Health Tips
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Pregnant women who experience certain breathing problems during sleep may be more likely to develop complications like high blood pressure and diabetes, recent U.S. research suggests.

In the study of more than 3,000 women, researchers did home-based sleep studies twice during pregnancy to check for what's known as apnea, a potentially serious sleep disorder that involves repeated stops and starts in breathing. Risk factors for sleep apnea include older age and obesity.

Women who had sleep apnea were almost twice as likely to develop what's known as preeclampsia, a type of pregnancy-related high blood pressure, and up to 3.5 times more likely to develop pregnancy-related diabetes, the study found.

"Although we found an association with sleep disordered breathing preceding the development of both pregnancy-related hypertensive disorders and gestational diabetes, we cannot conclude that universal screening for, and treatment of sleep disordered breathing in pregnancy would reduce the risks of these adverse outcomes," said lead study author Dr. Francesca Facco of the University of Pittsburgh's Magee-Women's Hospital.
That's because even among people who are not pregnant, there isn't conclusive evidence that the most common treatment for apnea can reduce the risk of developing hypertension or diabetes, Facco said by email.

For the most common apnea treatment, patients wear breathing masks at night. The masks are connected to a machine that provides continuous positive airway pressure (CPAP), which splints the airway open with an airstream so the upper airway can't collapse during sleep.

Some patients can't tolerate sleeping with CPAP machines. This intervention may not make sense for pregnant women, particularly if they have only mild apnea, Facco said.

"We do not know if treating sleep-disordered breathing in pregnancy will improve clinical outcomes in pregnancy, and our study cannot answer that question," Facco added.

Sleep tests done for the study found that early in pregnancy, between six and 15 weeks gestation, 3.6 percent of the women had apnea. Later in pregnancy when they had gained more weight, between 22 and 31 weeks gestation, 8.3 percent of the women had apnea.

Overall, 6 percent of the women had preeclampsia, 13 percent had pregnancy-related hypertensive disorders and 4 percent developed gestational diabetes, researchers report in the journal Obstetrics and Gynecology.

Early in pregnancy, women with apnea were 94 percent more likely to develop preeclampsia, 46 percent more likely to have hypertensive disorders and 3.5 times more likely to develop diabetes than women without sleep disordered breathing.

Women who had apnea later in pregnancy were 95 percent more likely to develop preeclampsia, 73 percent more likely to develop hypertensive disorders, and 2.8 times more likely to have diabetes than women without sleep disordered breathing.

The study is observational and doesn't prove apnea causes these pregnancy complications.
One limitation of the study is the potential for home-based sleep tests to leave some cases of apnea undetected, potentially underestimating the prevalence of sleep-disordered breathing.

"Currently, we still need more data on whether improving or treating sleep-disordered breathing will lessen the risk of high blood pressure or diabetes during pregnancy," said Dr. Sirimon Reutrakul, a researcher at Mahidol University in Bangkok who wasn't involved in the study.

"However, overweight or obesity is a risk factor for high blood pressure and diabetes during pregnancy, as well as sleep-disordered breathing," Reutrakul added by email. "Therefore, keeping healthy body weight through diet and exercise should lessen the risk for these problems."

Women have many health reasons to start pregnancy at a healthy weight and a younger age, two things that may also lower the odds for apnea, said Dr. Marie-Pierre St-Onge, a researcher at Columbia University Medical Center in New York who wasn't involved in the study.

"Obstructive sleep apnea is associated with obesity," St-Onge said by email.

"Although this study did not find an interaction between weight status and OSA on hypertension and diabetes, I would suggest that women enter pregnancy at a normal weight and gain weight appropriate for their weight status," she said.

"Whenever possible, avoiding delaying pregnancy to a more advanced age would be advisable," St-Onge added.

We all know the diabetes is a disease, which arises due to the body's inability to regulate blood sugar levels. Insulin, the hormone responsible for converting blood sugar into energy, is unable to carry out its function and as such the patient's blood sugar levels spike up causing various health issues. Now there are various factors that can cause diabetes - unhealthy diets, no physical activity, genetics, so on and so forth. Sometimes, women who are not diabetic can show signs of the disease while undergoing pregnancy. This condition is commonly known as gestational diabetes, which is dangerous, with risks of complications. Though experts pinpoint obesity or being overweight as one of the major causes, a recent study states that early periods could also play a role.

The normal age for onset of periods is considered to be 13 and above, However, there are many cases when girls get what is known as 'first periods' as early as 11 years or lesser. According to a research done by University of Queensland, girls who start their first period at age 11 or younger are 50 per cent more likely to develop gestational diabetes during pregnancy than those who experienced it at the age of 13.

"Early puberty in girls had now been shown to be a significant marker for several adverse health outcomes, including gestational diabetes," said Gita Mishra, professor at University of Queensland. Gestational diabetes is an increasingly common pregnancy complication and can have long-lasting health consequences for mothers and their children. "Research into this topic is of particular public health importance due to global trends of girls starting their menstrual cycles at a younger age," said Mishra.

The significant association with gestational diabetes risk remained even after researchers took into account body mass index and childhood, reproductive and lifestyle factors.

For the study, published in the American Journal of Epidemiology, the team analysed data from more than 4,700 women and found a higher number of women who reported having their first period at a younger age had later developed gestational diabetes.

"The finding could mean that health professionals will start asking women when they had their first period to identify those at higher risk of gestational diabnetes," said Danielle Schoenaker, researcher at University of Queensland.

A large number of women who develop diabetes during pregnancy are overweight or obese. Encouraging those who have early puberty to control their weight before pregnancy may help to lower their risk of gestational diabetes, said Schoenaker.

Older women, over 75, taking statins, which are cholesterol-lowering drugs, may be at 33 per cent increased risk of developing diabetes, according to a new study. The risk increased to over 50 per cent for women taking higher doses of statins, said researchers of the University of Queensland in Australia. Statins are prescribed to reduce the incidence of cardiovascular events such as heart attacks and strokes as well as reduce mortality. This study links its usage to the risk of diabetes, one of the most dangerous kinds of lifestyle diseases affecting millions across the globe.
"The study showed that almost 50 per cent of women in their late seventies and eighties took statins, and five per cent were diagnosed with new-onset diabetes," said Mark Jones from the University of Queensland.

"What's most concerning was that we found a 'dose effect' where the risk of diabetes increased as the dosage of statins increased," Jones added.

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For the study, published in the journal Drugs and Ageing, the team included 8,372 Australian women born between 1921 and 1926. The results showed that elderly women should not be exposed to higher doses of statins. Elderly women currently taking statins should be carefully and regularly monitored for increased blood glucose to ensure early detection and appropriate management of this potential adverse effect, including consideration of de-prescribing, the researchers suggested.

"Those elderly women taking statins should be carefully and regularly monitored for increased blood glucose to ensure early detection and management of diabetes," added Jones.

Can the climate that you inhabit affect your pregnancy? Most of us would not believe but experts have actually been able to draw a correlation between the temperature of the region where you live and the state of your pregnancy. Experts at the St. Michael Hospital in Ontario, Canada studied the effects of climatic conditions on pregnant women. Those who were exposed to an outdoor temperature of more than 24 degrees Celsius or above were more prone (7.7%) to gestational diabetes. Pregnant women living in colder climates were at a lesser risk (4.6%). With every 10 degrees Celsius increase in temperature, the risk also got elevated by 6-9%. The study was published Canadian Medical Association Journal and studied 555,911 births among 396,828 women living in Canada over a 12-year period (2002 to 2014).

"Many would think that in warmer temperatures, women are outside and more active, which would help limit the weight gain in pregnancy that predisposes a woman to gestational diabetes," said lead author Gillian Booth, a researcher at St Michael Hospital in Ontario, Canada.

Some of the previously conducted studies have linked colder climates with enhanced metabolism as the brown adipose tissue gets activated in colder temperature and facilitates calories burning, increasing metabolism and better management of insulin.

Experts found that women born in cooler climates who were exposed to cold temperatures during pregnancy had a gestational diabetes rate of 3.6 per cent, while those exposed to hot temperatures had a rate of gestational diabetes of 6.3 per cent.

Diabetes is a lifelong disease caused by high sugar level in the blood. This happens because the body is unable to produce sufficient insulin, or the body is not using it correctly .Insulin is a hormone produced by the pancreas. Its main function is to transport the glucose from the blood into the cells where it is used for energy. However if there isn't sufficient insulin the glucose builds up in the blood.

There are two types of diabetes:

1. Type I diabetes

The cause for this is still unknown but in most people it is an outcome of destruction of the beta cells of the pancreas by our own immune system. Type I diabetes often develops in children, with a positive family history of a sibling or parent with diabetes. Certain viral infections like mumps, rotavirus or coxsakie virus B and cold climate may precipitate this to.

2.Type-II diabetes

Where insulin is present but is not sufficient or is unable to work efficiently. The common risk factors for women are:

• Overweight or obesity (BMI of 25 or above),
• Older age of 45 and above. After menopause women are at a greater risk of obesity and higher waist circumference ,increasing the risk of Diabetes
• Family history-parent or sibling with diabetes
• Ethnicity-Indians are at a greater risk of DM2
• Giving birth to a baby of 9 pounds or above
• Presence of diabetes during pregnancy
• High blood pressure with medication
• Low HDL cholesterol and high triglycerides
• Suffering from polycystic ovarian disease (PCOD)
• History of heart disease or stroke

High sugar levels have a detrimental effect on the blood vessels and nerves. Nerve damage can lead to pain or loss of sensation in the affected area. Blood vessel damage can lead to heart diseases, stroke, blindness, kidney failure, amputation, hearing loss, problems in conceiving and during pregnancy, and repeated urinary and vaginal infections

Are you at a risk?

India has the dubious distinction for being the diabetes capital of the world. Though we as a population are genetically prone to diabetes, rapid urbanization, poor diet and exercise, obesity are the main causes for this epidemic. Women are as prone to diabetes as men, but women are less likely to seek and follow medical advice and treatment for themselves.

Prevention they say is better than cure: You just need to follow 3 simple rule to protect yourself against diabetes

1. Weight Management

The number one risk factor for the onset of diabetes is overweight. More fatty tissues in the body make it resistant to the action of insulin. Furthermore, the apple shaped body, where there is fat accumulation around the abdomen predisposing you to a higher risk of diabetes. Shed those extra kilos. In a study participants who lost about 7% of their weight improved their risk of not getting diabetes by 60%. Fad diets aren't the answer, you may lose some weight initially but will it stay off? Eat healthy and exercise regularly, the only way to maintain weight without compromising on your health.

Simple tricks to help you eat less are-
• A smaller bowl or plate
• Use a tea spoon or child fork to eat smaller bites
• Eat slowly, chew your food well , it takes 20 minutes for your brain to register that the stomach is full
• Do not eat in front of the TV
• Drink a large glass of water 10 minutes before your meal
• Fill your plate like this- 1/4th protein, 1/4th whole grain, ½ vegetable and fruit with some skimmed dairy

2. Eat: healthy

• Whole grains protect against diabetes. In the Nurses' health study I and II which followed 160,000 women over 18 years, researchers found that women who ate two to three servings of whole grains reduced their risk of diabetes by 30%. Indian diets are based on whole grain cereals, find a chakki and get fresh whole grain atta, it will not only be beneficial for you but your entire family. Barley, steel cut oats, hand pounded rice, brown and red rice are other good choices.

• Instead of drinking juices, eat whole fruits. In the same nurses study II women who drank 1or more sweetened drink increased their risk of diabetes by 83%. Sugary drinks may contribute to chronic inflammation, high triglycerides decreased HDL (good cholesterol) and insulin resistance. Our traditional chaas, nimbu pani, bael sharbat, aam panna, all taste fabulous without sugar. Fresh coconut water, plain water, sugar free green tea and coffee are all good choices.

• Good fats like poly unsaturated oils from vegetable sources, nuts, seeds, protect against diabetes. Trans fats usually found in packed bakery goods, street foods, fast food restaurants can play havoc with your health. Any label that reads partially hydrogenated oil should be put away. Look for the amount of Trans fat on the label while buying ready to eat and ready to cook foods.

• Evidence from the Nurses study I and II , Health professionals follow up study and another 6 long term studies highlighted the substitution of red and processed meat with fish , poultry low fat milk and nuts decreased the risk of diabetes by 35%
All these points highlight that our traditional eating practises are the healthiest, we just need to re learn them.

3. Move your body

Being active helps you control your weight as well as improves insulin sensitivity.

• Get active, start with 30 minutes a day for 5 days of the week. Walking is the easiest form of activity start and then you can try other forms of exercise.

• Put on the radio and dance away your calories. Make your family join in for a fun filled jam session at home.

• Download an exercise video and follow it

• At office, walk for your water, to deliver a message, to catch up with a colleague

• Walk to the market if safe instead of taking a car.
The benefits of even moderate exercise are humungous .Start today.

Preventing Diabetes is about making healthy choices for life, as the lady of the house you can create an environment where everyone benefits. You do not need to do anything separately, do it for the whole family.
Remember you are the pivot of the family and taking care of yourself is as important as taking care of others.

Dr. Manish Rawool
Dr. Manish Rawool
MS/MD - Ayurveda, Ayurveda Family Physician, 4 yrs, Pune
Dr. Ashwini Hirekar
Dr. Ashwini Hirekar
BHMS, Homeopath Family Physician, 4 yrs, Mumbai Suburban
Dr. Pradnya Shirke
Dr. Pradnya Shirke
MS/MD - Ayurveda, Gynaecologist Infertility Specialist, 17 yrs, Pune
Dr. Amarsinha Nikam
Dr. Amarsinha Nikam
MD - Homeopathy, Homeopath, 33 yrs, Pune
Dr. Vijay Shirke
Dr. Vijay Shirke
MS/MD - Ayurveda, Ayurveda Family Physician, 17 yrs, Pune