Welcome to Journal Of Pakistan Medical Association

 Supplement Vol:66, No:9 September, 2016

Editorial >>

Before conception, beyond completion of pregnancy: Prevention of gestational diabetes mellitus

Fatema Jawad, Sanjay Kalra,

Gestational diabetes mellitus (GDM),1 by definition, is a condition which is recognized during gestation, and which (ideally) should resolve after delivery. How then, can a "gestational" condition be managed before conception or after completion of pregnancy?

Diabetes in Pregnancy

Hajera Mahtab, Bishwajit Bhowmik,

Diabetes is now a global epidemic. In 2015, an estimated 415 million people, corresponding 1 in 11 worlds\' adult population had diabetes. The number is expected to grow to 642 million by 2040, corresponding to 1 in 10 adult populations.1
Diabetes can be hard on wo....

Message >>

Message

Dr. Mohammad Idrees Adhi,

The number of diabetics is on the increase in alarming proportions all over the world including Pakistan. Pregnancy in diabetics is a stress on an already compromised metabolism and the physicians must have a clear idea about the physiological changes in pregnant diabetics so as to be in a better....

Basic Sciences and Preconception >>

Gestational diabetes mellitus in South Asia: Epidemiology

Fatema Jawad, kiran Ejaz,

Gestational diabetes mellitus, is defined by the American Diabetes Association as "diabetes diagnosed in the second or third trimester of pregnancy that is not clearly overt diabetes".
WHO has further classified the period of diagnosis as Hyperglycaemia in Pregnancy and Gestation....

Metabolic Physiology in Pregnancy

Sultan Ayoub Meo, Asim Hassain,

The metabolic physiology during pregnancy is unique in the life of women. This change is a normal physiological adaptation to better accommodate the foetal growth and provides adequate blood, nutrition and oxygen. The metabolic changes prepare the mother\'s body for pregnancy, childbirth and la....

Genetics of gestational diabetes mellitus

Venkatesan Radha, Sekar Kanthimathi, Ranjit Mohan Anjana, Viswanathan Mohan, Ranjit Mohan Anjana, Viswanathan Mohan,

Gestational diabetes mellitus (GDM) has now become a major public health problem because of its prevalence and its associated complications during pregnancy. Earlier studies have suggested that type 2 diabetes mellitus (T2DM) and GDM might have similar pathophysiology, such as increased insulin r....

Preconception optimization of glycaemic control in diabetes

Najmul Islam,

The prevalence of Diabetes Mellitus is increasing worldwide. In developing countries 25% of adult females with diabetes are in the reproductive age. Thus in developing countries increased number of pregnancies are complicated by diabetes. Uncontrolled diabetes in pregnancy is associated with incr....

Diagnosis and Monitoring >>

Screening and diagnosis of gestational diabetes mellitus

Yashdeep Gupta, Bharti Kalra,

American Diabetes Association defines gestational diabetes mellitus (GDM) as diabetes which is diagnosed in the 2nd or 3rd trimester of pregnancy and is not clearly overt diabetes. GDM, if missed or not treated properly can result in maternal and foetal complications, short as well as long term. ....

Glucose monitoring in pregnancy complicated by diabetes

Aisha Sheikh, Abdul Jabbar,

Diabetes in pregnancy is associated with adverse maternal and neonatal outcomes. Due to variations in insulin resistance throughout pregnancy there is a continuous need to implement Medical Nutrition Therapy (MNT), exercise and pharmacological treatments which have to be escalated. Self-monitorin....

The diabetic pregnancy: An ultrasonographic perspective

Shahina Bano, Vikas Chaudhary, Sanjay Kalra,

The incidence of congenital foetal anomalies and perinatal mortality in diabetic pregnancy is much higher than that in the normal pregnancy. The purpose of this review is to evaluate the role of ultrasound in the management of pregnancy complicated by diabetes. The ultrasound has been found to be....

Cardiotocography and diabetic pregnancy

JB Sharma, Manu Goyal,

Foetal monitoring in antenatal period and during labour is done to detect foetal distress and to take necessary action timely in order to improve perinatal outcome. Maternal awareness of foetal movement is routinely recommended in all pregnancies after 28 weeks gestation. In high risk pregnancies....

Metabolic Management >>

Lifestyle modifications for GDM

Atul Dhingra, Kamlesh Ahuja,

Prevalence of gestational diabetes mellitus (GDM) is increasing worldwide more so in Southeast Asian countries like India and Pakistan. 1 GDM is associated with various adverse foetal and maternal effects. The management of GDM aims at reducing blood glucose to reduce mater....

Insulin pump therapy in pregnancy

Jothydev Kesavadev,

Control of blood glucose during pregnancy is difficult because of wide variations, ongoing hormonal changes and mood swings. The need for multiple injections, pain at the injection site, regular monitoring and skillful handling of the syringes/pen further makes insulin therapy inconvenient. Insul....

Non-insulin pharmacological therapy in pregnancy

Sarita Bajaj,

During pregnancy, when glycaemic levels remain uncontrolled, despite lifestyle modification, pharmacotherapy is advised, usually insulin which has been the gold standard for treatment. Recent studies however suggest that certain oral anti diabetic agents (OADs) may be safe and acceptable alternat....

Insulin therapy in pregnancy

Sanjay Kalra, Fatema Jawad,

Insulin is the mainstay of pharmacotherapy in pregnancy complicated by diabetes. This review covers the various insulin regimes and preparations, explaining how to use them, and decide appropriate doses in pregnancy. It approaches insulin treatment from a patient - centred, as well as physician a....

Metabolic Complications >>

Microangiopathy and pregnancy

Said Azzoug, Farida Chentli,

Diabetic microangiopathy is a frequent complication of longstanding diabetes mellitus. Micro vascular lesions may have severe implications for both maternal and foetal health.
Patients with advanced underlying lesions are at increased risk of progression during pregnancy. Severe retinal le....

Macrovascular complications in pregnancy and diabetes

Rakesh Kumar Sahay, Venu Madhavi Pydi,

This review discusses macrovascular conditions which may occur during pregnancy complicated by diabetes. It describes the effect of dyslipidaemia and hypertension on foeto-maternal outcomes and explores the pathogenesis of these states.
Keywords: Cholesterol, diabetes, hypertension,....

Sleep disorders in Pregnancy: Glycaemic implications

K.V.S. Hari Kumar,

Sleep is one of the essential biorhythms of the body that helps in optimum restoration of many body functions. The sleep-wake cycle is determined by the circadian centre and is responsible for the anabolic functions in the body. Infants require about 14 to 18 hours of sleep per day, which reduces....

The obese pregnancy

A. H. Aamir,

Weight gain in pregnancy is physiological but if a woman is overweight prior to pregnancy, this will put both women and foetus at risk of adverse complications. Obesity can affect women at all the stages of pregnancy. Obese women can be a cause of reduced fertility as compared to a normal weight ....

Obstetric Management >>

Antenatal management of pregnancy complicated by diabetes

Shabeen Naz Masood, Yasir Masood, Uzma Naim, Safina Abdul Razzak,

The prevalance of Gestational Diabetes Mellitus (GDM) is increasing worldwide. It is estimated that 21 million women develop gestational diabetes out of which 1 in 7 births are affected. Women who have been previously diagnosed as GDM are at higher risk of developing diabetes in subsequent pregna....

Maternal complications in pregnancy with diabetes

Vidushi Kulshrestha, Nutan Agarwal,

Maternal complications of diabetes in pregnancy include obstetric complications such as pre-eclampsia, preterm labour, polyhydramnios, increased operative delivery and increased infective morbidity. These can be minimized with optimal glycaemic control. Additionally, pregnancies with overt/preges....

First Trimester complications in pregnancy with diabetes

Bishwajit Bhowmik,

Diabetes is the most prevalent medical condition complicating pregnancy in the world. It carries both acute and long-term health consequences for the mother and her offspring. Both preexisting (type 1 and type 2) and gestational diabetes are a high-risk state for miscarriage, stillbirths and cong....

Third Trimester foetal complications in pregnancy with diabetes

Vidushi Kulshrestha, Nutan Agarwal,

Diabetes in pregnancy starts affecting the foetus even in the pre-conception period. The complications encountered in third trimester are foetal macrosomia and intrauterine foetal demise; birth of a macrosomic baby further leads to shoulder dystocia, birth trauma, brachial plexus injury. Addition....

Management of labour in pregnancy complicated by diabetes

Sadiah Ahsan Pal, Mariam Iqbal Ali,

Diabetes mellitus complicates <5% of all pregnancies in Pakistan, but is a major cause of perinatal morbidity and mortality, as well as maternal morbidity. Appropriate glycaemic control is not only important throughout pregnancy but is equally important during the intra-partum period. Increase....

Neonatal management of pregnancy complicated by diabetes

Fauzia Mohsin, Shareen Khan, Md. Abdul Baki, Bedowra Zabeen, Kiswhar Azad,

Women with diabetes in pregnancy, either pre-gestational Diabetes Mellitus (Type 1 & Type 2) or Gestational Diabetes, are at increased risk for adverse pregnancy outcomes, including preterm labour and increased foetal mortality rate. Adequate glycaemic control before and during pregnancy ....

Post Delivery Management >>

Postpartum management of diabetes pregnancy

Nazli Hossain,

Diabetes mellitus has assumed the role of an epidemic. Previously considered a disease of affluent developed countries, it has become more common in developing countries. Pakistan is included among the countries with a high prevalence of diabetes. In this scenario, postpartum management of a woma....

Breastfeeding for diabetes prevention

Resham Raj Poudel, Dina Shrestha,

Breastfeeding has been consistently observed to improve metabolism in mothers and their offspring. Apart from mother child bonding and nutritional benefits; it is associated with a decreased risk of acquiring metabolic syndrome and type 2 diabetes mellitus (T2DM) in mothers, obesity and type 1 di....

Outcomes of offspring born to mothers with gestational diabetes

Noel Pratheepan Somasundaram, Chandrika Jayakanthi Subasinghe, Wickrama Kankanamge Maheshi Gimhani Amarawardena,

With the global explosion of Diabetes and obesity at epidemic proportions, keeping Asia at its epicenter, 1 in 7 live births get complicated with hyperglycaemia; either pre-existing Diabetes or Gestational Diabetes. In utero, exposure to an adverse metabolic environment with nutrient excess or de....

Contraception and Diabetes

Faria Afsana,

Contraception for women with diabetes mellitus is an important issue mainly as the pregnancy outcome depends on glycaemic control before conception among women with diabetes. Type of diabetes as type 1 or type 2 Diabetes, women with history of gestational diabetes and breast feeding diabetic moth....

Public And Social Health >>

Psychosocial aspects of pregnant women living with diabetes

Amin Muhammad Gadit,

A pregnant woman is exposed to a number of stress factors that can affect the pregnancy, maternal health and well-being of the foetus. Among these are the biological, social/environmental and psychological factors. The biological factors include medical condition of the pregnant woman, most notab....

Integrating GDM management in public health: Pakistan perspective

Musarrat Riaz, Abdul Basit,

Pakistan is a developing country with diverse social, economic and cultural dimensions along with limited resources. Non communicable diseases (NCDS) including diabetes are highly prevalent compromising the already challenged health care system. Gestational diabetes mellitus (GDM) with its associ....

Integrating GDM management in primary care: Gulf Cooperation Council (GCC) perspective

Qudsia Anjum, Shadma Mumtaz,

Diabetes is prevailing universally and Gulf Cooperation Council (GCC) is no exception. Pregnancies associated with gestational diabetes place women at high risk of natal complications.
Statistics from GCC gives variable figures for GDM.
Family Physicians are the first level health c....

Prevention of Gestational Diabetes Mellitus (GDM)

Sanjay Kalra, Yashdeep Gupta, Arun Kumar,

Prevention of Gestational diabetes mellitus holds the key to prevention of the diabetes and metabolic syndrome epidemic sweeping the world. This review discusses prevention of gestational diabetes and provides a scientific framework for the study of this topic. It classifies prevention in various....

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