour due to big baby

  • Perineal injuries

  • Postpartum haemorrhage

FETAL :

  • Fetal Macrosomia  – With good Diabetic control , incidence of Macrosomia is markedly reduced .

  • Congenital Malformation – It is related to the severity of Diabetes affecting organogenesis , in the first trimester ( both in Type 1 and Type 2 Diabetes ) .

  • Birth injuries

  • Fetal death

NEONATAL :

  • Hypoglycemia ( < 37mg / dl )

  • Respiratory distress syndrome

  • Hyperbilirubinemia

  • Cardiomyopathy

Macrosomia

AYURVEDA :

In Ayurveda Madhumeha disease can be correlated with Diabetes Mellitus . Though there is no direct reference of Gestational Diabetes but Garbha Vriddhi is described as a complication .

Garbha Vriddhi : In Garbha Vriddhi , there is excessive increase in size of abdomen and perspiration . Labour is difficult .

This can be understood as Overweight fetus or Macrosomia .

MANAGEMENT :

Ayurveda helps in limiting the maternal and fetal complications . Herbs are helpful as a supportive treatment along with the modern medicine under supervision .

Generally beneficial , congenial , purifying and suppressive dietetics and mode of life , not causing loss of doshas and dhatus but capable of decreasing the increased doshas and dhatus should be used .

Garbhadhan Vidhi : Pre conception counseling is a must .

Diet : Following can be included in the diet ( in moderation ) :

Vegetables : Bitter gourd , fenugreek leaves , tomatoes , bell pepper , spinach , cucumber , radish , sponge gourd , drumstick leaves & fruits , broccoli , kale , lettuce , cauliflower , cabbage .

Pulses : Mainly beans – green gram , bengal gram , black eyed pea , garbanzo beans , chick pea .

Spices : Turmeric , cinnamon , garlic , fenugreek seeds .

Cereals : Wheat , barley , pearl millet , oats .

Fruits : Plums , kiwi , lime , oranges , guava , java plum / black plum , apple,  peaches , gooseberry .

Dry Fruits : Almond , apricot , walnut .

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                   Though the most appropriate diet for women with Gestational Diabetes has not been established , it is suggested that obese women with a body mass index greater than 30 kg / m2 may benefit from a 30 – 33 % caloric restriction .

                   This should be monitored with weekly tests for ketonuria because maternal ketonemia has been linked with impaired psychomotor development in the offspring .

Physical Activity : Physical activity during pregnancy reduces the risk of Gestational Diabetes .Resistance exercise helps avoid insulin therapy in overweight women with Gestational Diabetes .

Pranayam and Yogasana is beneficial .

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Herbs : Tinospora cordifolia , Holarrhena antidysenterica ,                                Rubia cordifolia , Emblica officinale , Boerhavia diffusa , Withania somnifera , Tribulis terrestris , Hemidesmus indica etc can be given under supervision .

9 thoughts on “Ayurveda And Diabetes During Pregnancy (Gestational Diabetes)

  1. very nice article.evaluation of dosha and prakopaja nidana will be more beneficial as a preventive aspect.

  2. Sir,
    I am 27 yrs old and got pregnancy of 2 mnths. I am suffering from type2 diabetes .any ayurvedic remedies for this please reply me

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