Book of Medical Disorders in Pregnancy - Tintash

special tests to decide about the mode
and timing of delivery.
Diet - At first visit, the diabetic meal
plan is worked out. While working out
diet for a diabetic patient total number of
calories needed should be kept in mind.
A reasonably accurate estimate of calories
can be worked out by providing 30
calories per kilogram of body weight and
adding 200 extra calories. Caloric
requirements for 60 kilogram women
would be 30 x 60 + 200 = 2000 calories.
These calories should come from
carbohydrate, protein and fats. Carbohydrate-30
X 1/10th of the body weight
i.e. 30 X 6 = (180 grams), proteins = 30
X 1 120th of the body weight i.e. 30 X 3
= (90 grams) and the rest should come
from fats.
These 2000 calories can be split as l/7th
of total at breakfast 2/7th at lunch, 1/7th
at afternoon snack, 2/7th at dinner, and
1/7th at late night snack. The time table
can be useful for the dietician or the
relatives and physician of the patient to
plan menu.
Tools to estimate food intake:
24 hours recall, Diet diary, Food charts
Weekly visits to or dietician
endocrinologists, Serum glucose
monitoring and Hb A1C An ideal weight
gain in pregnancy should be one tenth of
the ideal body weight, 10 calories per
pound is provided; 30 to 40 per cent is
added for activity and fetal growth. The
diet should be planned to permit a
weight gain of 15-20 pounds; the obese
patient may, however, need to have the
weight reduced, but she should not be
restricted to fewer than 1400 calories per
day. Majority of early diabetics can be
controlled on diet and do not require
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insulin but those who need this should
have a properly planned therapy.
Oral hypoglycemic agents:
Oral agents are a pragmatic alternative to
insulin therapy in pregnancy because
they are easy to administer and
noninvasive and therefore user friendly.
Since the original study in 2000, many
experts and authoritative organizations
in the United States (e.g., the Fifth
International Workshop on Gestational
Diabetes and the North American
Diabetes in Pregnancy Study Group)
have endorsed the use of glyburide (a
sulfonylurea) as an alternative pharmacological
therapy to insulin during
pregnancy. The introduction of any new
drug in pregnancy will raise concerns
about fetal and maternal safety. The
ultimate proof that a drug cannot affect
the fetus during pregnancy is founded on
its inability to cross the placenta. The
majority of drugs used in pregnancy
cross the placenta. Thus, even if a new
drug crosses the placenta, it remains to
be proven that it will cause a teratogenic
effect on the fetus in utero. If there is no
adverse effect on the fetus, the drug can
be used. Glyburide does not cross the
placenta. Our original observations have
been re-confirmed by several studies.
Glyburide has been safely used in
pregnancy without adverse effects on the
fetus. In contrast, metformin,
rosiglitazone, and pioglitazone freely
cross the placenta. We await further
evidence on safety when fetuses are
exposed to these drugs. In the case of
metformin with patients who have
polycystic ovary syndrome, data from
retrospective studies give us hope for its
safe use. The ongoing Metformin in
Gestational Diabetes study from
Australia and New Zealand is evaluating