Medical Tips and News

Medical Science News around the world

Showing posts with label Women Health. Show all posts
Showing posts with label Women Health. Show all posts

Epidemiologic context of diabetes in pregnancy


PRACTICE POINTS

• The prevalence of all forms of diabetes in pregnancy, namely
Type 1, Type 2, and gestational diabetes mellitus (GDM),
ranges from below 2% to over 20%, although variations in
defi nition, screening, and diagnostic criteria of GDM make
comparisons diffi cult.
• The prevalence of Type 2 diabetes, GDM, and probably Type
1 diabetes in pregnancy is increasing and varies signifi cantly
between ethnic groups and between locations.
• The prevalence of some risk factors for GDM and Type 2
diabetes in pregnancy (e.g. obesity) is increasing.
• Adverse pregnancy outcomes are generally increased 2 – 7 - fold
in women with pre - existing diabetes and are similar for Type
1 and Type 2 diabetes.
• There is good evidence that intervention for diabetes in
pregnancy can reduce adverse pregnancy outcomes: it has
been estimated that for every US$1 invested in diabetes in
pregnancy, there is a saving of US$3 – 4 on downstream
health costs.
• The health, social, and economic impacts of intergenerational
transmission of diabetes are unknown.

BACKGROUND

Historically, the study of diabetes in pregnancy has
focused on either women with Type 1 diabetes, whose
poor obstetric outcomes once led to an editorial entitled
“ They give birth astride the grave ” 1 or GDM, an entity
which remains contentious, 2,3 with variable approaches
to defi nition, screening, and diagnosis. 4 The current
epidemic of obesity and diabetes among children,
adolescents, and non - pregnant adults 5 has changed
the situation, leading to growing numbers with Type 2
diabetes in pregnancy and GDM (including undiagnosed
Type 2 diabetes). 6 – 8 In parallel, our understanding of the
impact of diabetes in pregnancy for future generations, 9
and our increasing ability to reduce pregnancy complications,
10 and postpone, if not prevent, diabetes after
GDM, 11 have emphasized the epidemiologic and public
health importance of diabetes in pregnancy.

OUTCOMES FROM DIABETES
IN PREGNANCY

That there is no common unique pathognomonic complication
of diabetes in pregnancy, combined with the
apparent continuous relationship between glucose and
fetal macrosomia, has resulted in a lack of consensus on
the diagnosis of GDM. While diabetes in pregnancy is
associated with increased obstetric risk compared with
normal pregnancy, the overall contribution of diabetes to
most obstetric and neonatal complications on a population
basis is actually relatively low, with the largest impact
being on shoulder dystocia (through GDM). Table 1.1
shows examples of odds ratios for each obstetric and
neonatal complication by diabetes type and the proportion
that diabetes in pregnancy contributes on a population
basis. 12 – 15
Apart from malformations, which are likely to have
resulted from preconceptional or periconceptional
hyperglycemia, improvements in obstetric practice have
led to major reductions in adverse outcomes. Avoidance
of such outcomes may dictate the need for complex
obstetric decision - making, with the inevitable increase in
fetal monitoring (see chapter 12 ) and which is strongly
infl uenced by the preconceptional and antenatal management
of hyperglycemia (see chapters 8 and 10 ). The
importance of other metabolic factors, such as obesity 16 – 19
and hypertriglyceridemia, 20 in pregnancy are also now
increasingly being recognized.







The long - term implications of diabetes in pregnancy
for the offspring, particularly obesity and Type 2 diabetes,
are discussed in chapter 25 . While there is early
evidence that optimal management of diabetes during
pregnancy may reduce excess adiposity in the offspring
(and hopefully, ergo, subsequent diabetes), 21 this urgently
requires confi rmation. As yet there is no evidence that
poorer neurodevelopmental outcomes, which may be
associated with GDM, are amenable to change. 22
Such analyses can be confounded by the associations
between socioeconomic status and both GDM and
achievement.

DIAGNOSIS OF GESTATIONAL DIABETES MELLITUS

While it is generally accepted that severe hyperglycemia
in pregnancy is associated with adverse maternal fetal
outcome, the signifi cance of lesser degrees of hyperglycemia,
along with the lack of common pathognomonic
sequelae, and the apparent continuum between glucose
and, for example, fetal macrosomia 24 have fuelled the lack
of consensus on the optimal glycemic threshold for diagnosis
of hyperglycemia in pregnancy. This is discussed in
chapter 6 , but essentially involves deriving a glycemic
threshold above which the benefi ts of intervention outweigh
any harm and are cost - effective.
Outside of pregnancy, the 75 - g 2 - hour oral glucose
tolerance test (OGTT) is used. Diabetes and prediabetes
are defi ned by their association with macrovascular and
microvascular complications, the clinical appearance of
the latter (retinopathy) being largely unique to diabetes.
As a result, diabetes in non - pregnant adults has a globally
agreed defi nition, as does impaired glucose tolerance (IGT) (Table 1.2 ). There remains disagreement between the World Health Organization (WHO) and the American
Diabetes Association (ADA) defi nition of impaired
fasting glucose (Table 1.2 ). As GDM is defi ned as
carbohydrate/glucose intolerance fi rst identifi ed/with
new onset in pregnancy, intuitively it would be thought
that by defi nition, the criteria for diagnosis of GDM
would include a fasting glucose of greater than or equal
5.6 or 6.1 mmol/L ( ≥ 101– 110 mg/d L) (ADA or WHO)
and/or a 2 - hour glucose greater than or equal to
7.8 mmol/L (140 mg/dL ), with potentially some modifi -
cation should pregnancy outcomes be quantitatively
worse below these cut - off points. This is discussed more
fully in chapter 6 .
There have been multiple attempts to defi ne the glycemic
thresholds for fetal and maternal outcomes (i.e.
diagnostic criteria) for GDM (Table 1.2 ). These have traditionally
been based upon a fasting blood glucose test,
50 – 100 - g glucose load, 4 followed by 1 – 3 hours of blood
glucose testing, and involving interpretation of the results
either singly or in combination.
A global move to standardize the diagnostic criteria
was the rationale for the Hyperglycaemia and Adverse
Pregnancy Outcomes (HAPO) study, a large study among
25 000 women across continents and, importantly,
involving many ethnic groups. 24 Of importance is the fact
that this study showed that the impact of hyperglycemia
for maternal/fetal outcome was applicable to all ethnic
groups 24 and independent of maternal obesity, a recognized
risk factor per se for large babies. 16 – 19 Further analysis
of data from the HAPO study will address the
important question of whether different glycemic thresholds
are needed to predict a greater risk of glucose - sensitive
adverse outcomes.




PREVALENCE OF PREGESTATIONAL DIABETES IN PREGNANCY

The prevalence of Type 1 and Type 2 diabetes in pregnancy
would be expected to refl ect the rates of diabetes
in the background population. 25,26 However, the standard
fertility ratio (SFR) is low in Type 1 diabetes (0.80, 95%
CI 0.77 – 0.82), and is particularly low among women with
retinopathy, nephropathy, neuropathy, or cardiovascular
complications (0.63, 0.54, 0.50, and 0.34, respectively). 27
While fertility rates in Type 2 diabetes have not been
reported, they would also be expected to be low (particularly
in view of the additional associated obesity, polycystic
ovarian syndrome [PCOS], and vascular disease).
The incidence of Type 1 and the prevalence of Type 2
diabetes has been increasing over time, 28 with a reduction
in the age at diagnosis of Type 2 diabetes. Both of these
factors predict an increasing number of women with
pregestational diabetes. However, the more rapid increase
in Type 2 diabetes in pregnancy has resulted in some
diabetes clinics now seeing a predominance of Type 2 over
Type 1 diabetes, which has been accentuated further by
ethnicity. In the US, the ratio of women with Type 1 to
Type 2 diabetes has shifted from 3 : 1 to 1 : 2 between 1980
and 1995. 28 This may be partly due to changes in the population
(e.g. in Birmingham, UK the ratio of Type 1 to Type
2 diabetes was 1 : 2 in South Asians but 11 : 1 in Europeans
29 ). Meanwhile, there have been other important
changes. Women with diabetes in pregnancy are now
expected to survive. The perinatal mortality for pregnancies
complicated by Type 1 diabetes has also dropped from
40% to much nearer the background rate . 23,28 In Type 2
diabetes, the evolving evidence suggests that perinatal
mortality and the frequency of congenital malformations
are similar to those of Type 1 diabetes, 23 including in those
women diagnosed with GDM but found to have Type
2 diabetes postnatally. 6,29 While these trends are more
often seen in women of non - European descent, it is likely
that a similar picture will be seen in all groups eventually.
To date there are few reports of the prevalence of
monogenetic forms of diabetes or secondary diabetes in
pregnancy. Glucokinase mutations are present in up to
5 – 6% of women with GDM and up to 80% of women
with persisting fasting hyperglycemia outside pregnancy,
a small glucose increment during the OGTT, and a family
history of diabetes. 30 Cystic fi brosis is associated with a
doubling in the prevalence of diabetes outside of pregnancy,
with a further increase during pregnancy (e.g.
from 9.3% at baseline to 20.6% during pregnancy, and
14.4% at follow - up).

Intra-Uterine Device IUD Removal



This 3D medical animation shows the anatomy of the female reproductive system and roles of estrogen and progesterone in the menstrual cycle. Displaying both hormonal and copper intrauterine devices, and explains how they prevent pregnancy.


How To Lift Your Breasts Naturally?



Ways to Lift Your Breasts:

 Right Bra Size: Firstly, it is very important to get the size of your bra right. Squeezing into a small bra may cause injury to breast tissue, poor posture or even back pain. Also, right bra size can give your breasts a natural lift.

Exercise: Though the breasts are mainly composed of fat, the entire mass sits on top of a muscle called pectoral. Exercise can build up the muscle, and prevent drooping breasts or sagging. Here are few exercises you can do to keep your breasts firm:

Push-ups: Practice around 10 push-ups a day to strengthen your pectoral muscles. The right way to do it is by starting on your fours, with feet close together and palms slightly wider than your shoulders. Your body should form a straight line from head to toe. Lower down until your chest almost touches the floor. Keep your upper arms at a 45 degree angle to your torso. Pause, then repeat. You should see results in a month or two.

Weight Lifting: Weight lifting is a great way to build up your pectoral muscle. You can try bench pressing or the dumbbell fly. To start off with, try a simple balance ball exercise you can do at the gym or at home. Use a balance ball to support your weight under your upper back and extend your legs out in a 90 degree angle. Start with a free weight in each hand with your hands rested on the ground at your sides. Bring your arms up into a 90 degree angle and hold the position for a few seconds. As soon as you can no longer handle the position, drop the weights back down to your sides, take a few seconds to rest and go back into the same motion.

Aloe Vera Gel: Aloe Vera is known to have natural skin tightening properties. Massaging with Aloe Vera Gel exercises the muscles and tones the breasts. You can also try almond oil, as it increases blood circulation.

Nutrition: The muscles will become tight if you fulfill the protein requirement of the muscles. Your body requires essential nutrients such as vitamins, calcium and minerals. These can be found in foods like tomatoes, cabbage, cauliflower, broccoli, carrot, meat etc. But along with this you need to reduce the intake of caffeine and also stop smoking.

Swimming: Just spending about half an hour in the pool can do wonders for your breasts! Swimming tightens the muscles responsible for holding your breasts. Swimming can help you burn fat and build muscle in your upper body, hence helps you lift your breasts and keep them firm.




Home Hair Remedies


Try out natural hair masks the next time you want to give your hair a deep treatment.

Treating your hair to a deep, nourishing mask every few weeks will make the world of difference. Women have been looking after their locks for decades - way before famous brands were around - so what did they use to use to give wonderful shine and soft-to-touch finish?

There are an astonishing amount of items in your kitchen which are great to use on your tresses. One which may surprise you is the banana, which is high in potassium and vitamins A, C and E.
Pop the mushy filling into a bowl or food processor and mix into a smooth paste. You want to make sure it's lump free as any small bits may prove tricky to rinse out.

Once easy to handle simply apply it to your hair and cover with a shower cap or plastic bag to stop the dripping. Or, if you wanted to really stimulate your roots to absorb extra nutrients, use your hair dryer after around 20 minutes to allow the banana to set.
Then all you have to do is rinse out the fragrant mixture, using a fine-toothed comb if needed as well as your regular shampoo.
If dry hair is your problem you may be brave enough to try out the next option.

Mayonnaise is a cheap, easy to purchase beauty treatment for your dehydrated locks. The gloopy white mixture is packed full of oil, which is guaranteed to add an extra shine and moisture to your hair. You don't need to go out and buy a whole new jar - a little amount will go a long way for this process.

Pop a small dollop of mayonnaise onto your hand and work it through your hair from roots to the tips. If the eggy smell is too much for you add a drop of scented oil to the mixture before applying.

You can leave this on for up to an hour to ensure your hair soaks up the oil before rinsing out thoroughly and shampooing.
Not all old-fashioned hair masks are made up of squidgy ingredients. One suggestion aimed at getting rid of dandruff is lemon and olive oil. Make sure your oil is plain - a flavoured one won't leave the nicest of smells!

All you need to do is squeeze two table spoons of fresh lemon juice into a small bowl with the same amount of olive oil and water. Mix thoroughly and rub into your hair, wrapping a warm damp towel over your hair to make sure no excess liquid evaporates. The good thing about this method is that it can be done once or twice a week as it's easy to make, apply and doesn't leave you with banana or mayonnaise smeared hands.


What is Vaginal infection and how is it treated ?



A vaginal yeast infection is mostly caused bij a yeast called Candida albicans. This animation explains what a vaginal yeast infection is.

What causes a vaginal yeast infection, which symptoms can occur, and what can you do to prevent it? Finally, treatment options are discussed.


Breast self-examination (BSE)


Breast self-examination (BSE) is a screening method used in an attempt to detect early breast cancer.

Watch the video here:

The Best Masturbation Tips Ever



The maxim "He knows me better than I know myself"? Well, it probably doesn't hold true when it comes to pleasure centers. If you're like many women, you have had a long-term relationship with a vibrator and, with concentration, can get the deed done during a commercial break—without even muting the TV—if you so choose.

All joking aside, self-pleasure is important because it "lets you take control of your satisfaction," says Charlie Glickman, Ph.D., a sexuality educator. "It also gives you room to try new things without stressing about a partner's expectations." Add to that: Masturbation is a pressure release, a natural sleeping pill, and a plain old-fashioned good time (as if we needed to sell you on it).

Still, even if you and your vagina are so in sync you finish each other's sentences, your sex life with yourself, like with any long-term partner, has room for improvement.

So put away your vibrator. Not forever—just for a few minutes. Because to improve your self-loving skills, the best place to start is the mind. "Seduce yourself," suggests sex coach Amy Levine, founder of IgniteYourPleasure.com. That doesn't mean making a rose-petal path to your bed, but some low-maintenance pampering can get you in the mood. Levine recommends playing soft music and lighting candles. Porn works too, if that's your thing. So does eyes-closed fantasizing. Says sexuality educator Timaree Schmit, Ph.D.: "Envision a situation that turns you on, and let it fully develop. Never judge yourself or say you should be thinking about something or someone differently. There's no so-called thought police."

Once you've worked yourself into a mental lather, focus on your body. Levine suggests starting with a slow full-body self-massage. You already know the one or two spots that can send you over the edge, but now is your chance to discover untapped sources of pleasure. Levine says to pay special attention to your neck, the back of your knees, your thighs, and your perineum, which is the stretch of skin between your vagina and anal opening.

After your massage, avoid falling into your time-worn getting-off pattern. Switch up your position, suggests Levine: If you always masturbate while lying on your back, try it on all fours, or sitting in a comfortable chair, or even standing, bent over a table or the bed. Try kneeling as if you're straddling your partner.

Variety is key to your sex life, so why shouldn't that extend to your self-love life? If you need more convincing, know this: By masturbating the same way every time, you might have more difficulty getting off when you're with a partner. So stay flexible.

Speaking of which, consider taking a yoga class and then getting it on with yourself as soon as you arrive home, says Levine. "The breath work and the flow of the poses allow us to be in the moment and out of our head," she says. In other words, yoga can diminish all those thoughts of your boss, your bank account, or whatever other worries might distract you.

Now, getting back to your vibrator. If yours is a trusty rabbit style, it might be time to introduce vibrator 2.0. Perhaps something that hits the doubted-by-scientists-but-not-by-women G-spot? (A rabbit is tailored to the clitoris.) "Look for something that has a curve," suggests Glickman. "Stronger vibrations, or ridges or bumps, often help too."

Glickman recommends using a G-spot wand that's waterproof, like the Good Vibrations Silky G Waterproof G Spot Vibrator. Draw a bath, climb in, and go to town. Aim the toy's curve toward your navel when you insert it—the G-spot is a couple of inches inside the vagina, on the front wall. "Try to find an area the size of a dime or a nickel that feels raised, or ridged, or firmer than the tissue around it," says Glickman. "It's often easier to find when you're turned on, because it swells."

Don't feel like embarking on The Great G-Spot Hunt? No problem, says Leigh, who is all for clitoral focus. "There's increasing pressure that you should be able to get off from G-spot stimulation," she says. "But just do what feels best to you." She recommends clitoris-specific egg-shaped vibrators for easy use and storage.

"But the Cadillac of vibrators is still the Hitachi wand," she says of the massage device that resembles a giant microphone. "It's huge. It often requires an electrical outlet and can be noisy as all get-out. But if nothing else will get the job done, this will."

Of course, toys aren't everyone's cup of tea. And that's fine. All that matters is that you feel good. And if you're playing sexy music, massaging yourself, and writhing in a chair while feeling good, all the better.