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 .

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13 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

      • sir, I am 29 yrs old, and 8 month pregnant, having diabetes from 7 th month of pregnancy, taking insulin R6-0-R5 dosage, im feeling hungry always how to control it?

      • Greetings for the day.
        Mam , your weight , diet and physical activity has to be balanced. I’ll recommend you to eat 6 small meals throughout the day, about 2-3 hours between meals. When hungry you can have nuts / salad/ roasted bengal gram, barley, oats etc.
        Go for walk or do yoga under supervision. Meditate or sit in silence for few minutes to calm your mind.
        Monitor the blood sugar levels regularly.
        Follow your doctor’s instructions
        Kindly go through the article. Thanks.

  3. I’m interested in how best to care for mother post partum if she has had gestational diabetes. Lactating, I’m mindful of not prescribing too many herbs for her. Would manjistha be too strong on breast milk/baby? Is it better to stick to kitchen herbs such as fenugreek and cinnamon? Gourds, greens and beans are recommended to keep blood-sugar stabalised but would you have any other recommendations? Many thanks.

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