Gestational Diabetes

Gestational diabetes is a disorder of sugar (glucose) regulation that occurs specifically in pregnancy. It means that your body’s ability to regulate your sugar levels is not up to the strain of pregnancy.

Normally, sugar levels are regulated by a balance between two hormones insulin (produced in your pancreas) and glucagon (made by your liver). Insulin is released when your blood sugar levels rise after eating, allowing your body to remove excess sugar from your bloodstream. Glucagon is released when your blood sugar levels are low, triggering a rise in your blood sugar levels.

Diabetes And Labor

Women with gestational diabetes requiring treatment are at increased risk of having a large baby the risk depends partly on how well blood sugars are controlled during your pregnancy. If you have diabetes, your doctor will usually estimate your baby’s birth weight before you go into labor, either by feeling your baby through the uterus or using ultrasound. If your baby is normal size, your physician may induce labor at 39 weeks because of the increased risk of fetal complications in prolonged pregnancy in women with diabetes. During labor you will need to have an IV and your blood sugars will be carefully monitored every hour or two. If your baby weighs more than 9-9½1b (4 to 4.5kg) there is a risk that the shoulders may get stuck (known as shoulder dystocia), which increases the chance of a birth injury or other serious complications. Your physician will talk to you about this risk and may offer you a cesarean delivery.

Type Of Diabetes

In gestational diabetes, your body either fails to produce enough insulin to cope with the strain of pregnancy or your body’s cells are resistant to insulin’s action. This is similar to type 2 diabetes (sometimes called adult onset diabetes). Type 1 diabetes, which usually begins in childhood or adolescence is different in that the pancreas doesn’t make any insulin. During pregnancy, your placenta produces a hormone called human placental lactogen (HPL), which makes your blood sugar levels rise. As a result of this, your body has to produce more insulin to maintain normal sugar levels. Gestational diabetes will disappear after your pregnancy is over, but you are much more likely to develop type 2 diabetes later.

How Is It Diagnosed?

Gestational diabetes is initially detected in the third trimester of pregnancy by a one-hour glucose test a screening test to identify women at a higher risk of sugar problems. Women who are found to be at risk then haw diagnostic test called a glucose tolerance test to determine whether or not they have gestational diabetes. This test is very similar to the one-hour test, but you have to get your blood drawn four times instead of just

Headaches

Some women have headaches that are often aggravated by hormonal changes with their menstrual cycles. These women may notice an increase in headaches during pregnancy, but this is uncommon.

The first line of treatment for a headache in pregnancy should be a product that contains pure acetaminophen. Products that contain aspirin or nonsteroidal anti inflammatory agents (NSAIDs) such as ibuprofen should be avoided because of the risks of harming the baby. If you have migraines, you may need prescription medication. However, don’t take serotonin receptor agonists such as sumatriptan because these can reduce blood flow to the placenta. If necessary, severe migraine pain can be treated safely with opioid analgesics such as oxycodone and codeine. Beta blocking agents can be continued to be used to prevent migraines if necessary. In general, migraines tend to improve during pregnancy and most women have complete remission from headaches or a significant decrease in symptoms. If you have a severe headache in the last trimester of pregnancy and you don’t normally suffer from severe headaches, you should call your care provider right away, especially if you also have visual changes such as flashes of light or blurry vision. This could be a sign of preeclampsia.

What’s safe to take

Acetaminophen some beta blocker drugs, opioid analgesics.

What to avoid

Aspirin, ibuprofen and other nasids.

Nasal Stuffiness

Many women notice increased nasal congestion when they are pregnant. This stuffiness is due to the increase in blood flow to the mucous membranes in the nose. The hormone estrogen causes an increase in mucous secretion during pregnancy. Increased blood flow to the fragile blood vessels in your nose also makes nosebleeds very common. While the increased congestion is annoying, it is quite normal and will not interfere with the amount of oxygen that your baby receives. Avoid using of nasal sprays (except pure saline) because they tend to cause even more nasal stuffiness if you do not use them constantly. If you find it hard to sleep, you may get some relief by using a humidifier at night.

What’s safe to use

Diphenhydramine phenylephrine

What to avoid

Nasal sprays.

Dizziness

During pregnancy, most of your blood vessels dilate (widen) to allow unrestricted blood flow to the uterus and your baby. This produces a small drop in blood pressure and may increase the chances that you feel dizzy. Pregnant women are especially sensitive to changes in position, and you are most likely to feel dizzy when you stand up too quickly. Try to avoid rapid change, in position, and sit back down if you feel dizzy. Dizziness on its own is not a sign of a health problem. As your pregnancy progresses, you may also notice you feel dizzy when you lie on your back. This is because thc uterus presses down and cuts off blood returning from your lower body to your heart. Lying on your side should alleviate this dizziness, If your dizziness comes on after heart palpitations, or if it is not relieved by lying on your side, consult your doctor.

Bleeding Gums

Most women notice that during pregnancy their gums are much more likely to bleed after being brushed. This is normal and results from the increase in blood flow to the gums in pregnancy. However, it’s important you look after your teeth properly. Gum disease, for example may be associated with problems such as preterm labor. If you have not seen your dentist recently, it is safe to have your teeth cleaned or cavities fixed, but try to avoid dental x-rays unless necessary.

Palpitations

Heart palpitations, recognizable by the feeling that your heat has missed a beat or flip-flops inside your chest, seem to be more common and more noticeable during pregnancy. Generally, palpitations are not serious if they only happen occasionally and you don’t have other symptoms like dizziness. If you do have other symptoms, discuss them with your provider right away.

Since most women menstruate approximately every 28 days, if one counts the first menstrual day as day one, the usual time of ovulation is day 13 or day 14, which explains the fact that pregnancy is most likely to occur in midcycle, midway between menstrual periods. In very rare instances, however, pregnancy may result from intercourse at virtually any time during the menstrual month which implies that ovulation in exceptional cycles occurs at exceptional times. There is evidence that female orgasm infrequently may trigger an abeltant ovulation in some women. All experienced clinicians can site examples of women becoming pregnant at odd periods in the cycle. Anecdotal reports of pregnancies being established during menses and very early and very late in the non bleeding part of the cycle abound. In truth, such pregnancies are quite rare.

The two times in the month when pregnancy is least likely to occur, the relatively “safe periods” for sexual relations without causing conception, are the first week of the cycle including the menses, and the last week, that is, the week prior to menstruation.

Some women occasionally spot or even bleed lightly for up to 48 hours in midmonth, at the time of ovulation. Many experience pain in occasional cycles for 4 or 5 hours on one side or the other of the lower abdomen, depending on whether the egg that particular month was ovulated from the left or right ovary. This is called mittelschmerz (German: mittel – mid, schmerz – pain). At times of the month other than these several days in midcycle, the cervical canal contains a scant, sticky, opaque mucus, onto which sperm are entrapped, quite like flies on flypaper.

During intercourse, the spermatozoa are catapulted into the upper vagina, near the cervix. The sperm cells swim haphazardly in all directions, some into the upper recesses of the vagina, some toward the outside, others away from the middle of the vagina far to one side or the other. Most spermatozoa never reach the protective confines of the cervical canal, but remain in the vagina, exposed to the acidic environment of vaginal secretions. Sperm cells are sensitive to an acid medium, and those remaining in the vagina become motionless and dead within a few hours. A relative few, by sheer spatial accident, immediately gain the sanctuary of the alkaline cervical mucus. This was demonstrated by studies in the 1970s in which cooperating couples notified research physicians as soon as male orgasm had been accomplished. The physicians then took samples of mucus from high up in the cervical canal. Much to the surprise of the scientific community, the cervical mucus was already swarming with sperm cells. Some sperm reach the site of fertilization in the fallopian tube within 5 minutes of ejaculation, the majority, within 4 to 6 hours.

Some of the sperm swim straight up the one-inch canal with almost purposeful success, while others bog down on the way, getting hopelessly stranded in tissue bays and coves. A small proportion of the total number ejaculated eventually reach the cavity of the uterus and begin their upward two-inch excursion through its length. This progress is aided by muscular contractions of the uterus. The undaunted sperm reach the openings of the two fallopian tubes-one on each side of the uterus. From there, they continue their upward journey into one of the tubes.

If the egg has reached the midportion of a tube, a spermatozoon swimming up the opposite tube has no chance of meeting it. Only a few thousand of the four hundred million cells ejaculated ever reach the trysting site, the midsegment of the fallopian tube containing the egg, two or three inches above where the uterus meets the tube. Only a few hundred sperm ever come near the egg cell.

The one sperm that achieves its destiny has won against gigantic odds, several hundred million to one. The baby it engenders has a far greater mathematical chance of becoming pregnant than the sperm had of fathering a baby. No one knows just what selective forces are responsible for the victory. Perhaps the winner had the strongest constitution, perhaps it was the swiftest swimmer of all the contestants entered in the race. Perhaps it was merely the luckiest in finding a fluid current leading straight to the ovum.

The method by which the tiny sperm cells locate the egg is not clearly understood. Because of the few spermatozoa, just several thousand, in the relatively long tube at the time of fertilization, many investigators feel some process other than random encounter is involved. One suggested explanation is that the egg exerts a chemical trapping effect, increasing sperm concentration by making them swim more rapidly when they are headed toward it and less rapidly when going away from it. When sperm egg collision occurs, the sperm immediately becomes bound to the egg’s surface.

If ovulation occurred within several minutes to 24 hours before the sperms journey ends, the ovum will be in the tube, awaiting fertilization. If ovulation took place more than 24 hours before the sperm’s arrival, the egg cell will have begun to deteriorate and fragment by the time the spermatozoon reaches it. If ovulation has not yet occurred, but takes place within 2 or 3 days after intercourse, living spermatozoa will be cruising at the tubal site waiting for the egg .

We have followed the sperm and egg to their meeting place, and we can now observe what happens when they meet-that is, the actual process of fertilization.

Internal insemination, as practiced by humans, by the other mammals, and by many sub mammalian forms, is far more efficient. In this pattern of reproduction, a special organ of the male, the penis is inserted into a special organ of the female, the vagina. In addition to depositing the semen well on the way to the precise area where it is to function, this method of introducing the male ejaculatory organ deep within the body of the female protects the spermatozoa by releasing them in a highly favorable environment. Such conditions as temperature and moisture within the cervical canal, the uterus, and the fallopian tubes of the female reproductive tract are optimal for the conservation of sperm.

The egg capsule, the zona pellucida, is relatively firm and rigid, its thickness is approximately one-tenth the diameter of the egg. Precisely how a spermatozoon gets through the capsule is not completely known. One effect of capacitation is to increase the speed of the sperm. This may be important in allowing it to move through the zona. Once a sperm passes through the zona pellucida, the zona undergoes a reaction called the zona reaction. This makes it impervious to other sperm. Only a single sperm-one that has undergone the acrosomal reaction-makes its way through the perivitelline membrane, just beneath the zona pellucida, to pair the twenty-three chromosomes of its nucleus with the twenty-three chromosomes of the nucleus of the egg.

If you use Depo-Provera (“the shot”), it may take a while for the hormone to clear your system. There is no danger in getting pregnant right away, but only about half of women who stop using Depo- Provera become pregnant within 10 months of the last injection. Be patient. About 93 percent of women using Depo-Provera become pregnant within 18 months after the last injection. This doesn’t mean the shot causes infertility-the percentage is no lower than the percentage of the general population who try to get pregnant and succeed within this time period. The rate of pregnancy at 18 months after the last shot is the same as the pregnancy rate following use of all reversible methods of birth control, but women should expect a longer delay in getting pregnant after discontinuing Depo-Provera than after discontinuing other methods.

Couples who rely on natural family planning methods have an advantage in becoming pregnant. You can continue using them, not to see when you are infertile, but to see when you’re most fertile

Invasive techniques, including amniocentesis, may be appropriate in the following situations -

• Women 35 years of age and older. This designation as high risk for a fetal defect is somewhat arbitrary, but 35 is the age at which the risk to the pregnancy of amniocentesis is approximately equal to the risk of having a baby with a trisomy, the most common of the chromosomal abnormalities. Both risks are about 1 in 200 at this maternal age. Some experts recommend testing when the father is 44 years or older, although a link between father’s age and Down syndrome has not been shown routinely.

• Parents who have had a child with Down syndrome or an­other chromosomal abnormality.

• Parents who are known carriers of a chromosome rearrangement, such as a translocation.

• Parents who have a family history of a genetic condition for which testing is available. A few of the more common ones are shown in the box below, although there are over 60 metabolic diseases that invasive testing is able to detect.

• Exposure to a teratogen, like certain medications, early in pregnancy that might increase the risk of an open neural tube defect, such as spina bifida.

• An elevated MSAFP or triple screen result indicating an in­creased risk for a neural tube defect or other condition, including a trisomy. As the mother’s blood levels are measured at or after week 15 of pregnancy, an amniocentesis, not CVS, is the appropriate follow-up test.

• Parents who are first cousins (called consanguinity).

• History of unexplained stillbirths or multiple miscarriages .

If you are planning to become pregnant within a year, or are actively trying to get pregnant, and have not discussed your plans with your gynecologist, midwife, or nurse practitioner, you should call for an appointment. Screening tests that can pick up potential problems for a pregnancy were probably not conducted at your routine annual gynecologic visit, nor were you likely to have been given information regarding self-help measures and practices to aid in preventing birth defects and other problems that can occur in pregnancy. These measures can be most important even before you know you are pregnant.

A few birth control methods, such as Norplant or the IUD, require a health care visit for removal. This would be a good time to have preconception care. If you use Depo-Provera, you can combine a preconception visit with your last shot .