dementia

Old and forgetful

Your Health   DR GITA MATHAI

The recent elections threw up a spate of experienced "senior citizen" politicians, astute, informed and ready with verbal repartee. They are part of the 4.5 per cent of our population over the age of 65 years. They present a stark contrast to many other senior citizens who cannot remember what was said to them a few minutes ago, though the past is still very vivid and easily recollected. Questions get repeated over and over and answers are irrelevant. Words seem lost, forgotten or are inappropriate. These individuals no longer seem to follow a logical train of thought. Their personalities change for the worse and they become short-tempered and difficult to deal with. Such people may struggle with 21st century gadgets such as microwaves, mobile phones and remote controls, which seem to make their life more complicated. Keeping track of medication becomes a logistic nightmare. Falls with injury and fractures occur as balance and co-ordination become faulty. People fitting this description are loosely classified as suffering from dementia, a Latin word that means "deprived of mind". Dementia may be due to many causes. Alzheimer's disease is the commonest type of dementia and is the diagnosis in 50 per cent of the cases. Dementia occurs in the elderly as brain cells deteriorate with age. Chemical messengers in the brain, essential for its proper functioning, become depleted and chromosomes shorten. Many of these changes are inevitable and irreversible. Young people may develop symptoms similar to dementia, but in their case it usually occurs as a sequel to a brain infection (encephalitis or meningitis), brain trauma owing to an accident or a sport like boxing, bleeding in the brain (subdural haematoma), poisoning with lead or other heavy metals, or lack of sufficient thyroid hormone (hypothyroidism). The dementia is often cured if the underlying condition is treated successfully. Recently, some types of dementia have been found to have a genetic basis. Many members of an affected family carry certain gene mutations that are passed on through the generations. Scientists are now beginning to identify these defects. The risk of developing dementia increases if the lifestyle involves excessive alcohol consumption, smoking, a sustained elevated abnormal lipid profile, uncontrolled hypertension or diabetes. Heart or lung diseases, which compromise blood supply to the brain, also accelerate dementia. The diagnosis of dementia is based on medical history and an evaluation of orientation, general intellectual, academic and language skills, memory, reasoning and judgment. Scans (computed tomography or CT and magnetic resonance imaging or MRI) and electroencephalograms (EEGs) help to evaluate changes in the brain and clinch the diagnosis. Dementia can be treated with medications like donepezil, rivastigmine, galantamine hydrobromide and memantine. Specific symptoms and behavioural problems can be treated with sedatives and antidepressants. It is important to take the medicines exactly as prescribed in the correct dosage, which is often individualised. Many people take alternative medications such as vitamin E, omega 3 fatty acids, Coenzyme Q or extracts of ginkgo biloba (a Chinese herb). The dosage schedules are not established. There may be unwanted reactions with the regular medication. For a long time Indian physicians thought that dementia was a "Western" disease. They felt it did not occur in India as we had longer hours of sunlight exposure. And also because our diet contained turmeric which has the protective anti aging antioxidant curcumin. Actually earlier, life expectancy in India was only 45 years. This made cases appear few and far between. Now it has increased to 64. Still, only 4.8 per cent of our population is over the age of 65 years. This is in contrast to Western countries where 12 per cent of the population falls in this group. Today, realisation has dawned that across the globe 0.3-0.4 per cent of the elderly suffers from dementia. We in India are not equipped to deal with it. Caretakers are expensive and family members are left with the difficult responsibility. Geriatrics is an emerging speciality and still not very popular. Old age homes are a recent phenomenon. Insurance is often not available to cover the medical care of the elderly. Dementia occurs in a genetically predisposed individual living in a conducive environment. Age and genes cannot be changed but blood sugars, lipid levels and hypertension can be controlled. Stimulating the brain by doing puzzles, painting or learning a new skill compensates for some of the changes associated with dementia. The more frequent the activity, the more beneficial the effects. Physical activity such as walking an hour a day also helps delay dementia. Many young adults do not exercise regularly. Old age seems far away and they feel "this cannot happen to me". Nothing could be further from the truth. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

stress injury

Listen to your body

Your Health   DR GITA MATHAI

Seating arrangement is vital while working on a computer Neanderthal cave men and women had tremendous physical prowess. They excelled in all kinds of physical activities. We, on the other hand, do not do everything — we are selective and specialise. We choose and pick our jobs, and this means we repeat some tasks, day after day. As a result, certain muscles and joints in our bodies get overused, while others atrophy from disuse. This has resulted in a spate of new diseases and diagnoses, namely, repetitive stress injuries or RSIs. RSIs are a common affair in the computer era. Be it a student or senior citizen, computers have infiltrated everyone's lives. People who had perhaps never imagined that they would need a computer — including housewives, schoolteachers, clerks, typists and salespersons in shops — are now forced to rely on the new technology. Everyone is busy using computers for work, browsing the Internet or playing games, or using the tiny keyboard on a mobile phone for repeated text messaging. These persistent rapid movements do not give the joints and muscles sufficient time to recover, resulting in inflammation, swelling and eventual damage. In children and teenagers, the growing ends of the bones are particularly susceptible. Early signs of injury are stiffness of the neck, tingling, numbness or pain radiating to the arms, and feelings of weakness or fatigue. The fingers and arm joints may start to "trigger". They get fixed painfully in a bent position and then get released with a painful internal pop. Long hours in front of the computer take a toll on the eyes as well. Eyestrain can cause headaches, neck pain and transient blurring of vision. An unfit workforce naturally means loss of man hours. A new science has thus evolved to tackle this problem. It is called ergonomics or the scientific study of people and their working conditions, especially to improve effectiveness. An ergonomically designed workplace goes a long way in reducing RSIs. The seating arrangement is important while using a computer. Since people vary in height, the entire workforce cannot use similar chairs. A one-size-fits-all policy cannot be followed unless the height is adjustable. Chairs should also have a contoured back support. The feet should reach the floor comfortably. To check if the height of a chair is correct, place a pencil on the legs while sitting. It should slide towards the body, not away from it. The monitor should be placed at eye level, directly in front (not to a side), at an arm's length from the eyes. If reading at this distance is a problem, increase the font size. The keyboard needs to be placed directly in front of the monitor. If it is angulated to a side, the eyes have to keep adjusting for different distances. Elbows should be placed close to the side of the body to prevent the wrists from bending. The fingers and wrists should remain at a 90-degree angle to the upper part of the arm. Even if your work is hectic and engrossing, you should walk around or at least stretch your arms and legs every half an hour. If your work requires long hours on the computer, do static, seated exercises (you can get the information on the Internet). To make it easier on the eyes, the lighting in the room should be soft, from the side and not directly overhead or from the back. You should also take eye breaks from time to time. Focus on a finger held a few inches in front of the face and then on something far in the distance and then back to the finger. Take eye breaks throughout the day. Consciously blink, as prolonged computer use can result in infrequent blinking and dry eyes. Sports activities can also cause RSIs. If you walk or jog for an hour every day, you need to prevent RSIs to your lower limbs. Warm ups and cool downs taught in school are excellent. Unfortunately, these stretches are often forgotten or done half-heartedly as they seem unnecessary and time-consuming. They are vital to condition and prepare the muscles for exercise and for adequate recovery. To prevent repetitive injuries, it is also important at any age to try and vary the daily exercise. Alternate walking or running with bicycling or swimming so that different groups of muscles are used. While exercising, wear appropriate footwear. Walking and jogging require running shoes or cross trainers, not Hawaii chappals or rubber sandals. Children require footwear suitable to the sport they are playing. Inexpensive, stiff plastic shoes or playing football barefoot can result in an injury. Listen to your body and seek prompt medical advice for any discomfort during work, sports or leisure activities. Don't concentrate on work alone. Incorporate aerobic exercises and stretches into your lifestyle. The benefits of regular exercise are immeasurable. Immunity and resistance to disease increase and the improvement in overall flexibility and strength can help prevent crippling RSIs. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

Stress today

Blame it on stress

YOUR HEALTH   DR GITA MATHAI

Self medication can be harmful, consult a doctor when your child is sick Your body is aching all over, and you are suffering from acidity and indigestion. Curiously, medical tests show there is nothing wrong with you. If you are flummoxed, give this idea some thought — is it possible that your suffering is actually a manifestation of stress? One out of two people in India suffers from stress. Such people are physically, mentally and emotionally unable to cope with the demands that life makes on them. It is not just men — very often the sole breadwinner of a family — who suffer from stress. It also affects working women who have to balance a career and home and housewives who have to take care of budgets that go haywire because of inflation. It doesn't spare children either. Stress affects the young who are in an increasingly competitive academic world. Any physical, chemical or emotional factor that causes mental tension can be defined as stress. It can play an important part in the cause of disease. Continuous stress sets in motion a train of physical events which can eventually precipitate disease. This is particularly so in the case of people medically "sitting on the fence". These individuals do not as yet have overt diseases such as high blood pressure or diabetes, but months of stress push them over the edge. Stress invokes a "fight or flight reaction" in the body. It results in a surge of chemicals, predominant among which are the neurotransmitters adrenaline and nor-adrenaline. These act on every organ in the body causing a rapid heart rate, palpitation and a cold, clammy skin. At night, they keep the person awake, tossing and turning in bed. This results in insomnia, one of the commonest early symptoms of stress. Eventually, other symptoms appear. The person's temper becomes short and he or she becomes touchy and irritable. Relationships with family members and peers are affected. After all, no one wants to be around a bad tempered person. This disrupts support systems that may actually be beneficial in coping. Marriages begin to suffer as the libido decreases. There is loss of interest in sex and in children and family activities. Nausea, vomiting and diarrhoea may produce an aversion to food. In some people satiety may be affected, resulting in overeating and food binges. In such a condition, muscles may go into a spasm and fail to relax. There may be headaches, neck and shoulder pain, and backaches. The skin may break out in rashes. Unable to relax or sleep, the person may turn to drugs or alcohol to relax. The dependence is not necessarily on hard core drugs such as heroin or cocaine — it may also be on painkillers such as propoxyphene. Many pharmacies may provide anxiolytics (anti anxiety drugs) or addictive sedatives like diazepam or alprazolam without a prescription. Stress usually builds up over time, although it can be triggered by sudden, unexpected pressure. It is aggravated by long hours of work, lack of job security, long journeys to and from work, and extended periods of exertion with no breaks or holidays. Short-term stress, however, has certain plus points. It often brings out the best in an individual so that tasks are completed efficiently and on time. By and large, long-term stress is detrimental to physical well-being. The pressures of work and life cannot be escaped. The stress generated can and should be managed. Time management is most important. It is best to prioritise tasks and not be sidelined by mundane everyday chores. Do only what needs to be done. Try to finish your work on time. Long hours do not necessarily add up to increased or better production. Eat meals regularly and on time. Eat healthy, non-greasy food and if necessary get it from home. Add around four to five helpings of fresh fruit and vegetables. The vitamins and antioxidants will give your body a natural boost so that you can avoid all the extra cups of coffee and tea. Excessive caffeine does not really help to keep you alert or active. It might produce more palpitations and tremors. Exercise is a great stress buster. Around 30-45 minutes of walking, running, jogging or swimming releases natural mood elevating chemicals from the calf muscles. You will not only have more stamina, but will also be rejuvenated. Exercise should be completed an hour before bedtime. Otherwise the chemicals released will keep you awake. The best results are obtained if the exercise is combined with relaxation techniques. Yoga for about 20 minutes a day is ideal. Otherwise deep breathing with the eyes shut and the mind emptied of all thought for five to 10 minutes may be sufficient. Constant stress may make you a high achiever, but unless balanced with diet and exercise, it might push you towards an early heart attack. Such a situation is not worth it and to a large extent avoidable. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

Breast cancer

Check your breasts for cancer

YOUR HEALTH   DR GITA MATHAI

Cancer. The word is derived from "crab" and conjures up visions of multiple tentacles insidiously spreading all over the body. Unfortunately, the vision includes undiagnosed, undetected, untreated versions of the dreaded disease. Women in India are prone to cervical (lower end of the uterus) and breast cancer. A vaccine (HPV or human papillovirus vaccine) was recently introduced to reduce the incidence of cancer of the cervix. However, there is no vaccine to prevent breast cancer. One in 22 women in India are projected to be diagnosed with breast cancer in the course of their lifetime. The incidence varies from eight per 1,00,000 women in rural India to 27 per 1,00,000 women in urban areas. Breast cancer is not a disease confined to women; in rare occasions, it can occur in men too. Lumps in the breast can be felt when they are pea sized. The tissue feels different, and is firmer and harder than in the surrounding areas. Later the skin over the lump may be discoloured or thickened (resembling an orange peel). Also, there may be retraction (pulling inward) of the nipple. Many lumps are harmless non-cancerous fibroadenomas. Others are not real lumps but nodular breasts reflecting the hormonal changes that occur during the course of a normal menstrual cycle. All lumps, however, must be taken seriously and evaluated as soon as they appear. Evaluation of a breast lump is usually done with a mammogram or an ultrasound examination. Once the position has been accurately localised, the lump is aspirated with a fine needle. Cells obtained during the procedure are used to diagnose the nature of the lump. Depending on the diagnosis, the breast is operated. This is followed by chemotherapy, radiotherapy, hormone therapy and immunotherapy. Breast cancer can occur at any age, though it is less common under the age of 25 years. The exact mechanism which sets in motion the changes responsible for breast cancer is not known. Certain environmental and genetic factors are associated with an increased risk of breast cancer. • Long years of menstruation with early menarche (less than 12) and late menopause (over 55) • Delayed childbirth • Failure to breast-feed children • Breast or ovarian cancer in first degree relatives • Smoking and drinking alcohol • Obesity • Cancer elsewhere and exposure to radiation • Post menopausal hormone replacement therapy for more than four years. In developed countries, the majority

Assault

Dealing with sexual assault

YOUR HEALTH   DR GITA MATHAI

Self medication can be harmful, consult a doctor when your child is sick We perceive India as a safe, tradition bound country that honours women and loves children. Yet, our cities are becoming famous, even internationally, for molestation and rape. The number of cases reported has increased 700 per cent since Independence. And this is probably only the tip of the iceberg. Shame, family pressures, social stigma, economic vulnerability and lack of knowledge of legal procedures coerce a victim into silence. To make things worse, the victim is often regarded by our inadequately educated, underpaid and insensitive police personnel as the one at "fault". Rape is traditionally considered a crime against women. But times are changing. Horror stories abound about homosexual sexual predators targeting, kidnapping and victimising young boys. The victims range from six-month-olds to 80-year-olds. The perpetuators of rape, however, are almost always male. Around 80 per cent of the crime is committed by someone known to the victim. Often, the abuser is a member of the victim's family or belongs to his or her circle of acquaintances. In such cases, the crime is perpetuated in a known place, in either of their homes or that of a friend, relative or neighbour. Today, children of both sexes are in danger, in exclusive neighbourhoods as well as the slums. Their lack of knowledge, inexperience and trusting nature make them ideal victims. Many of these attacks are not random but well planned by a predator known to the victim. Police complaints are often followed by unwelcome media publicity. There are no "special victim units" in the police force yet, that may be trained to handle such cases with discretion and empathy. The guidelines provided deal mostly with the rape of women. The concept of male or child rape is new and the level of expertise in dealing with this is low. Despite this, if a parent or the victim wishes to prosecute the assailant, a physical medical examination, documentation of the evidence and registration of an FIR (First Information Report) must be done. Even otherwise, a thorough medical examination must be undertaken as soon as possible to treat and record lacerations and injuries, both external and internal. The greatest fear about sexual assault is that of acquiring STDs. The number infected varies between 5 and 10 per cent. Infection depends upon several factors, such as the type of sexual contact, number of assailants, and whether or not they had an STD at the time of the assault. The risk of contracting STDs can be reduced by taking medication as a preventive measure. Immediate and effective treatment options are available for some STDs such as hepatitis B, gonorrhea, syphilis, herpes, chlamydia and trichomonas vaginalis. The regimen recommended is a single injection of ceftriaxone, plus an oral dose of azithromycin, plus either secnidazole, tinidazole or metronidazole. Herpes can be tackled with a five or seven-day course of acyclovir. The risk of acquiring HIV infection is less than 1 per cent. However, it is important for medico-legal reasons to document the HIV status immediately. The test should be repeated after six months and then a year. A 28-day regimen of zidovudine and lamivudine provides post-exposure prophylaxis for HIV and should be started as soon as possible, preferably within 72 hours. Injuries and lacerations require a single booster dose of tetanus toxoid. Hepatitis B can be sexually transmitted. Most children today have received three doses of the vaccine as part of their immunisation schedule and are thus protected against the infection. In that case, only a booster dose needs to be given. If the victim has not been immunised in childhood, immunoglobulin needs to be given. In addition, three doses of the vaccine must be given — immediately after the incident, after a month and after six months. Prophylactic treatment against syphilis is not advised. Instead, a blood test can be done after three months to ascertain if infection has occurred. Counselling, psychiatric evaluation and support are necessary for the victim as well as his or her family to overcome the trauma. To protect children — • Make them learn addresses and phone numbers by heart • Teach them certain body parts are not to be touched • Discourage them from talking to strangers • Do not send them anywhere alone, especially after dark • Escort them to and from school bus stops • Encourage physical fitness and teach them martial arts • Teach them to trust their survival instincts and, if needed, run in the opposite direction as fast as they can, shouting all the way. For adults, the best bet is —   To have peepholes in the front door   Avoid dark and deserted areas   Be physically fit and able to run fast. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

Left handed or right?

Hope for clumsy clods

Your Health   Dr Gita Mathai

Being left handed does not come in the way of excellence, at least not for batsman Gautam Gambhir Right handed or left? Worldwide, about 90 per cent of the people prefer to use their right hand for doing things. Not surprisingly, life in all cultures is geared to the right-handed individual. Implements like nuts and bolts are difficult to handle for the left-handed. Incidentally, "right" also means "correct". The word "left" is derived from the Anglo-Saxon "lyft" which means "weak" or "useless". Our brains are wired for handedness. During the process of evolution, the centre for language moved to the left hemisphere in the majority of the people. The human brain functions such that the left and dominant hemisphere controls the right side of the body, making the majority (80 per cent) totally right-handed. The dominance does not extend to the use of the hand alone — such people are also are "right sided". Their dominant eye, ear and leg are on the same side of the body. Problems arise in 20 per cent of the population that doesn't have a dominant hemisphere to determine laterality or handedness. Their brains are "cross wired", giving them mixed handedness or laterality, cross dominance, mixed dominance or cross laterality. In short, the right hand may be matched with the left foot or the left hand with the right eye. This leads to confused, crossed signals in the brain when complex tasks are performed. The electrical and chemical signals have to criss-cross the midline before they eventually reach their final destination in the designated area of the brain. Therefore, such individuals are accident prone, and have things around them explode, collapse, catch fire or fall apart. Day-to-day objects are misplaced, and navigation from one place to another (with left to right confusion) — even along familiar roads — becomes a nightmare. These adults evolved from clumsy children, who kept bumping into things and frequently fell down. Their bodies have scars and evidence of healed fractures. Their school projects get "excellent" for imagination and "zero" for execution. Life is difficult for people with mixed laterality. Career choices are affected, with professions like driving or piloting a plane remaining distant dreams. People with mixed laterality alternate hands when writing and legs when kicking. They hold the telephone to the ear opposite to their writing hand. They subconsciously use one hand first and then the other to perform complex tasks. Earlier, such people were considered ambidextrous, but true ambidexterity is almost unknown. The uncertainty also extends to the mental image of their own limbs or body surface. This causes an inability to rapidly execute commands to turn right or left. The march past becomes a formidable hurdle, with everyone doing a "right turn", while the affected individual wanders off in the wrong direction. Hesitation is evident if they are asked to perform complicated tasks with alternating hands initiating the movement. Slowed reactions preclude split second decisions, causing frequent accidents. Also, people with mixed laterality do not perform well in track and field events. Their feet do not alternate quickly enough. Running is slow and uncoordinated. The good news, however, is that they excel in games involving a bat (such as hockey, cricket, tennis, badminton and table tennis). This is because the bat is held across the body on the dominant side. Mixed laterality also has its advantages. The criss-crossing of brain signals uses and strengthens many normally unused brain synapses and pathways. Hence such people are exceptionally talented, creative and artistic. If portraits or photographs of some famous artists — such as Leonardo da Vinci and Rembrandt — are scrutinised, you will see that they may paint with one hand, while tilting the head to the other side and crossing the opposite leg. This demonstrates mixed laterality. To check your laterality, figure out — * Which hand you use to write, pick up objects or dial the telephone * Which leg you use to kick or which is uppermost when your legs are crossed (this remains constant all through life) * If you cannot hear clearly, to which side you tilt your head * The side of your jaw you use to chew (this is also constant unless there is a dental problem) If you have mixed laterality, it is possible to overcome the "defects" and strengthen both sides equally, in a way that it "compensates" for mixed laterality. These exercises, that require 10 repetitions, may be of help — • While walking, clench and unclench your hands, alternating them with the foot you use to step forward (right hand and left foot) • Standing on one leg at a time • Close one eye first and then the other • Close one ear at a time • Doing yogic breathing through one nostril at a time. If a child is "left" handed, that may be the "right" laterality for him or her. Punishment, ridicule or forceful correction messes up the brain connections. Desist from interference, or you might just have sabotaged the emergence of the next Einstein. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

Gestational diabetes mellitus

Not all sugary

	Your Health   DR GITA MATHAI
Self medication can be harmful, consult a doctor when your child is sick

Shock was writ all over her face and her husband's. "How can I have diabetes," asked the young woman. "When I saw the result of the blood sugar test, I thought it was a mistake. No one in my family has diabetes!" Well, that may be true, but it is also a fact that 2 per cent of the Indian population has diabetes and 15 per cent of pregnant women have abnormal blood glucose values.

Despite the epidemic of diabetes in our young urban adults, statistics about the exact prevalence of the disease in pregnancy are difficult to obtain. Many pregnant women are not tested. In centres offering antenatal care, the presence or absence of "sugar" in the urine — an unreliable test at best — is used to diagnose diabetes.

Blood should be tested as part of routine antenatal care. A fasting glucose level of more than 126mg/dL or 7mmols/L in pregnancy is considered abnormal. A blood sample can also be drawn one hour after ingesting 50g of glucose. A normal value is less than 140mg/dL or 7.8mmols/L. If it is higher, it needs to be followed by a three-hour OGTT (oral glucose tolerance test) with a 100g glucose load. A positive diagnosis is made if the fasting value is 105mg/dl, the one-hour value 190 mg/dL, the two-hour value 165mg/dL and the three-hour value 145 mg/dL or more.

Some of the women with these values are diabetics who are asymptomatic and unaware of their condition. Others have relative insulin insufficiency, or MODY (maturity onset diabetes of the young), and are already on oral diabetic medications. Women with polycystic ovarian syndrome may be on the oral diabetic drug metformin. They may become overtly diabetic during pregnancy.

Others with abnormal blood sugar levels have gestational diabetes mellitus (GDM), a peculiar type of glucose intolerance which first appears during pregnancy in an otherwise normal woman. It can occur at any time during the pregnancy, though it is more likely to occur after 24 weeks. The exact reason for gestational diabetes is not known.

Women at risk are those who

* Have a family history of diabetes,

* Have a BMI (body mass index — that is, weight in kilogram divided by height in metre squared) of more than 30,

* Are older than 25,

* Have previously had large babies (more than 4kg) or still births.

The glucose in the mother's blood crosses over via the placenta to the baby. The excess sugar supplied makes the baby grow rapidly. The baby's pancreas starts to work overtime to lower the sugar to normal by secreting insulin. The excess calories are stored as fat. This gives rise to a large baby (macrosomia) weighing more than 4kg. This in itself increases mortality by 50 per cent. The size may cause the baby to get stuck in the birth canal. Forceful extraction can result in fractures of the collarbone or paralysis of the nerves to the arm. After birth, the baby's pancreas continues to produce high levels of insulin as it is acclimatised to do so. This may cause the blood sugar levels in the baby to drop precipitously. The baby may then have seizures. In addition, it may develop other problems such as low blood levels of calcium and magnesium. Many babies also die (that is, are still born) while others (up to 50 per cent) may have breathing difficulties.

About 33 per cent may have polycythemia (excess blood) and 16 per cent develop jaundice at birth or soon after.

Mothers with GDM are also prone to develop other complications during the pregnancy such as hypertension. Almost 60 per cent of these women develop GDM in subsequent pregnancies, particularly if there has been maternal weight gain between the two pregnancies. Around 35 per cent will go on to develop diabetes in the next 15 years. The blood sugar in mothers with GDM should be well controlled to prevent complications in her as well as the baby. Diet regulation is needed to keep the sugars under control. Since not all women with GDM are obese, the diet has to be adjusted in accordance with the mother's BMI. The diet should consist of 40 per cent carbohydrate, 20 per cent protein and 40 per cent fat.

Pregnant women do not really "have to eat for two". The calorie requirements are

*35kcal/kg/ 24hour for a woman of normal weight (BMI 25).

* 24kcal/kg/ 24hour for overweight women (BMI 25-30).

* 12 to 15 kcal/kg/24hour for morbidly obese women (BMI 30-40).

* 40kcal/kg/24hour for underweight women (BMI less than 25).

A combination of diet control and aerobic exercise such as brisk walking for 45 minutes every day usually keeps the blood sugars normal. If the sugars remain high, insulin therapy may have to be started. Many of the oral diabetic medications cross the placenta and cause hypoglycaemia in the baby. Some of them are, however, used under supervision.

Unlike other forms of diabetes, which are permanent, GDM disappears after delivery. It, however, acts as a warning. Exercise for 45 minutes or more a day, reduce your weight and maintain your BMI at 23. That way, diabetes may not plague you in your later years.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in