Zunthlum nei mah la, naute hrisel tak i nei thei ang em? (Diabetes in Pregnancy) Hemi chungchang hi han sawi ila!

Chibai! Tunlai hian naute i beisei a nih chuan, a bik takin zunthlum i vei a nih chuan i rilruah zawhna leh hlauhna tam tak i nei ngei ang, a dik em? "Aw, zunthlum ka neih hunah naute lakah harsatna a awm dawn em ni?" "Hei hi uluk taka enkawl a ni dawn em ni?" Chutiang thil chu i ngaihtuah mai thei. Lungngai suh, nangmah chauh i ni lo. Nu tam takin hetiang dinhmun hi an tawk thin. A pawimawh ber chu hriatthiamna dik leh damdawi lam thurawn zawm chuan nang pawhin naute hrisel tak i nei thei a ni. Hemi chungchang hi chipchiar deuhin sawi ila, kan sawi dawn em ni?

Engtin nge zunthlum hian naupai a nghawng?

A awlsam zawngin, naupai hmaa Type 1 emaw Type 2 emaw diabetes i neih chuan "pregestational diabetes" an ti. Hei hi gestational diabetes nen a danglam a, naupai laiin a lo awm thin. Gestational diabetes hi naute i neih hnuah a bo tlangpui.

Zunthlum i vei tawh a nih chuan naupai laiin i thisen sugar level control chu a harsa deuh thei. Eng nge i hriat? Naupai lai hian kan hormone te hi a inthlak nasa hle. Chutiang inthlâk danglamnate nên chuan i ei leh in, exercise tih dân, leh i damdawi ei pawh i thlak danglam a ngai mai thei. Vawi tam tak chu he zunthlum enkawlna ruahmanna hi i naute pian ni thlengin vawi tam tak tihdanglam a ngai dawn a ni. Chuvangin i medical team te nen inbia fo a, i dinhmun hrilh thin hi a pawimawh hle. Chumi hnuah chauh chuan eng enkawlna nge i mamawh tih leh tihdanglam a ngai em tih chiang takin an rel thei ang.

Mahse hei hi hre reng ang che, zunthlum i neih chuan naute hrisel i nei thei lo tihna a ni lo. Tlem chuan a harsa deuh a, mahse thil theih loh a ni lo. I medical team te chu i tanpui turin an awm reng a ni.

Type 1 diabetes hi naupai dinhmun hlauhawm tak a ni em?

Ni e, Type 1 diabetes leh Type 2 diabetes hian naupai laiin harsatna a thlen theihna a tipung a ni. Chuvangin, i obstetrician chuan i naupai chhung zawngin i naute hriselna leh i thisen sugar level chu uluk takin a enfiah ang a, chu chuan i hrisel level a vawng reng ang. I thisen glucose level a sang lutuk emaw, a hniam lutuk emaw a nih chuan a hlauhawm thei a, harsatna a thlen thei bawk.

Maternal-fetal medicine specialist (MFM) nen in thawk dun fo ang. I obstetrician bakah hian i medical team-ah hian:

• Endocrinologist: Hormone kaihhnawih natna hrang hranga mithiam tak a ni.
• Registered dietitian: Zunthlum dona kawnga pui thei leh naupai laiin ei leh in hrisel chungchanga kaihhruaina pe theitu.
• Diabetes educator: Diabetes enkawlna lama training leh hriatna zau tak nei specialist a ni.

Engtin nge zunthlum vei chuan naupai atan a inbuatsaih theih ang?

Diabetes i vei a, nau neih i tum a nih chuan i doctor nen inbia hmasa ber tur a ni. Naute neih i tum tan hma thla ruk vel he thu hi sawi hmasak a tha ber.

Naupai hmain i thisen sugar level uluk taka control a pawimawh. Naupai lai hian tum ber chu i thisen glucose level chu a tlem berah dah a ni. Naupai hnuah pawh hetiang hi vawn reng a harsa zawk thei.

Guidelines tam tak chuan naupai hmain i A1C chu 6.5% emaw a aia hniam emaw ah dah tur a ni . Hei hi harsatna i neih theihna tur tihtlem nan a ni. I hria em? Naute taksa peng leh taksa peng pawimawh dangte chu naupai thla thum khatnaah a lo piang tan a. Chumi chhung chuan i thisen sugar level a sang reng a nih chuan naute thanlenna a nghawng thei a ni.

Naute neih tum hmaa i medical team nena inhmuhkhawm hian a hnuaia hlawknate hi a nei a ni:

• Doctor-te chuan i thisen sugar level hrisel taka thlen theihna tura puih theih dan tur an rawt thei ang.
• Dietitian chuan naupai leh zunthlum enkawlna atana tha tak ei tur ruahmanna siam turin a pui thei che a ni.
• Naupai hnuah zunthlum damdawi i thlak a ngai mai thei.
• Naupai laiin a bik takin diabetes technology thar (entir nan, continuous glucose monitor - CGM) hman i thiam thei mai thei.
• I doctor chuan naupai hmain i mit (retinopathy hlauhawmna), kal (nephropathy hlauhawmna), leh thinlung enfiah hmasa phawt turin a rawt mai thei a, naupai hian a chang chuan zunthlum avanga harsatna a thlen thei emaw, harsatna thar a thlen thei emaw a ni.

Naupai lai hian engtin nge ka zunthlum enkawl dan hi a danglam ang?

Naupai laiin zunthlum i enkawl dan tur tichhe thei thil pawimawh engemaw zat a awm a:

• Naupai laia harsatna awm thei tihziaawmna turin thisen glucose level chu a tlem zawka dah a ngai.
• Insulin mamawh danglam zel nena inmil.
• Naupai laiin thisen sugar level inthlauhna hmanga ei leh in mamawh enkawl.

Zunthlum vei naupai laiin thisen sugar target

A tlangpuiin zunthlum vei nu naupai te thisen sugar target chu hetiang hi a ni:

• Chaw nghei: 95 mg/dL aia tlem
• Chaw ei atanga darkar khat: 140 mg/dL aia tlem
• Ei atanga darkar hnih: 120 mg/dL aia tlem

Phên dangin sawi ila, heng thiltumte hi `time in range (TIR)` anga ngaih theih a ni. A tlangpuiin, naupai laia `Type 1` zunthlum vei puitlingte tana `TIR` tum ber chu:

• 63 leh 140 mg/dL inkar (target range chhungah) 70% tal
• 63 mg/dL hnuai lam 5% aia tlem lo
• 140 mg/dL aia sang a nih chuan 25% aia tlem lo

Guidelines tam zawk chuan naupai laiin an rawt thin`A1C` value 6% aia hniam vawn reng chuan harsatna awm theihna a ti tlem thei a ni.

Heng thil tum khauh tak takte avang hian i doctor chuan naupai laiin continuous glucose monitor (CGM) hman a rawt mai thei. Fingerstick hman ai chuan CGM hian hun kal zelah i glucose level a inthlak dan a tarlang tha zawk a, chu chuan i zunthlum enkawlnaah inthlak danglamna dik tak siam a awlsam phah a ni.

He thisen sugar range tawi tak hi vawng reng tur chuan kawng hrang hrang i zawm a ngai ang:

• I chaw ei leh snack-a carbohydrates awm zat uluk takin chhiar la.
• Ei hma minute 10-15 chhunga (a nih loh leh a hma pawhin) insulin ei.
• Thisen sugar level control nan taksa tihchakna hman.

I doctor chuan heng methods leh strategy dangte hi a sawipui ang che.

Naupai laiin insulin mamawh thlak danglam

Naupai laiin i insulin mamawh a inthlak fo beisei ang che. Hei hi i taksaa hormone hrang hrang awm vang a ni ber. Zunthlum hian mi zawng zawng a nghawng dan a inang lo ang bawkin naupai pawhin a nghawng ve tho. Chuvangin, i diabetes management plan-a siamthat ngai eng pawh siam turin i medical team te nen thawhhona tha tak neih a pawimawh hle. Heng inthlak danglamna te hi nangmah leh i mamawh danah a danglam bik ang.

Type 1 diabetes i neih chuan first trimester-ah insulin mamawh tlem hi thil awmdan pangngai a ni – mahse mi zawng zawngin an mamawh lo. Naupai kar 16-na vel ah chuan insulin mamawhna a pung tan thin. Hei hi a chhan chu nausen (placenta) hian insulin resistance tipungtu hormone a siam chhuak a ni. Hei hi naupai zawng zawngah a thleng a, zunthlum vei chauh ni lovin.

Naupai kar 36 emaw kar 37-na thlengin insulin tam zawk i mamawh ngei ang. Chutih lai chuan insulin resistance chu a stabilize tlangpui. Mi tam tak chuan naupai hmaa insulin an ei zat aiin a let hnih atanga a let thum velin an mamawh mai thei.

Naupai laiin insulin tihdanglamna tul apiang siam turin i doctor nen in thawk ho ang. Hei hian a huam thei ang:

• I `basal` emaw, hun rei tak thawk thei (background) insulin (`hun rei tak thawk thei insulin`) emaw chu .
• Insulin leh carb inthlauhna (ICR) 1.1.
• Insulin sensitivity factor (ISF) hmanga thil tih a ni.

Pawimawh tak chu, nausen (placenta) a lo piang tawh chuan i insulin mamawh chu nasa takin a tlahniam ang. Nausen piang atanga minute 30 vel chhungin i insulin mamawh chu naupai hmaa a level-ah a kir leh ang – a nih loh leh a hniam zawk pawh a ni ang. I doctor chuan nau neih hnua insulin regimen siamrem dan tur a sawipui ang che. Hei hi ruahmanna siam a pawimawh.

Naupai laiin zunthlum leh ei leh in mamawh

Naupai hrisel tur chuan ei leh in mumal hi a pawimawh hle. Naupai laia ei leh in mamawh inthlauhna siam leh thisen sugar range tlemte vawn reng chu a harsa deuh thei. Naupai laiin nausea leh/or vomiting i neih chuan a buaithlak zawk thei.

Hmeichhe naupai zunthlum vei chungchanga specialist registered dietitian chuan ei tur ruahmanna siam turin a pui thei che a ni. Anni hian nitin i ei tur `macronutrients` (major nutrients) – chu chu `carbohydrates` (carbohydrates), `protein` (protein) leh `dietary fat` (dietary fat) – i ei tur zat chungchangah an kaihruai ang che. An rawtna chu zunthlum vei lo naupai tan rawtna tlangpui nen a danglam thei. Thisen sugar level a nghet reng theih nan `macronutrients` balanced ei tur leh snack ei tur an rawt bawk ang.

Naupai laiin Type 1 Diabetes enkawl dan

Type 1 diabetes vei tam tak chuan naupai laiin an insulin mamawh chu a danglam fo thin – a tlangpuiin kar khat atanga kar khatah – a danglam fo thin tih an hmuchhuak. I glucose level ngun taka enfiah a, trend hriat chian hian nang leh i doctor te chu in enkawlna ruahmannaah inthlak danglamna dik tak siam turin a pui thei a ni.

Nitin injection (MDI) tam tak i ei a nih chuan, i doctor chuan insulin settings siamremna kawngah flexibility tam zawk pe turin insulin pump-ah inthlak turin a rawt thei ang che. Mahse, MDI hmangin naupai hrisel tak i la nei thei tho. I naupai hmaa damdawi dang i ei a nih chuan, naupai laiin chu damdawi chu i hmang chhunzawm thei ang em tih chu sawipui ngei ang che.

A hma ang bawkin thisen sugar sang leh thisen sugar level hniam hi rang taka enkawl a pawimawh. Thisen sugar sang leh/ emaw hniam i neih fo chuan i doctor nen inbia ang che.

Naupai laiin Type 2 Diabetes enkawl dan

Type 2 diabetes tan chuan oral medication leh non-insulin injectable tam zawk hi naupai laiin hman a tha lo. A danglamna awm chhun chu metformin a ni. Chuvangin, naupai laiin i thisen sugar level enkawl nan a vawi khatna atan insulin i hman a ngai mai thei. Tin, i naupai lai hian insulin mamawh a pung thei bawk.

I medical team te chuan management plan siam turin thawhhona tha tak an nei ang. I hman loh chuan CGM (continuous glucose monitor) hman an rawt mai thei.

Zunthlum vei naupai lai hian eng nge i beisei theih ang?

Zunthlum i neih chuan naupai pangngai aia nau neih hmaa tlawh leh test tam zawk neih i beisei thei a ni. Hei hi i nau neih hmaa enkawltuin i naute hmasawnna leh i hriselna zawng zawng ngun taka a enfiah theih nan a ni. Nau neih hmaa test pangngai (thisen test leh anatomy scan ang chi) bakah hian heng "extra" test te hi i beisei thei bawk ang:

• Fetal echocardiogram: I doctor chuan i naute thinlung insiam dan enfiah nan he test hi a rawt mai thei a, zunthlum vei hian pianpui thinlung natna (congenital heart conditions) a neih theihna a tipung a ni.
• Growth scans (ultrasounds): I doctor chuan i naute than dan enfiah nan kar tlemte danah scan neih a rawt thei ang. Hei hi a pawimawh hle a, a chhan chu i naute chu a tlangpui aia lian a nih theihna a sang hle. Mahse, heng ultrasound te hi estimate chauh a ni tih hre reng ang che. I naute chu scan-a a lan aia lian emaw, a te emaw pawh a ni thei.
• Nonstress test (NSTs): Naupai thla thum chhung hian i doctor chuan kar tin NST neih a rawt thei ang. Heng test te hian naute lungphu leh che vel te an enfiah thin.
• Biophysical profiles (BPPs): I doctor chuan kar tin BPPs ei tur a rawt thei bawk. Hengte hi ultrasound hmanga nausen thawk dan, taksa ruh (muscle tone) leh a che vel enfiahna a ni. Amniotic fluid awm zat pawh an teh bawk.

I endocrinologist emaw diabetes educator emaw nen pawh inbiakna neih fo a ngai bawk ang. I glucose level chu i target range nena inhnaih thei ang bera awm tir turin kawng leh tihdanglam dan tur an rawn rawt ang.

Naupai laiin Type 1 emaw Type 2 emaw diabetes neih hian eng hlauhawmna leh harsatna nge a neih?

Naupai lai hian zunthlum enkawl dan tur ngaihtuah a pawimawh. I thisen sugar level a sang lutuk a nih chuan harsatna engemaw zat i neih theihna a sang hle. Thisen sugar level hniam fo emaw, na tak emaw pawh hi a hlauhawm thei hle.

Heng mite hi pregestational diabetes an neih avangin harsatna an tawk nasa zawk a ni:

• Embryo leh naupai lai
• I naute pian hnuah
• Nangmah

Nau neih hma leh nau neih hnua harsatna awm thei

Naupai laiin zunthlum vei hian nausen tan harsatna a thlen theihna a tipung thei a, chungte chu:

• Birth defects (congenital conditions): Naupai laia naupai laia zunthlum vei tawh zinga 6% atanga 12% velah nau piangsual hi a awm thin. Congenital heart defects hi a tam ber a, mahse neural tube defects leh thil danglam dang a awm thei bawk.
• Fetal macrosomia: Hei hi nausen piang thar pound 9 leh ounces 15 aia rit a nih chuan a ni. Naute lian tak neih hian nang leh i naute tan pawh nau neih laiin hliam an tuar theihna a tipung a ni.
• Polyhydramnios: Hei hi amniotic sac chhunga amniotic fluid awm zat tihpunna a ni. Hei hian nau neih hma leh nau piang thi a thlen thei a ni.
• Hun hmaa nau neih:Complication a awm chuan nau neih hmaa nau neih theihna a sang zawk a, i doctor chuan full term i la thleng lo a nih pawhin nau neih hi a him ber a ni tih a rel thei a ni.
• Nau piang thi: Naupai laia zunthlum vei tawh chuan nau thi thi neih theihna a tipung thei a ni.

Pian hnuah pawh i naute hian hriselna lama harsatna engemaw zat a neih theihna chance a sang zawk bawk. Zunthlum vei tam zawk chuan naute hrisel tak tak nei mah se, heng thilte hi a hlauhawmna a sang deuh hlek a ni:

• Nau piang hnua thisen sugar level hniam
• Thâwk lak harsat
• Jaundice a awm

I naute hian heng harsatnate hi a neih chuan NICU ( neonatal intensive care unit)-ah enkawl a ngai mai thei.

Zunthlum vei te hnen atanga naute piang te pawh hi an naupan hnuah an thau zawk thei bawk.

I nghawng thei tur complication te

Naupai laiin zunthlum i neih hian:

• Preeclampsia: Preeclampsia hi thisen sang leh zun chhunga protein awm vang a ni. Diabetes hi preeclampsia vei theihna tur risk factor lian tak a ni. Preeclampsia vei theihna tihziaawm nan i doctor chuan naupai kar 12 hnuah aspirin tlemte ei turin a rawt thei ang.
• Cesarean section (`C-section`) neih a ngai: Hei hi a chhan ber chu naute pian tirh atanga a lian lutuk vang a ni.
• Thisen sugar hniam: I thisen sugar level chu a tlem berah dah i tum avangin, thisen sugar level hniam fo leh/ emaw, nasa taka awm theihna a sang hle.
• Diabetes-related ketoacidosis (DKA): Naupai laiin DKA vei theihna i nei sang zawk a, a chhan chu insulin resistance a san vang a ni. Zing natna avanga luak chhuak hian DKA a thlen thei bawk.
• Zunthlum kaihhnawih harsatna: Naupai hian zunthlum (retinopathy, nephropathy, leh neuropathy ang chi) a tizual thei emaw, harsatna thar a thlen thei bawk.

Engtin nge zunthlum hian nau neih leh nau neih a nghawng?

A tam zawkah chuan doctor-te chuan zunthlum vei naupai tan planned induction (`scheduled induction`) an rawt thin. Induction an rawt hun chhung hi thil engemaw zatah a innghat a, mahse naupai kar 39 emaw a hma emaw hian a thleng tlangpui. Mi tin leh naupai apiang hi a danglam vek. Nang leh i doctor chuan i tana tha ber tur chu in rel dun ang.

Nau neih laiin hormone leh taksa a inthlak danglam avangin i thisen sugar level a sang emaw a tlahniam emaw thei – chiang taka sawi a harsa hle. I doctor leh damdawi in policy a zirin nau neih leh nau neih laiin insulin pump emaw injection emaw hmangin mahni in enkawl thei a, IV insulin drip i mamawh thei bawk.

Placenta lakchhuah hnuah chuan insulin mamawhna chu nasa takin a tlahniam ang – a tlangpuiin naupai hma ang bawkin emaw a hniam zawk emaw a ni. Nau neih hnua i zunthlum enkawl dan tur ruahmanna siam thar leh dan tur ruahmanna siam chungchangah i doctor nen sawiho rawh.

Zunthlum leh naupai avanga inthlak danglamna lo awmte chu engtin nge ka hmachhawn ang?

Zunthlum leh naupai hian harsatna thar a thlen thei a ni. I naupai lai hi i beisei aia danglam a ni thei a, i zunthlum enkawl dan tur chungchangah zawhna i nei thei bawk. Mi zawng zawng zinkawng a inang lo hle laiin, zunthlum vei tu pawhin an naupai huna an thil tawn chu a hrisel thei ang bera siam turin heng tips te hi an zawm thei a ni:

• I thisen sugar level enfiah fo (doctor-in a tih angin).
• I thisen sugar level chu target range chhungah dah la.
• Insulin, damdawi leh enkawlna dangte chungchanga i doctor thupek zawm rawh.
• Nau neih hmaa clinic appointment leh checkup-naah te tel ve rawh.
• Taksa chak takin awm rawh. I doctor nen i activity level chungchang leh i thlak danglam a ngai em tih te sawipui rawh.
• Chaw hrisel, inthlau tak leh snacks ei rawh.
• Zu leh zuk leh hmuam thil chi hrang hrang in tur in loh tur.
• I rilru hriselna kha uluk takin enkawl rawh. Hetih lai hian stress neih hi thil pangngai tak a ni. Thu sawi hlau suh la, tanpuina dil rawh.

Engtikah nge ka doctor ka hmuh ang?

Zunthlum i vei a, heng zinga pakhat tal i hriat chuan i nau neih hmaa enkawltu hnenah sawi rawh:

• I theihtawp chhuah chung pawhin i thisen sugar level chu target range-ah i dah thei lo a nih chuan. (A hniam lutuk emaw, a sang lutuk emaw a nih chuan.)
• I thisen sugar level a san thut emaw, i hriatthiam loh chhan a inthlak emaw a nih chuan.
• Nausen chu a che tlem zawk nia i hriat chuan.
• I vagina atanga tui emaw thisen emaw chhuak i neih chuan.
• I mit a fiah lo emaw, tuihal lutuk emaw i neih chuan.
• I luak chhuak a nih chuan a pawi lo, ei leh in i dah hniam theih loh chuan a pawi lo.

Ngaidam leh zawhna zawh ai chuan him taka awm hi a tha zawk fo tih hre reng ang che. Naupai chungchanga lungkhamna bakah hian zunthlum enkawl dan tur ngaihtuah buai hi a buaithlak thei hle. I rilru put hmang chu second-guess suh la, ngaihthah suh – i doctor nen kaihhruaina dil rawh.

Doctor hnenah eng zawhna nge ka zawh ang?

Zunthlum i vei a, nau i pai a nih chuan, i doctor hnenah hengte hi i zawt mai thei:

• Ka thisen sugar level engzat nge ka enfiah ang?
• Ka target range chu eng nge ni tur?
• Ka thisen sugar level chu target range chhunga dah a nih loh chuan eng harsatna nge thleng thei?
• Ka insulin dose hi ka thlak a ngai dawn em ni?
• Damdawi dang ka chawlhsan tur nge, ka tan tur?
• Nunphung thlak danglam hi i rawt em?
• Engzat nge follow-up turin ka lo kal a ngai dawn?
• Induction hmasa ber ka neih a ngai dawn em ni?

Type 1 diabetes vei te hian naute hrisel tak tak an nei thei ang em?

Ni e, Type 1 diabetes (leh Type 2 diabetes) vei tam tak chuan naute hrisel tak tak an nei a. I thisen sugar level enkawl leh i medical team nena inbiakpawhna tha tak neih hi naupai hrisel tak neih theihna tur kawng pawimawh tak a ni.

Naupai laiin zunthlum enkawl hi a harsa thei hle a, kum sawm tam tak chhung zunthlum vei tawhte tan pawh a harsa thei hle. Naupai lai hian i thisen sugar level hrisel taka dah hi rilru leh taksa lamah a harsa thei hle. Mahse support system dik tak leh diabetes management plan i neih chuan diabetes hian naupai laia harsatna a thlen thinte chu i hneh thei ang.

I medical team te nen inbiakpawhna tha tak nei rawh. I lungngaih lai khan hrilh rawh. Chu zawng zawng kal tlang chuan tunnel tawp lama êng chu ngaihtuah la – i naute hmu rawh.

Take-home message hnuhnung ber a ni

Okay, chuvangin kan sawi tawh atang chuan zunthlum vei naupai chungchang hi i chiang tur a ni. Hlauh tur a awm lo, mahse fimkhur tur a ni.

• Ruahman lawk rawh: Naute neih i ngaihtuah a nih chuan thla engemaw zat hmain doctor thurawn la hmasa phawt ang che.
• Thisen thlum control: I naupai chhung zawnga i doctor-in a tum a siamah i thisen sugar level awm reng turin theihtawp chhuah ang che. `CGM` ang chi thilte hian hei hi a pui thei a ni.
• Medical team nen thawk ho rawh: anmahni nen inbia fo la, zawhna zawt la, i rilru put hmang sawi rawh.
• Nunphung hrisel: Ei leh in tha, a tul chuan exercise (Doctor-in a tih angin), leh rilru hahdamna te hi a pawimawh hle.

Zunthlum vei mah la, enkawl dan dik leh damdawi lam enkawlna hnuaiah nang pawhin he khawvelah hian naute hrisel leh hlim tak i rawn hruai thei tih hre reng ang che. Chutianga ti tûra i mamawh chakna leh huaisenna chu hmu rawh se!

` Zunthlum, naupai, thisen thlum, insulin, nau neih, harsatna, naute hrisel