DR. U.J. Agim

About DR. U.J. Agim

https://ujahealth.com

A Senior Registrar in Obstetrics and Gynecology (OBGYN) National Hospital Abuja, Nigeria. He has interest in women’s health and a passion for educating women on their obstetrics and gynecological health.

Posts by Unimke Agim:

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VASECTOMY OPERATION IS THE MALE PERMANENT CONTRACEPTION

Vasectomy operation is the male permanent contraception. It is the male equivalent of bilateral tubal ligation. Vasectomy is also called male sterilization. Although, data has shown an increase in the uptake of vasectomy in the western world, it is yet to be widely accepted in Africa. In fact, I am yet to refer a case to the urologist for one. This is because, I have never succeeded in getting a couple to agree to vasectomy operation.

Even if the man agrees, the woman is often always the one to disagree. This is due to the concern of loss of sexual capacity which the women often express. Despite counseling, this singular concern is always the reason for not accepting vasectomy. These women will prefer to have a bilateral tubal ligation than allow their husbands to have vasectomy.

INDICATION FOR VASECTOMY OPERATION

The indication for vasectomy is when a couple have completed their family size and are in need of a permanent method of contraception. A man who do not want to father a child or who no longer want to have more children and want a permanent contraception is a candidate for vasectomy operation.

CONTRA-INDICATION TO VASECTOMY

A couple that do not accept vasectomy or are undecided will not have it performed on the man. Also, in the setting of emotional instability on the patient, vasectomy should be with hold. If the vas deferens cannot be felt or mobilize for the procedure, vasectomy may not be carry out. The condition that can cause challenge in feeling or mobilizing the vas deferens include; anatomic abnormalities like varicocele or hydrocele, if he had had a previous scrotal surgery or trauma that causes scaring in the scrotum.

In addition, the presence of an active local infection on the scrotum will hinder carrying out the procedure. This will prevent further spread of the infection. A patient on anticoagulant or antiplatelet medications (which are taken to thin the blood to prevent blood clot formation) can increase the risk of bleeding during the procedure or blood clot formation in the scrotum after the procedure. It is important to let your doctor know when you are on these medications.

WHAT TO EXPECT AT VASECTOMY OPERATION?

The procedure is usually done at an outpatient basis. It does not require general anaesthesia. It only requires local infiltration or spray of anaesthetic agent around the site of the procedure. This office procedure does not require hospital admission and has a quick recovery time. The man will be awake during the procedure but will not feel pain.

The vas deferens will be approached through a small opening in the midline. Then, by going through several layers of tissues. The vas deferens is identify and brought out through the small opening created by the use of other instrument other than cutting through. This is called the non-scalpel vasectomy. The vas deferens can be occluded by tying with an absorbable suture and cut, a clip can be applied or by the use of electrocautery.

COMPLICATION OF VASECTOMY

The complication of vasectomy includes

  • Bleeding
  • Infection
  • Collection of blood clot in the scrotum
  • Pain which could be immediate or persistent chronic pain. This usually follows a nerve injury during the operation.
  • Atrophy of the testis can occur as a rare late complication when its blood supply is compromised during the operation.
  • Formation of sperm granuloma which is a small painful nodule at the cut end of the vas deferens near the testis.

WHAT TO DO AFTER THE PROCEDURE

When at home after the procedure, the man should lie down, stay quiet for the remainder of the day, and avoid heavy lifting or exercise for a few days. Ice pack can be applied intermittently to help with pain and swelling. You should call your doctor when you observe any of the above complications.

It should be noted that the man still remains fertile and can impregnate a woman after the vasectomy procedure. To avoid this, additional contraception such as condom is required until sterility is confirmed. Normal sexual activity without additional contraception can begin after 20 ejaculations or two consecutive seminal fluid analysis results done four to six weeks apart shows no sperm in the test sample. It can take up to ten to twelve weeks to achieve sterility.

Some experts recommend only one semen analysis test after twelve weeks. If negative, sterility is confirmed and no need for further test.

FAILED VASECTOMY

Vasectomy is said to have failed if at the follow-up visit after 20 ejaculations motile sperm cells are found on the semen analysis test.

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INFERTILITY AND HOW TO KNOW YOU ARE FERTILE

In this article, infertility and how to know you are fertile. I will explain the signs and symptoms that will point to the possibility of infertility. Pregnancy is the sure confirmation of fertility. There are no specific symptoms or signs that will guarantee that a man or woman is fertile. However, there are certain symptoms or signs whose presence signifies the woman or man will need assistance for the couple to conceive.

For these symptoms and signs, they may be present at the moment or you might have experienced them in the past. Their residual effects might hinder conception.

SYMPTOMS AND SIGNS of INFERTILITY IN WOMEN

A woman who sees her period regularly and experiences premenstrual symptoms such as mood swing, breasts fullness, breasts tenderness, nausea and bloatedness is most likely to be fertile. If she is infertile, it is not likely due to ovulatory dysfunction, which is the common cause of infertility. During the course of evaluation for infertility, certain questions will be asked by the gynaecologist or urologist. These questions are asked to rule in or out the possibility of any medical condition that can cause infertility.

Apart from the inability to conceive, infertility on its own has no particular symptoms or signs. However, the manifestations of other underlying medical condition that can cause infertility are what you can feel and see as the possible symptoms and signs of infertility respectively.

If a woman is unable to conceive with the following symptoms and signs such as; irregular menses; with or without an anterior neck mass; heat (feels hot in cold weather) or cold intolerance (feels cold in hot weather), and excessive weight loss or gain. Thyroid disease may be responsible for these symptoms and signs. Abnormal thyroid hormone interferes with ovulation.

Also, some infertile women may have breast milk coming from the breasts.  Whether they expressed it or it was spontaneous; with or without headache, dizziness or visual disturbance. The likely cause is due to high blood prolactin levels. This high blood prolactin levels could be as a result of tumour in the pituitary or from nipple stimulation. This stimulation can be from direct suckling on the breasts, nipple piercing or herpes zoster involving the chest wall. High blood prolactin interferes with ovulation.

Furthermore, menstrual irregularities associated with abnormal body hair distribution, excessive weight gain, acne with or without voice change is associated with polycystic ovarian syndrome. Women with this condition have very few menses in a year. Some have to shave not only their legs but also their facial hair. These women have excess androgen; the male hormone which is responsible for their male pattern of hair distribution. Their irregular menses is due to the fact that they do not ovulate.

Chronic cyclical pelvic pain that starts some days before the onset of menses, and wanes with the commencement of menstruation, with or without bleeding from other body parts like the navel, is suggestive of endometriosis. This is when the inner lining of the womb is found outside the womb. It bleeds just like the womb during menses. This condition can cause adhesions to form around the fallopian tubes and block the tubes. Therefore, the egg release at ovulation and the sperm cannot meet because the fallopian tubes are blocked. This will result in infertility.

Similarly, Infertility in a woman with a Prior history of pelvic inflammatory disease is due to tubal blockage. Pelvic inflammatory disease is a gynecological emergency because of it after effect on the fallopian tubes and subsequent infertility. It manifest as fever, lower abdominal pain and or swelling with abnormal vaginal discharge. If poorly treatment, it could result in scarring of the fallopian tubes and subsequent infertility.

In addition, pelvic inflammatory disease caused by Chlamydia trachomatis can run a sub-acute course. It will not manifest with the usual symptoms and signs that will prompt health seeking. Also, some individuals can carrier this infection without manifesting any symptoms but will subsequently transmit it to their sexual partners.

SYMPTOMS AND SIGNS OF INFERTILITY IN MEN

The fact that a man can achieve and sustain erection does not make him fertile. This is contrary to the belief that a fertile man should wake up every morning with an erection. Nocturnal penile tumescence commonly called “morning wood” is the erection that men get while sleeping or waking up in the morning. It might signify sexual capacity but not fertility. Some of the symptoms or signs of infertility might have occurred in the past or the man just began to notice these changes.

There are no specific symptoms and signs that signify infertility in a man. However, the presence of certain symptoms and signs in a man whose wife is having difficulty conceiving should be a cause for concern. These may be suggestive of an abnormality in sperm production or transport. These can result in Infertility and these symptoms and signs include:

  • The opening of the urethral may point up or down instead of being at the tip of the penis. This affects proper sperm deposition at the cervix.
  • Sudden reduction in sperm volume can follow retrograde ejaculation or obstruction of the sperm duct. This obstruction could be from inflammatory changes associated with infection involving the urethral, vas deferens or seminal vesicles.
  • Reduction in testicular volume or size may be due to atrophy following trauma, infection causing inflammation of the testis, testicular torsion or reduction in blood supply and oxygen to the testis from complication of sickle cell disease.
  • Inability to achieve and sustain erection may result from diabetes, effect of prolonged priapism (erection) in sickle cell male.
  • Testicular discomfort, swelling or pain and the scrotum might feel like it contains a bag of worms. This is suggestive of varicocele, it affects the sperm structure.
  • Breasts enlargement
  • Discharge of breast milk from a man’s breast, headache and visual disturbances resulting from a tumour in the pituitary gland can result in infertility.
  • Reduce sexual drive from reduce testosterone levels. This can be cause by effects of emotional stress, alcoholism or aging.

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THE PROBLEMS OF BREASTFEEDING PART TWO

The problems of breastfeeding in most cases can be from lack of experience and inadequate knowledge on the intricacies of breastfeeding. Also, it can be from cultural beliefs, health and socio-economic influences. As a follow up article on the problems of breastfeeding part one, outlined below are additional problems and challenges of breastfeeding that are quite common. The World breastfeeding week ends today. Mothers should be supported to encourage exclusive breastfeeding.

THE PROBLEMS OF BREASTFEEDING: NIPPLE CONFUSION

Babies are born with the natural instinct for breastfeeding. If you poke a baby’s cheek with your finger, the natural response is for the baby to turn to that side with the mouth open. This is called the rooting reflex. Nipple confusion arise from the baby’s difficulty to switch from bottle feeding to breastfeeding. In new born babies introduced to pacifier or bottle feeding, they may have difficulty latching onto the breast.  For older babies, they may start preferring the bottle feeding to breastfeeding.

In fact, breastfeeding is difficult for the baby than bottle feeding. So, it is normal for the baby to prefer the easy one. You will often hear parents say the baby stopped breastfeeding on its own. This is so because the baby was most likely introduced to a pacifier or bottle feeding. Note that not all babies will develop nipple confusion. One cannot tell which baby will have nipple confusion, therefore, prevention is key by avoidance of the stimulus.

INVERTED OR FLAT NIPPLES

The nipple is a small conical structure on the breast. A normal nipple should point outward and not appear flatten. A flattened or inwardly drawn nipple poses a great deal of challenge as one of the problems of breastfeeding. This makes latch on difficult. It is important for an inverted nipple to be discover early. This could be during breast self examination or usually at the antenatal care booking clinic during the clinical breasts examination.

Hence, necessitating breast preparation before delivery. So, attempts are made to pull the nipples out. Using the Hoffman exercise, the thumbs are placed on either side of the flat or inverted nipple on the left and right side of the areola. A slight inward then firm outwards pressure is applied on the areola. This manoeuvre should be repeated circumferentially at least 5times a day.

Also, a suction cup device, hard plastic breast shells or syringe can be used to attempt pulling out the flat or inverted nipple. Using a syringe, the other end away from the plunger is cut circumferentially, the cut end is applied to the breast around the nipple. The plunger is withdrawn and the suction pressure pulls the nipple out. Several attempts will be needed to make the nipple point out. This can be done before each feeding episode. The breast shells are worn inside the bra, they put pressure around the nipple making it protrude.

Whereas, the aforementioned methods may give results though not permanent, some expert have questioned their efficacy. Surgery has been advocated and one of such procedure is the nipple piercing. The flat or inverted nipple is elevated and pierced leaving a small horizontal bar to keep it elevated.

MASTITIS

Mastitis is the inflammation of the breast tissue resulting from infection or breast engorgement. Both or one breast might be affected. Affected individual could have breast pain, mild fever, malaise, nausea or vomiting. Treatment depends on whether the woman is breastfeeding or not. If she is breastfeeding, she should continue even on the affected breast. Manual expression of milk after breastfeeding will also help if the mastitis is due to engorgement.

If she is not breastfeeding, a tight fitting bra can be use, usually, the bra size she uses when she was not pregnant is advised. Medication can also be used to suppress breast milk production. For infectious mastitis, antibiotic is recommended.

BREAST ABSCESS

A breast abscess is formed when pus collect in the breast. Mastitis or secondary infection of a galactocele can result in breast abscess. Affected women come down with breast pain, fever, nausea or vomiting. The nipple may discharge pus; the surface of the breast may be warm, appear red-like, swollen; and there may be a punctum. Treatment here is by incision and drainage of the pus. Breastfeeding should be withheld on the affected breast.

UNSUPPORTIVE WORK PLACE POLICIES

Unsupportive work place policies are a major contributor to the uptake of exclusive breastfeeding. Women are a significant part of the work force in most countries. Married women will want to have babies since nature did not confer them with the advantage that they can afford to wait too long. So, in the course of their career progression, a child might come into the picture. They need all the support within and without to get through this period of raising a healthy child. An exclusively breastfed child will fall ill less often thereby, reducing the burden on the health system. Also, mothers will take less time away from work to take their babies to the hospital.

However, the work place might not be conducive enough to support exclusive breastfeeding. Maternity leaves should be at least six months to allow for exclusive breastfeeding and it should be a paid leave. Some organization do not have crèche where these babies can stay while their mothers work and intermittently come to breastfeed. Those that have crèches have no breastfeeding breaks.

Also, some mothers do not get the require duration of maternity leave as stipulated by law. Reason being that they have not spent up to six months at the said employment before delivery. Despite the reduction in the official leave period, some do not get paid during the period while they are on leave. For this reason, the law makers should take responsibility for making laws that will encourage exclusive breastfeeding. Also, enforce and ensure compliance with the law both in the public and private sectors. The Ministry Of Women Affairs should be in the vanguard of ensuring compliance with the laws. Also, ensuring women on maternity leaves are paid.

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THE PROBLEMS OF BREASTFEEDING PART ONE

The problems of breastfeeding can be quite overwhelming especially for the new mothers. As easy as breastfeeding might look, it can be very challenging. Breastfeeding is cost-effective but not cheap if you consider the sacrifice needed to succeed. A lot of time, patience, loss of sleep, understanding and above all support will be needed for a successful breastfeeding experience.

When care is not taken, the problems and challenges of breastfeeding might result in a poor breastfeeding experience for the mother and child. Knowing the benefits of breastfeeding might just be the only encouragement to continue. Some of the problems and challenges of breastfeeding are outlined below.

THE PROBLEMS OF BREASTFEEDING: INADEQUATE BREAST MILK PRODUCTION

In a woman with normal breasts, the breast milk is very adequate for the baby by nature’s design. The production is dynamic to meet the need of babies at each point in time in their growth and development. The production of breast milk is in two phases. The first phase starts from about 12 weeks during pregnancy. The second phase starts about 2 to 4 days after birth. The suckling effect of the baby is the key to unlocking the second phase.

Importantly, early commencement of breastfeeding is very crucial to achieving early and adequate milk production. It is recommended that babies should be put to breast immediately after delivery, at most, 30 minutes to one hour after delivery. Late initiation of breastfeeding or giving the baby other food will interfere with initiation of breastfeeding and adequacy of milk production.

BREAST MILK IS NOT ALWAYS ENOUGH FOR BABIES.

Some people belief that the breast milk is not always enough for babies especially male babies. This is not true for a normal breast. After birth, the production is usually small for some women but it will later pick up. The gradual increase in production should not be a cause of concern, even if it is as small as 2 to 5mls that is produce at the initial feeding. With frequent stimulation by the baby through suckling, the production will improve. You should also note that the new born stomach capacity is very small, about 5 to 7ml on the first day of life to about 20ml on the 3rd day of life.

Moreover, women with adequate breast milk production still complain of their babies crying after a short while following feeding. This is not due to the milk not been enough, the problem here is quality of feeding time. The mature breast milk is composed of the fore milk and the hind milk. The fore milk is mostly fluid while the hind milk contains fat. It is this part of the mature milk that gives satiety and fills the baby. To get to the hind milk, the baby should suckle for at least 20 minutes on one breast without switching to the other breast.

SORE OR CRACKED NIPPLE

The nipple can feel sore during or after breastfeeding, this should normally not happen. One of the common cause is mostly due to poor latch on. This result in the baby suckling on the nipple. After breastfeeding, take a look at the nipple, if it is flat or wedge shaped, the baby was not properly latched on the breast. If this continue, it can result in injury to the nipple called cracked nipple.

If the nipple is cracked, you should visit your healthcare provider for instruction on proper positioning and signs of proper latch on. Continue breastfeeding as before even on the affected breast to avoid engorgement. With proper latch on, you will not feel pain while breastfeeding on the breast with a cracked nipple. At the end of feeding, smear the nipple with breast milk. The breast milk contains enzymes and growth factors that will help with the healing process.

If you still feel pain with proper latch on, it might be from infection with candida. Look out for oral thrush in the mouth of your baby. These are whitish patches on the tongue, gum, cheek or roof of the mouth that won’t come off easily with gentle cleaning with a cotton bud. For this, both mother and baby will need antifungal medication for treatment. 

BREASTS ENGORGEMENT

The breasts can become swollen and painful if left to accumulate due to missed feeding periods. This is common in women who work in establishment that do not support breastfeeding mothers. It is important to have crèche within the mother’s work environment where she can sustain continuous breastfeeding.

Consequently, the brain sends chemical signal to stop further production when the one already produced is not been used. Therefore, continuous breast engorgement will affect milk production. The solution to this is to express the milk and store in a refrigerator while at work. This will not only relief the pressure but sustain production.

contrary to certain belief, the breast milk while still in the breasts cannot get sour. Even if you have not breastfed your baby for more than 24hrs, do not express and discard before feeding.

GALACTOCELE

The nipple is pierced by about 12 to 20 ducts that drain milk from the lactiferous sinuses. Please read here for a brief anatomy of the breast. When a breast duct is blocked, milk accumulate in the breast lobe drain by the duct to form a milk cyst called galactocele.

In this case, the blockage can result from trauma, inflammation or abnormalities of the nipple. Mothers who breastfed intermittently or use formula feed are more likely to develop a milk cyst. This is due to incomplete evacuation of the milk from the lactiferous sinus.

Usually, a galactocele is not painful and there is no fever. It is a firm, non-tender, single mass felt in the breast. Any mass in the breast has to be investigated to make sure it is not cancer. An ultrasound scan is useful. Treatment will be by aspiration of the cyst. Blocked duct can result in mastitis.

To be continued, the problems of breastfeeding part two.

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THE BENEFITS OF BREASTFEEDING IS NOT ONLY FOR BABIES

Mothers and aspiring mothers need to know the enormous benefits of breastfeeding. It might just be the encouragement they need to go through the period successfully. There is no better time to support and promote breastfeeding than now; the World Breastfeeding week which kicked off from 1st to 7th August, 2022. The theme for this year’s commemoration is, ‘Step up for Breastfeeding: Educate and Support’. Breast milk is nature’s wonder that contains all the nutrient your baby need at each stage of life.

THE BENEFITS OF BREASTFEEDING

According to the World Health Organization, about 2 out of 3 children are not exclusively breastfed for the recommended 6months. Despite the many benefits of breastfeeding, the uptake of exclusive breastfeeding has not improved. According to the Nigerian Demographic and Health Survey data of 2018, only 29% of babies were exclusively breastfed, 22% of babies under 6months had breast milk with complimentary foods, 48% had breast milk with other liquids while 2% were not breastfed.

According to the United States of America Centre for Disease Control in 2019, about 24.9% of babies under 6months had exclusive breastfeeding while 35.3% had supplemental infant formula with breastfeeding. These statistics are not encouraging.

The benefits of breastfeeding to the baby include:

  • Immunity to the baby; it provides protection to the baby from infectious agents the mother was exposed to.
  • Plays a role in the development of a healthy intestinal flora that helps to reduce allergy, inflammatory bowel disease and diarrhoea disease
  • Early breastfeeding promote tolerance and reduces the incidence of food allergies
  • The docosahexaenoic acid (DHA) is an omega-3 fatty acid found in breast milk that is belief to help in visual and brain development of both the unborn and breastfed babies.
  • Exclusively breastfed babies tend to have higher intelligence quotient (IQ)
  • Breastfeeding can be used to comfort the baby; the fastest way to stop a baby from crying is breastfeeding.

The benefits of breastfeeding to the mother include:

  • Reduces the risk of breast cancer
  • Reduces the risk of ovarian cancer
  • Prevent bleeding after delivery
  • Help in losing the additional weight gained during the pregnancy period.
  • Encourage mother and child bonding

To the environment, breastfeeding is eco-friendly as it does not generate waste for disposal.

BREASTFEEDING INITIATION         

It is recommended that breastfeeding should be initiated immediately after delivery, as soon as the mother is stable. It is recommended to start within 30 minutes to 1hours of delivery even if the delivery was by caesarean section. Breastfeeding should be on demand or every 2 to 3hour. You may have to wake your baby up to breastfeed, if the baby sleeps for more than 3hrs. Breastfeeding should be exclusive; giving only breast milk for 6months either directly from the breast or expressed breast milk. Complimentary feeds should be introduced at 6months. Breastfeeding should continue for one year and beyond.

For women with hepatitis B virus infection, breastfeeding should start immediately after the baby receives hepatitis B virus immunoglobulin and vaccine. For HIV positive patient that opted for breastfeeding, the baby should be given antiretroviral medication for pre-exposure prophylaxis before initiating breastfeeding. HIV expose babies on prophylaxis should be breastfed exclusively till 6months. Complimentary feed should be introduced thereafter with breastfeeding continuing till one year.

COMPOSITION OF BREAST MILK

The composition of the breast milk changes with time and feeding. The first milk is called the colostrum which is produced within the first 4days after delivery. Its colour varies depending on maternal dietary level of β-carotene. It might be yellow, orange or light brown. After 4days, the transitional milk takes over. The mature milk starts 14days after delivery. The mature milk is composed of the foremilk and the hind milk.

The foremilk is predominantly fluid and the hind milk is high in fat. The baby needs to suck for at least 30minutes to get the both components of the mature milk. The hind milk is responsible for satiation. Babies will cry often if they do not stay long on the breast to get the hind milk. Ensure the baby empties one breast before changing to the next.

Also, the breast milk is composed of macro-nutrients, micro-nutrients, growth factors and enzymes. One of my trainers describe the breast milk as, ‘’milk a life’’ due to the presence of the enzymes. The enzyme lipase helps the child to handle the digestion of fat. The macro-nutrients include; carbohydrate with oligosaccharide inclusive, oligosaccharide promote the growth of favourable bacteria that protects the baby’s intestine; protein and fat.

The micro-nutrients consist of vitamins, calcium, iron and zinc. The growth factors such as epidermal growth factor, platelet derived growth factor, vascular endothelial growth factor and insulin-like growth factor.

Furthermore, breast milk is specific to the mother. It contains immunoglobulin A, E G and M. The immunoglobulins contained in breast milk depend on the maternal exposure to infectious agents. These are passed to the baby to provide passive immunity to prevent infection and allergy.

TECHNIQUES OR POSITIONING FOR BREASTFEEDING

There are several techniques of breastfeeding, the common one is the sit up position.

  • The mother sit upright with her back well supported
  • The back of the baby’s head in front of her elbow
  • Her open palm supports the buttock of the baby
  • The mother brings the baby to the breast and not bend towards the baby. Note that bad posturing will cause back ache and affect the breast feeding experience.
  • A pillow can also be placed on the mother’s thigh for support too.
  • With the other hand, the mother can support the breast with her four fingers beneath and the thumb above the breast. Note that this is just to support the breast and not for pressing or milking the breast. Pressing the breast will obstruct the milk duct.

WHAT CONSTITUTE A PROPER LATCH ON?

Proper latch on or attachment to the breast during breastfeeding ensures that the baby is getting the breast milk. If the baby is not properly latched, the child will be suckling on the nipple and this can result in cracked nipple. Proper latch on consist of the following;

  • The baby’s lips should be wide open and everted
  • The baby’s lips should cover most of the areola which is the pigmented part of the breast after the nipple
  • There should be no suckling sound. If you hear this, the baby is not properly latch
  • You should hear swallowing sound
  • You can also see milk at the angle of the baby’s mouth.

PROBLEMS OF EXCLUSIVE BREASTFEEDING

The problems of breastfeeding are outlined below;

  • Not enough milk production
  • The belief that breast milk is not enough for babies
  • Sore or cracked nipple
  • Breasts engorgement
  • Mastitis
  • Breast abscess
  • unsupportive work policies

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SPEECH DEFECT LINKED TO INSULIN USE IN PREGNANCY

Can a child’s speech defect be linked to insulin use in pregnancy? A patient with gestational diabetes at the antenatal clinic asked if insulin causes speech defect in children. She feels one of her child who cannot speak at age 4years was due to the insulin she used to control her blood sugar in that pregnancy. The other child has no problem with speech because she did not use insulin while pregnant. She strongly believes it and also claimed she read online that insulin use in pregnancy causes speech problem in children.

On further probing, she did not develop gestational diabetes in the pregnancy that resulted in that child with no speech problem. Also, the one with speech difficulty is actually having difficulty hearing. So, can insulin use in pregnancy cause speech problem in children? If insulin is not the culprit, what then could be responsible? Stay with me as you will have your answers right here.

GESTATIONAL DIABETES, INSULIN AND ORGANOGENESIS

The period of organogenesis also called the embryonic period is from the 3rd to the 8th weeks of pregnancy. This is when all the body’s organs are formed, exposure to agents that disrupt the process will result in birth defect.

The development of the sense of hearing starts in the early 4th week of pregnancy. Babies born with deafness maybe from their genetic makeup or the presence of other maternal medical conditions such as; diabetes or infection with toxoplasmosis, rubella, cytomegalovirus, herpes or syphilis.

Hearing plays a significant role in the acquisition and development of communication skills. A child that cannot speak may not be hearing. Children born with deafness can be helped to restore their sense of hearing. They may require surgery to correct any malformation or for insertion of implant. Some may benefit from the use of hearing amplification devices and audiology rehabilitation. Significant progress has been made in research on hearing loss; in auditory hair cell and nerve regeneration.

WHAT IS INSULIN?

Insulin is a hormone produce naturally in the body by specific cells in the organ called the pancreas. The hormone is key to the uptake, utilization and storage of blood sugar in the body. It also plays a role in the production of protein and fat in the body. Intake of carbohydrate meal stimulate the release of insulin. The relative, body cells not sensitive to insulin, or absolute deficiency of this hormone insulin results in diabetes.

The discovering of insulin revolutionises the treatment of diabetes; initially, the insulin used was gotten from pig and cow, later, synthetic human insulin was produce with some limitations. The production of synthetic insulin analogue has overcome the limitation associated with human insulin. Available data from studies do not associate insulin use in pregnancy with any major birth defect or miscarriage. Side effect of insulin includes; allergic reaction, weight gain, hypoglycaemia, hypokalaemia.

WHAT IS GESTATIONAL DIABETES?

Gestational diabetes or GDM is carbohydrate intolerance that is first discovered in pregnancy and resolves within six weeks after delivery. In simple term; it means abnormal blood sugar level that is discovered for the first time in pregnancy in a woman who is not previously diabetic.

CAUSES OF GESTATIONAL DIABETES

The cause of gestational diabetes is not exactly known but there are risk factors associated with it. Although, genetic and environmental factors seem to play a major role. Pregnant women with the following risk factors as outlined below are called potential diabetes. They include;

  • Family history of diabetes
  • Previous history of gestational diabetes
  • Obesity; weight at antenatal booking ≥90kg or a body mass index of ≥30kg/m2
  • Previous delivery with one or more babies weighing ≥4kg
  • Previous history of a child with birth defect
  • Previous or current history of too much baby water
  • Previous history of fetal demise
  • Persistent glucose in urine test
  • Recurrent or persistent vaginal discharge

HOW IS GESTATIONAL DIABETES DIAGNOSE?

Gestational diabetes is diagnosed using the screening test called oral glucose tolerance test (OGTT) when it is abnormal. The screening for gestational diabetes depends on the guideline for screening in your country, this differ from country to country. In my facility in Nigeria, only women with the above risk factors are screened while in other countries the recommendation is for all pregnant women to be screened.

Oral glucose tolerance test is a screening test for diabetes done between 24 to 28weeks of pregnancy. For patients who book early in pregnancy with the above risk factors, a blood sugar level is determine after a period of fasting and 2hours after eating. However, some experts advocate for an earlier OGTT which should be repeated at 24 to 28weeks of pregnancy.

WHAT TO EXPECT AT THE ORAL GLUCOSE TOLERANC TEST?

 Before the OGTT is done, there are some prerequisite to be met and they include;

  • The patient should fast for at least 8hrs prior to the test
  • She should be on her regular diet with no carbohydrate restriction
  • She should not smoke

On the morning of the test, 75g glucose is mix in 250ml of water to be consumed within 5minutes. A blood sample is drawn to measure the fasting sugar level before starting the test. After drinking the solution, blood samples are drawn at one hour and 2hours.  Urine samples are also taken same time as the blood to check for the presence of sugar in the urine.

If any one of the result is abnormal; either the fasting, one or two hours’ blood sugar result, the patient is confirmed to have gestational diabetes.

COMPLICATIONS OF GESTATIONAL DIABETES

The complication of GDM could be to the mother or baby and they result from poor sugar control. Sometimes, these complications would have occurred in the baby before the diagnosis of GDM is made. The complication to the mother includes;

  • Eye complication called retinopathy
  • Kidney failure
  • Risk of developing preeclampsia
  • Difficulty in breathing from too much baby water
  • Risk of forming blood clot in the veins
  • Risk of developing type 2 diabetes later in life
  • placenta previa

The complication to the baby includes;

  • Big baby
  • Restriction of the baby’s growth in the womb
  • Birth defect that can involve any body system; including hearing loss
  • Death of the baby in the womb
  • Nerve injury at birth due to big size of the baby

TREATMENT OF GESTATIONAL DIABETES

The treatment of a woman with GDM in based on blood sugar level and the presence or absence of complication of GDM. This can be achieved via lifestyle modification, dietary modification and use of medication. For some patient, subscribing to the dietician feeding plan helps to control the blood sugar. However, insulin is needed when the dietary or oral medication control is not maintaining the desired blood sugar control or when there is a complication.

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