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Gestational Diabetes

Gestational diabetes is a condition in which your blood sugar level becomes high during pregnancy, affecting up to 10% of pregnant women, diagnosed by a blood test done at 24 to 28 weeks of pregnancy. Women with gestational diabetes don’t have diabetes before their pregnancy – and it usually goes away after giving birth.

What causes gestational diabetes?

Hormones produced by the placenta cause a build-up of glucose in the blood. Usually, enough insulin is produced to control blood sugar levels. However, if the body is unable to produce insulin or stops using it, then the blood sugar levels rise, causing gestational diabetes.

Who’s at risk of gestational diabetes?

At your first antenatal appointment, a healthcare professional should check if you’re at risk of gestational diabetes.
The likelihood of getting gestational diabetes increases if you:
• were overweight before you got pregnant.
• have had gestational diabetes in the previous pregnancy.
• have had a large baby in earlier pregnancy (4.5kg/10lb or more)
• have a family history of diabetes – parent or sibling.
• come from a South Asian, Black or African Caribbean or Middle Eastern background.
• have high blood pressure .
• have given birth to a stillborn baby.
• are older than 30 years.
Having gestational diabetes increases your risk of developing it again in future pregnancies. It also increases your risk of developing Type 2 diabetes later in life. You can reduce the risk of developing gestational diabetes by managing your weight, eating healthily and keeping active before pregnancy.

Gestational diabetes symptoms.

Women with gestational diabetes don’t usually have symptoms. Most find out that have it during a routine screening.
You may notice that:
• You’re thirstier than usual
• You’re hungrier and eat more than usual
• You urinate more than usual

Gestational diabetes tests and diagnosis.

Gestational diabetes is diagnosed by routine screening, called Oral Glucose Tolerance Test, also known as an OGTT. The OGTT is done when you’re between 24-28 weeks pregnant. If you’ve had gestational diabetes before, you’ll be offered an OGTT as soon as possible, and another OGTT between 28-32 weeks if the first test result is normal.

How do you manage gestational diabetes?

The goal is to reduce blood glucose to the normal levels exhibited by a woman without gestational diabetes.

This involves:
• Measuring your blood sugar level four times a day
• Eating a healthy and balanced diet
• Performing moderate physical activity for about 150 minutes per week (Running, walking and swimming are good options)
• Reducing stress as much as possible.

These measures must be taken while continuing regular checkup with your doctor and adjusting them as needed. Changes in habits will sometimes not be enough; in such cases, metformin or insulin injections should be used during the pregnancy.

Target blood sugar levels in pregnancy:
• Before a meal: 95mg/dl or less
• An hour after a meal: 140mg/dl or less
• Two hours after a meal: 120mg/dl or less

Tips for eating well with gestational diabetes:
• Eat regular meals.
• There’s no need to ‘eat for two’. Portion size will have the most significant effect on your blood glucose level.
• Include carbohydrates but look for low GI (glycemic index) options and keep the consumption to the optimum level
• Get your five vegetables a day for vitamins, minerals and fibre.
• Cut back on salt, too much salt is associated with high blood pressure, which increases the risk of diabetes complications.
• Stick to water or sugar-free drinks.

What are the potential complications?

In the child:
• Macrosomia (above-average weight)
• Risk of being born with low blood sugar levels and respiratory problems
• Risk of obesity and type 2 diabetes later in life

In the mother:
• Risk of a difficult delivery, possibly by C-section, depending on the baby’s weight
• Surplus of amniotic fluid, which could trigger premature delivery
• Gestational hypertension & Preeclampsia
• Risk of developing type 2 diabetes later
• Risk of suffering from gestational diabetes again in a future pregnancy

Most of the complications can be prevented with appropriate treatment.
In conclusion, in the vast majority of cases, gestational diabetes is easy to control, with your blood sugar levels likely to normal in about six weeks after childbirth. However, the risk of developing gestational diabetes in the next pregnancy increases, with the women also likely to develop type 2 diabetes in the future. It would help if you got follow-up tests every year. Many problems can be avoided through healthy lifestyle habits. Don’t panic and talk to your doctor to see how you can put the odds in your favour.

PCOS (Polycystic Ovarian Syndrome)

PCOS (Polycystic Ovarian Syndrome) is the most common endocrine disorder among women between the ages of 18 and 44. It is a condition that affects almost 1 in 5 women and the incidence is rising. Exact cause is not known but there is genetic tendency and Life style changes are contributors for development of PCOS.
In PCOS, there is hormonal imbalance in woman’s sex hormones with increase in male hormone levels and insulin resistance in body. This leads to spectrum of symptoms in PCOS. Symptoms vary from person to person but common are Menstrual irregularities with tendency to delay menses ,missed periods or medicines to get periods ,Acne , Excessive hair growth on face ,body and hair loss on scalp ,Weight Gain and difficulty in losing weight .

PCOS also causes difficulty in conceiving and is the leading cause of anovulatory infertility. On ultrasound, there will be multiple small cysts seen in ovary like string of pearl. These cysts are actually immature follicles. In normal menstrual cycle, follicle develops and grows to form an egg which ovulates, but in PCOS follicular development is arrested at early stage due to disturbed ovarian function and they form multiple cysts
How do we treat PCOS?
PCOS can be controlled mainly by Change in life style with opting for healthy food habits and regular exercise keeps normal BMI (Body mass index). Gynecologist can prescribe medicines to increase the insulin sensitivity or pills to regularize cycles.
If fertility is a concern then further treatment to form egg may be required.
PCOS not only affects appearance, fertility but has long term health risks associated with metabolic effects like developing Diabetes, High blood pressure, dyslipidemia, heart disease and also risk of endometrial hyperplasia and endometrial (womb) cancer.
Regular health checkups are recommended to control PCOS and its long term effects.

Are women more prone to kidney disease?

Although kidney disease can affect people of all ages and ethnicities, women are prone to face more specific challenges tied to kidney disease. The incidence of Chronic Kidney Disease (CKD) is at least as high in women as in men and may even be higher. Studies have shown that CKD affects approximately 195 million women worldwide and is currently the 8th leading cause of death in women. There is a risk of morbidity associated with CKD and in many cases it progresses towards kidney failure, necessitating kidney replacement therapy i.e. dialysis and/or kidney transplantation.

Types of kidney diseases that are more common in women

Lupus Nephritis is a disease that leads to kidney damage, caused by an autoimmune disease called systemic lupus erythematosus (SLE). The disorder causes the body’s immune system to attack the body’s own cells and tissues. Kidney disease due to lupus may worsen over time and can lead to kidney failure. SLE is much more common in women often striking during the child-bearing years. It is estimated that 9 in 10 people diagnosed with SLE are women.

Pyelonephritis (kidney infection) is a kind of urinary tract infection (UTI) most commonly caused by bacteria which starts in the lower urinary tract. If untreated, it can move upstream to one or both of the kidneys. Kidney infections can cause sepsis, which can be life threatening. Due to their anatomy, UTI is more common in women and girls.

Health challenges that are unique to women

Conception – CKD is considered as a risk factor that affects fertility, especially in its advanced stage, when dialysis is required. While it may be challenging, conception is still possible while on dialysis and the results have been shown to improve with intensive treatment of daily or closely frequent sessions. The use of contraceptive pills as a birth control method is generally discouraged for women with CKD as it may cause an increase in blood pressure and blood clots that can make kidney disease worse.
Pregnancy-related complications – CKD may be caused by both Acute Kidney Injury (AKI) and preeclampsia (PE – a complication in pregnancy which can lead to high blood pressure and kidney damage in the mother). It not only poses a threat to maternal health, but is also associated with fetal mortality, preterm birth and restricted intrauterine growth.
If the mother has any pre-existing kidney disease it can negatively affect the pregnancy and may pose a threat to the health of both the mother and the fetus. Increased chances of adverse pregnancy outcomes including preeclampsia, AKI, progression of CKD, spontaneous abortion, stillbirth, malformations, and other long-term issues have been observed.

While Pregnancy offers an opportunity for diagnosis of kidney disease, it is also a state where acute and chronic kidney diseases may develop which may impact the health of future generations.

As individuals, it is important for women to be aware of how important your kidneys are to your overall health and how you can prevent or slow down the progression of kidney disease.

Key questions to ascertain your risk
  • Do you have high blood pressure?
  • Are you diabetic?
  • Do you smoke?
  • Are you overweight?
  • Do you have a family history of kidney disease?
  • Are you over 50?
  • Are you of African, Hispanic, Asian or Aboriginal descent?

If your answer is yes to one or more of these questions, it is advisable to discuss with your doctor. Early chronic kidney disease is silent and has no signs or symptoms. By treating kidney disease early, you can help delay or prevent kidney failure.

Obesity: A National Burden


Obesity has become a global issue these days leading to a lot of comorbidities. Almost 2.8 million people die every year for being overweight or obese as per a WHO survey. Obesity is measured by measuring one’s Body Mass Index (BMI). Body mass index is a simple calculation using a person’s height and weight. The formula is BMI = kg/m2 where kg is a person’s weight in kilograms and m2 is their height in meters squared. Healthy range is 18.5 to 24.9. Above 25 is overweight and above 30 enters the obesity range


Contributing factors include genetic inheritance, diet and lifestyle. In a survey done recently almost 12% of UAE population was found to be obese. Obese people are 85% more prone to develop type 2 diabetes mellitus and when we compare the UAE population with the rest of the world, the incidence of type 2 diabetes is increasing rapidly. A lot has been talked about obesity, but very little awareness is being noticed amongst the population. Being obese is like abusing one’s own body and health.

Obese females have a higher risk of developing polycystic ovarian disease which leads to infertility. Obesity is associated with diabetes, hypertension which is considered to be lifelong diseases and also has high association with chronic arthritis secondary to which almost 40-50% of the people end up requiring joint replacement surgeries. Unhealthy food as well as eating out is one of the major factors contributing to obesity which has been observed recently. Sedentary lifestyle is not far behind as a contributor

Weight loss is essential to prevent the complications related to these dangerous yet common conditions including diabetes and hypertension.obesity Hence regular exercises and dietary modification play a key role. But as the incidence of obesity is increasing day by day, simply sticking to these conservative management plans fail to control the problem in the long run. Here the role of weight loss through bariatric surgery comes into play.

As laparoscopy has developed, surgeries for obesity have also not lagged behind. Multiple procedures to cure obesity have been introduced, the commonest performed being sleeve gastrectomy where a part of stomach is removed leaving the patient with a new smaller stomach which leads to reduced capacity for food intake and thereby sustained weight loss. It is as safe as any other procedure in today’s world of medical advancement.

Making population free of obesity itself reduces the burden on the healthcare system. We all should come forward and promote NO OBESITY to make UAE a healthier nation.