A rationale approach to Gestational Diabetes Mellitus through Ayurveda - Case...

[Full title: A rationale approach to Gestational Diabetes Mellitus through Ayurveda - Case Series]

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[Find the meaning and references behind the names: Sri, Hassan, Deepthi, Mar, Gayathri, Good]

CASE REPORT Mar-Apr 2021 Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2021 | Vol. 6 | Issue 2 257 A rationale approach to Gestational Diabetes Mellitus through Ayurveda - Case Series Dr. Gayathri Bhat N.V. 1 , Dr. Deepthi G.B. 2 1 Professor & HOD, 2 Final Year Post Graduate Scholar, Dept of Prasutitantra and Streeroga, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, INDIA. I NTRODUCTION Diabetes is one of the common complications of pregnancy. Women can be classified into two categories - Pregestational/overt in whom diabetes is recognized before pregnancy and the other in whom diabetes is recognized in pregnancy [1] Gestational diabetes mellitus is defined as severe stages of Address for correspondence: Dr. Gayathri Bhat N.V. Professor & HOD, Dept of Prasutitantra and Streeroga, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, INDIA. E-mail: gaya 3 hassan@gmail.com Submission Date: 18/03/2021 Accepted Date: 07/04/2021 Access this article online Quick Response Code Website: www.jaims.in Published by Maharshi Charaka Ayurveda Organization, Vijayapur, Karnataka (Regd) under the license CCby-NC-SA glucose intolerance which first appears in pregnancy, because of physiological changes in glucose metabolism during pregnancy. Pregnancy causes a diabetogenic state because decreased sensitivity to the action of insulin due to the placental hormones such as cortisol, HPL, prolactin etc. and there is tissue insulin insensitivity [2] Insulin resistance is an impaired response to insulin that characterizes normal pregnancy. The physiologic result of insulin resistance is an increase of insulin secretion by the pancreatic β cells. The same metabolic changes characterize obesity, a well-known factor on the path of the metabolic syndrome to the end point of type 2 diabetes mellitus. Women with GDM are unable to increase insulin production to compensate for the increased insulin resistance. Insulin resistance and the relative insulin deficiency due to t he pancreatic β -cell deterioration are the primary metabolic changes in GDM, and same process occurs in prediabetes stages of type 2 diabetes mellitus. Gluconeogenesis is A B S T R A C T Introduction: Gestational diabetes mellitus results in stages of carbohydrate tolerance levels with its first onset during pregnancy. This happens due to the alterations in the glucose metabolism during pregnancy. The incidence of diabetes complicating pregnancy has increased approximately 40% from 1989-2004. The increasing prevalence of type-2 diabetes in pregnant younger women has led to adverse maternal complications and fetal mortality and morbidity. Methodology: Here is a case series of 3 primigravida patients admitted in the In-patient department of Prasuti Tantra & Stree Roga , SDM Hospital, Hassan, 2 of these patients in 2 nd trimester and 1 patient in 3 rd trimester with increased blood glucose levels first diagnosed during pregnancy. They were given Ahara , Vihara and Aushadha as per principals of Ayurveda, Nishamalaki tablet and Asanadhi Gana Kashaya was given in same quantity and duration. Regular diabetic chart was maintained in the In-patient department and alternative day blood sugar levels were measured. Discussion: The holistic approach of treating gestational diabetes mellitus with Ayurveda utilizing the concept given by Acharyas have shown good results in patients paving the way in controlling the blood sugar levels and preventing the complications caused by GDM on both mother and the fetus. There was reduction in the blood glucose levels and no complications were noticed during delivery. Hence here is an article regarding rationale approach to GDM through Ayurveda . Key words: Gestational Diabetes Mellitus, Ayurveda, Garbha Avastha Janya Prameha, Case Series.

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[Find the meaning and references behind the names: Main, Rasa, Ama, Medo]

Dr. Gayathri Bhat N.V. et al. A rationale approach to Gestational Diabetes Mellitus ISSN: 2456-3110 CASE REPORT Mar-Apr 2021 Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2021 | Vol. 6 | Issue 2 258 increased as a result of hepatic insulin resistance and relative insulin deficiency [3] Incidence and prevalence of gestational diabetes mellitus The prevalence of diabetes is increasing globally and India is no exception. The 1997 WHO estimates of the prevalence of diabetes in adults showed an expected total rise of > 120% from 135 million in 1995 to 300 million in 2025 [4] These numbers also include GDM, and should alert physicians to the need to direct special attention to this population, especially in developing countries. In 1995 the world had seen 118 million gestational diabetes mellitus and in 2010 it was 221 million. It was increased by 87%. In India 6.2 million live births are affected by hyperglycemia in pregnancy. Of which 5.9 million are due to gestational diabetes mellitus [3] The increasing prevalence of type-2 diabetes mellitus in general and in younger people in particular has led to an increasing number of pregnancies [5] with complications, adverse maternal effects including an increase in frequency of gestational hypertension and cesarean delivery [6] Pregnant lady who is obese, maternal age <30 yrs, with past history of GDM, family history of DM/GDM, history of PCOD, persistent glycosuria, a history of delivering a baby with birth weight >/= 4 kg, history of recurrent abortions, unexplained stillbirths, gestational hypertension should be screened for glucose during pregnancy. Glucose screening is done as a routine investigation during ANC visit, during first month the presence of glycosuria and elevated RBS levels are checked and if there is risk for GDM the glucose screening is done by OCGT (oral glucose challenge test) and GTT (glucose tolerance test) by oral intake of glucose and testing for the elevated blood glucose levels in the maternal blood and urine during 24-28 weeks of gestation Understanding of Gestational diabetes in Ayurveda Vyaadi Direct references of Garbhini Prameha (Gestational Diabetes Mellitus) is not described in Bruhat Trayee and Laghu Trayee . Scattered references are found in classics. Maternal nutrition plays an important role in fetal growth and development. Food taken by the Garbhini serves three main purposes; it helps in proper growth of the fetus, maintaining maternal health for her and for lactation after childbirth. By the proper Ahara Rasa, Raktadhatu produced from it indirectly forms the Apara (placenta) and from Rasadhatu Garbha Nabhi Nadi. [7-8] Hence the right diet is considered the most important factor . If the Garbhini Stree consumes more of Kapha Vardhaka Ahara, Ati Madhura Sevana without considering the quantity ( Matra ) and Agni [8] along with Viharas such as Adyashana, Diwasapna causes Atisantarpana state; it leads to Agni Dusti causing Ama Utpatti and there will be Uttarottara Dhatu Dusti , and causes Medha Dusti leading to Prameha and symptoms such as Prabhuta Avila Mutrata, Ksuda Atimatrata etc. Hence if there is any vitiation of Dosha or Abhighata during pregnancy, the same Bhaga Doshana occurs in Garbha has been explained (Medha Dusti creates Prameha in the mother and as well Medo Dusti in the Garbha. ) While explaining about Garbhopaghatakara Bhava, daily consumptions of Madhura Rasa lead to Premeha and Atisthulata of Garbha. [10] Lakshanas While describing the Lakshanas of Garbha Vrudhi, [11] “ Vivrudham Garbham Ati ” meaning Visheshena Vrudhi ; has been described which denotes the increase in the size of the body parts (macrosomia) and further adds that the labor becomes difficult in such cases [12] Chikitsa Siddhanta Acc to Kashyapa for Jwaradi Vyaadhis occurring in pregnancy, Sukshma Chikitsa has to be done with protection of the fetus and mainly Santarpana Chikitsa to be followed. The main principal treatment of Garbhini Paricharya explained in classics focuses on Santarpana in which Tridosha Shamaka Ahara, Vata Anulomaka and Kapha

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[Find the meaning and references behind the names: Sara, Mala, Asta, Shakti, Kala]

Dr. Gayathri Bhat N.V. et al. A rationale approach to Gestational Diabetes Mellitus ISSN: 2456-3110 CASE REPORT Mar-Apr 2021 Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2021 | Vol. 6 | Issue 2 259 predominant Ahara such as Madhura Rasa, Ksheera , has been advised which are Prithvi Mahabhuta predominant and helps in the growth of the Garbha. Garbhini should also consider her Agni status and consume food in proportionate quantity [9] (acc to Desha and Kala ). M ATERIALS AND M ETHODS Here is a case series of 3 Primipara patients presented in the inpatient department of Prasuti and Stree Roga of Sri Dharmasthala Manjunatheshwara Hospital, Hassan. Case 1 Case 2 Case 3 Primi Age - 28 yrs H/O Amenorrhea since 8 months C/O increased frequency of micturition since 15 days H/O past illness - K/C/O hypothyroidism (under medications) Family history - all are said to be healthy Admitted on 22/4/19 LMP - 27/8/18 EDD - 4/5/19 POG - 35 weeks 2 days Primi Age - 22 yrs H/O Amenorrhea since 6 months on ANC screening found to be increased blood sugar levels Family history - all are said to be healthy Admitted on 28/9/19 LMP - 6/4/020 EDD -13/1/020 POG - 26 weeks 2 days Primi Age - 26 yrs H/O Amenorrhea since 7 months Diagnosed with GDM since 4 months Family history - All are said to be healthy Admitted on 29/8/020 LMP - 15/2/020 EDD - 22/11/20 POG - 26 weeks 6 days Vayaktika Vrutanta Appetite - Increased Bowels - Normal Micturation - Increased in frequency Sleep - sound Vayaktika Vrutanta Appetite - Good Bowels - Regular Micturation - Increased in frequency Sleep - sound Vayaktika Vrutanta Appetite - Good Bowels - Regular Micturition - Increased in frequency Sleep - Sound Gynecological history M.C - Regular General examination G.C - Fair Wt - 71 kgs Ht - 152 cms BMI - 30.7 (obese class 1) Gynecological history M.C - Regular General examination G.C - Fair Wt - 62 kgs, Ht -155 BMI - 25 (overweight) Gynecological history M.C - Regular General examination G.C - Fair Wt - 82 kgs Ht - 172 cms BMI - 27.7 (overweight) Dashvidha Pareeksha Bhava Prakruti - Kapha Pitta Prakruti Vikruta - Kapha Pradana Tridosha Sara - Meda Sara Purusha Samhanana - Susamhita Satmya - Madhura Rasa Satmya Pramana - Supramanita Satwa - Madyama Ahara Shakti - Madhyama Vyayama Shakti - Avara Vaya - Yuvana Dashvidha Pareeksha Bhava Prakruti - Vata Pitta Prakruti Vikruta - Kapha Pradana Tridosha Sara - Rakta Sara Purusha Samhanana - Susamhita Satmya - Madhura Rasa Satmya Pramana - Supramanita Satwa - Madhyama Ahara Shakti - Madhyama Vyayama Shakti - Avara Vaya - Yuvana Dashvidha Pareeksha Bhava Prakruti - Kapha Vata Prakruti Vikruta - Kapha Pradana Tridosha Sara - Meda Sara Purusha Samhanana - Susamhita Satmya - Madhura Rasa Satmya Pramana - Supramanita Satwa - Avara Ahara Shakti - Madhyama Vyayama Shakti - Avara Vaya - Yuvana Asta Sthana Pareeksha Nadi - 94 bpm Mala - Prakrita Mutra - Increased in frequency Drik - Prakrita Akruti - Prakrita Sparsha - Prakrita Jihwa - Lipta Asta Sthana Pareeksha Nadi - 72 bpm Mala - Prakrita Mutra - Increased in frequency Drik - Prakrita Akruti - Prakrita Sparsha - Prakrita Jihwa - Alipta Asta Sthana Pareeksha Nadi - 76 bpm Mala - Prakrita Mutra - increased in frequency Drik - Prakrita Akruti - Prakrita Sparsha - Prakrita Jihwa - Lipta

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[Find the meaning and references behind the names: Kalpana, Rupa]

Dr. Gayathri Bhat N.V. et al. A rationale approach to Gestational Diabetes Mellitus ISSN: 2456-3110 CASE REPORT Mar-Apr 2021 Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2021 | Vol. 6 | Issue 2 260 Investigations On 22/4/19 FBS- 164.3 mg/dl FUStraces PpBS- 241.8 mg/dl PPUS- 0.5% Investigations On 28/9/19 FBS- 270 mg/dl FUS 1% PPBS-373 mg/dl PPUS- 1% Investigations On 24/08/020 FBS - 234 mg/dl FUS 1.5% PPBS - 309.9 mg/dl PPUS -2.0% Nidanas Due to excessive consumption of Atisantarpita Ahara , Adhika Madhura Rasa Sevana, Kapha Pradhana Ahara Sevena , Adyashana , Diwaswapna and other Kapha Prakopaka Ahara Vihara Sevana leads to Atisantarpana . Purvarupa : Shrama, Dourbalya. Rupa: Prabhuta Avila Mutrata Samprapti Ghatakas ▪ Dosha - Kapha Pradhana Tridosha ▪ Dushya - Rasa, Rakta, Mamsa, Meda ▪ Agni - Jataragni ▪ Ama - Jataragni Janya Ama ▪ Srotas - Medovaha Srotas ▪ Srotodusti - Atipravruti and Sangha ▪ Udbhava Stana – Ama Pakvashaya ▪ Vyakta Stana - Sarva Deha ▪ Rogamarga - Madhyama Roga Marga T REATMENT GIVEN Ahara - Diabetic Diet Timings Kalpana Quantity 8:30 AM Mudga Amalaka Yusha 300 ml 11.00 AM Methi Siddha Takra 250 ml 1.30 PM Yava Rotika + Veg Palya 2 quantity 4.00 PM Ragi Peya 300 ml 7.00 pm Veg soup / boiled vegetables 1 bowl Aushadha Medicines Dosage 1) T. Nishamalaki 1-0-1 Before food 2) Asanadi Gana Kashaya 3 tsp - 0 - 3 tsp Before food Along with regular ANC medications After Treatment: Report of the 3 cases after following Ahara , Aushadha and Vihara Investigations On 26/4/19 FBS - 104 mg/dl FUSabsent On 29/04/19 FBS - 158.6 mg/dl FUSabsent Investigations On 11/10/19 FBS - 148 mg/dl FUS traces PPBS - 181 mg/dl PPUStraces Investigations On 28/04/020 FBS - 191 mg/dl FUS 1% PPBS - 283 mg/dl PPUS-2.0% R ESULTS Case 1 Before Treatment After Treatment On 22/4/19 FBS - 164.3 mg/dl FUStraces On 26/4/19 FBS - 104 mg/dl FUSabsent Garbhini Prameha Medodusti Agni Dusti Ama Utpatti Ama of Rasa, Mamsa, Meda Atisantarpana Nidana Sevana by Garbhini Kapha Vardhaka Ahara Ati Madhura Sevana

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[Find the meaning and references behind the names: Dhanya, Anna, Vargas, Guru, Don]

Dr. Gayathri Bhat N.V. et al. A rationale approach to Gestational Diabetes Mellitus ISSN: 2456-3110 CASE REPORT Mar-Apr 2021 Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2021 | Vol. 6 | Issue 2 261 PPBS - 241.8 mg/dl PPUS - 0.5% On 29/04/19 FBS- 158.6 mg/dl FUSabsent Case 2 Before Treatment After Treatment On 28/9/19 FBS- 270 mg/dl FUS 1% PPBS - 373 mg/dl PPUS- 1% On 11/10/19 FBS - 148 mg/dl FUS traces PPBS - 181 mg/dl PPUStraces Case 3 Before Treatment After Treatment On 28/9/19 FBS - 270 mg/dl FUS 1% PPBS - 373 mg/dl PPUS- 1% On 28/04/20 FBS - 191 mg/dl FUS 1% PPBS - 283 mg/dl PPUS-2.0% There was marked decrease in the symptoms and laboratory investigation after following the Ahara , Vihara and Aushadhi principals as per Ayurveda . DISCUSSION Garbhini should be treated with utmost care, she has to be considered as the pot filled with oil and slight disturbance leads to spillage of the oil [13] Similarly slight alteration in Ahara , Vihara and Aushadha leads to complications of pregnancy. Management of Gasbhaavstajanya Prameha should be done by proper assessment of Dosha, Dushya, Agni, Prakruti , Kala , Vaya . The risk group should be identified as prior as in Pre-Conceptional period and proper Garbhadhana Samskara should be provided as per classics; [14] this is helpful in preventing gestational diabetes mellitus. Later on, proper Garbhini Paricharya with Do’s and Don’ts of the Garbhini should be followed. Prameha should be treated for pregnant and non-pregnant women on the same principles as explained in the classics. Careful management by protecting the Garbha and Garbhini treatment should be given [15] For proper development of Garbha , pregnant lady should take proper Hita Ahara and avoid Vidahi , Dwidala Anna , Guru Ahara , and Ati-Tarpana Ahara should be avoided as it hampers the glucose metabolism. Discussion on Ahara The proper Ahara consumed in proper manner helps in the proper growth of the body. On other side if taken in improper manner leads to various kinds of diseases. All types of diseases can be cured without any type of medicine by just following wholesome regimen. Whereas even hundreds of medicines cannot cure a disease in absence of wholesome regimen [16] An optimal diet for a pregnant woman with GDM provides adequate nutrition for fetal growth and maternal health while minimizing hyperglycemia and excessive weight gain. Carbohydrate containing foods have the greatest impact on postprandial blood glucose levels. Nevertheless, carbohydrate containing foods can be important sources of energy, vitamins, minerals, and fiber. It is recommended that women with GDM to consume at least 175 g of carbohydrate per day according to the Institute of Medicine Dietary Reference Intakes [17] A major focus of medical nutrition therapy for GDM is modifying both the carbohydrate content and type of the meal plan to achieve and maintain normoglycemia while ensuring that nutrient needs are met. Distributing the carbohydrate intake throughout the day in three small-to moderate meals and two to four food items are recommended. In Prameha , the Pathya recommended are Mantha , Amla , Masura, Mudga and similar Laghu Pathya. [18] Among Shaka Varga all vegetables except tubers are advised and in Dhanya Vargas Mudga , Methika is recommended and in Phala Varga fruits like Dadima, Amalaki , in Mamsa Rasa Jangala Mamsa is recommended [19] Food items that contain greater than 5 g of carbohydrate per serving (such as fruits, milk, grain products, starchy vegetables, and concentrated sweets) have the potential to increase blood glucose levels [20] Here for the 3 patients the diabetic diet was planned and given timely. For morning breakfast Yusha

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[Find the meaning and references behind the names: Guna, Long, Nisha, Pala, Atta, Green]

Dr. Gayathri Bhat N.V. et al. A rationale approach to Gestational Diabetes Mellitus ISSN: 2456-3110 CASE REPORT Mar-Apr 2021 Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2021 | Vol. 6 | Issue 2 262 prepared with Mudga and Amalaki is given. Acharya Shrangdhar described the Yusha recipe as one Pala of Dravya (like Kulatha, Mudga ) mixed with half Karsha of Shunthi and Pippali Churna and boiled in one Prastha or 16 times of water [21] Mudga (Green gram) - Mudga is the best among Shimbhi Dhanya . It is rich in iron (3.9 mg/100 gm) and potassium (1150 mg/100 gm). Mudga is best among pulses utilized in the form of soup [22] Many pulses have Kaphamedohara property and is considered as Pathya in Prameha . Amalaki alleviates Tridoshas and specially normalizes Pitta Dosha . Vagbhata describes Amalaki as the best drug for Prameha (diabetes) along with Haldi (turmeric). It is very rich in Vitamin C and contains many minerals and vitamins like Calcium, Phosphorus, Iron, Carotene and Vitamin B Complex. Amalaki is also a powerful antioxidant and acts as an Antiagening agent [23] Later at 11.00 am Methi Siddha Takra was given. Methika is pungent, Laghu (light), Snigdha (unctuous) in nature, and hot in potency, best Vatashamaka and can be indicated in Vataja Prameha , including Madhumeha . Leaves, seeds, are common ingredients of daily Indian diet. It is found to have hypoglycemic, hypocholesterolemic property on pharmacologic screening. 25 Clinical studies carried out on Methika (fenugreek) seed powder in the dose of 9 g/day for 3 months, shown significant decrease in blood sugar levels, serum cholesterol, and triglyceride values [24-25] For lunch Yava Rothika was prepared and given. Yava (Barley), which is high in fiber content (4 g in 100 g) among all relative grains, is highly recommended in Diabetic diet in different forms. Ruksha (dry) and Kaphashamak (pacifies vitiated Kapha ) properties of Yava support its role on Diabetes. Use of the mixture of whole Atta of barley and wheat is considered Kaphashamak and is recommended for diabetics. Many recent researches also proved its efficacy in diabetes. Hence, found especially suitable cereal for diabetes mellitus [27] Evening at 4.00 pm Ragi Peya was given. Ragi ( Eleusine coracana ) is a minor millet utilized by the economically weaker section of the population specifically with the aid of south India rural folk. The administration of Peya after main treatment procedure helps to achieve Agni Deepana and Vata Anulomana as well as sustaining the effect of treatment. Discussion of Aushadha The three pts were administered Nishamalki tablets and Asnadi Gana Kashaya . Here Nishamalaki is a compound formulation of Nisha and Amalaki is termed as “ Nishamalaki and is recommended in Ayurvedic classics, proven efficacious and widely practiced in the management (treatment, prevention of complications) of Madhumeha . Nishamalaki is helpful for attenuation of hyperglycemia like insulin mimetic property, enhancement of peripheral tissue glucose uptake, improvement of insulin sensitivity, regulation (reduction) of Hepatic glucose production, regulation of glucose production by kidneys etc. in acute control of blood sugars as well as control of blood sugars upon long term administration along with prevention of diabetic complications (microvascular and macrovascular) apart from merely controlling hyperglycemia by many mechanisms like antioxidant property, improvement in Insulin sensitivity etc [28-29] Asanadi Gana Kashaya : it contains drugs such as Asana (Pterocarpus marsipium), Tinisha (Ogenia dalburgirides), Bhurja (Betula utilis), Meshashrungi (Gymnema selvestris), Daruharidra (Berberis Aristata). All these drugs are Kashaya Rasa , Laghu Ruksha Guna , Sheeta Virya and Katu Vipaka indicated in Prameha , Medo Roga [30] This Kashaya was administered 3 tsp three times a day before food. CONCLUSION The holistic approach of treating Gestational Diabetes Mellitus with Ayurveda utilizing the concept given by Acharyas have shown good results in patients paving the way in controlling the blood sugar levels and preventing the complications caused by GDM for reducing maternal mortality and morbidity rate.

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[Find the meaning and references behind the names: Ali, Dennis, Sharma, Ben, Govind, Avi, Ayu, Jain, William, Balaji, Rao, Med, Naik, Prakashan, Mishra, Moshe]

Dr. Gayathri Bhat N.V. et al. A rationale approach to Gestational Diabetes Mellitus ISSN: 2456-3110 CASE REPORT Mar-Apr 2021 Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2021 | Vol. 6 | Issue 2 263 REFERENCES 1 Cunningham, F. G., Leveno, K. J., Bloom, S. L., Spong, C. Y., Dashe, J. S., Hoffman, B. L., Sheffield, J. S. William’s Obstetrics, 24 th edition. New York: McGraw-Hill Education diabetes, 2014. 2 DC Dutta's Textbook of Obstetrics. 7 th ed. New Delhi: Jaypee Brothers Medical Publishers, 2013;p.294-301. 3 Reece EA, Leguizamon G, Wiznitzer A: Gestational diabetes: the need for a common ground. Lancet 2009, 373:1789 – 1797.) 4 Avi Ben-Haroush, Yariv Yogev, Moshe Hod. Epidemiology of gestational diabetes mellitus. Textbook of Diabetes and Pregnancy. 2003:85-6. 5 Van Assche FA, Holemans K, Aerts L. Long term consequences for offspring of diabetes during pregnancy. Br Med Bull 2001;60:173-82. 6 Seshiah V, Balaji V, Balaji MS, Sanjeevi CB, Green A. Gestational diabetes mellitus in India. Japi. 2004 Sep 21;52(9):707-11. 7 Kowsalya RG, Jain A, Naik AD S. Significance of Rasayana Dravyas for Garbha Poshana- A review. J Ayu Herb Med 2020;6(1):37-3) 8 Vaidya Jadavji Trikamji Acarya (Ed.), Sushruta, Sushruta Samhita with the Nibandhasangraha Commentary of Sri Dalhanacharya, Eight edition, Chaukhamba Orientalia, Varanasi. 2009;p.357 9 Jadavaji Trikamji Aacharya (Ed.), Charaka, Charaka Samhita. Sutra Sthana, Cha.5, Matrashitiyam Adhyaya. 1 st ed. Varanasi: Krishnadas Academy;2000. p.24 10 Jadavaji Trikamji Aacharya (Ed.), Charaka, Charaka Samhita. Shareera Sthana, Cha.8 Jatisutriya Adhyaya. 1 st ed. Varanasi: Krishnadas Academy;2000. p.1-24 11 Jadavaji Trikamji Aacharya (Ed.), Dalhana, Sushruta, Sushruta Samhita, Sutra Sthana, Cha.14, Doshadhatumalakshayavrudhivijnaneeya Adhyaya, Verse 16. 8 th ed. Varanasi: Chaukhambha Orientalia;2005;p.1. 12 P. V. Tewari (Ed.), Kashyapa. Kashyapa Samhita. Khilasthana 10, Reprint Edition, Varanasi: Chaukhambha Vishvabharati;2008;p.575. 13 Jadavaji Trikamji Aacharya (Ed.), Charaka, Charaka Samhita. Shareera Sthana, Cha.8, Jateesutriya Adhyaya. verse 22, 1 st ed. Varanasi: Krishnadas Academy;2000. 14 Jadavaji Trikamji Aacharya (Ed.), Dalhana, Sushruta. Sushruta Samhita. Shareera Sthana, Cha.3 Garbhavakranti Adhyaya, verse 4. 8 th ed. Varanasi: Chaukhambha Orientalia;2005. 15 P. V. Tewari (Ed.), Kashyapa. Kashyapa Samhita. Khilasthana, Reprint Ed. Varanasi: Chaukhambha Vishvabharati;2008. 16 Dr. Mangalagowri Rao, Text Book of Swasthavritta, chapter no. 8, Chaukhamba Orientalia, Varanasi, 2014;p.79 17 Ali HI, Jarrar AH, El Sadig M, Yeatts KB. Diet and carbohydrate food knowledge of multi-ethnic women: a comparative analysis of pregnant women with and without gestational diabetes mellitus. PLoS One. 2013 Sep 12;8(9):e 73486.) 18 Kaviraj Govind Das Sen. Bhaisajya Ratnavali, edited by Mishra S, Shodhana-Marana-Gunadi Prakaranama: Chapter 21, Verse 97-102. Reprint ed. Chaukhamba Surbharati Prakashan, Varanasi, 2013:p.42-43. 19 Yadavji Thrikamji Acharya, Ashtanga Hridaya, Uttarasthana 40/48, Chaukhambha Surbharti Prakashan, 2013. 20 Gunderson EP (1997) Intensive nutrition therapy for gestational diabetes. Rationale and current issues. Diabetes Care 20: 221 – 226). 21 Sharangdhar Samhita, Dipika Hindi commentary by Brahmanand Tripathi, Choukhambha Sanskrit Bhawan, Varanasi, Madhyama khanda 2/154, 2011.) 22 Nishteswar K. Ayurvedic Concept of Food and Nutrition. J Nutrition Food Science, 2016; (6)46: 530. doi:10.4172/2155-9600.1000530 23 Bagde A, Ramteke A, Nimbalkar M, Tirpude S. NITYA SEVANIYA AAHARA (WHOLESOME DAILY FOOD) IN AYURVEDA – REVIEW ARTICLE.) 24 Sharama PV. Dravyaguna Vignana. Vol. 2. Varanasi: Chaukhambha Bharati Academy; 2005. p. 824; 684; 70; 363-4; 72-3. 25 Sharma PC, Yelne MB, Dennis TJ. Database on Medicinal plants. Vol. 4.New delhi, CCRAS Publication; 2002. p. 407; 291 26 Belguith-Hadriche O, Bouaziz M, Jamoussi K, El Feki A, Sayadi S, Makni-Ayedi F. Lipid-lowering and antioxidant effects of an ethyl acetate extract of fenugreek seeds

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[Find the meaning and references behind the names: Singh, Gupta, Nil]

Dr. Gayathri Bhat N.V. et al. A rationale approach to Gestational Diabetes Mellitus ISSN: 2456-3110 CASE REPORT Mar-Apr 2021 Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2021 | Vol. 6 | Issue 2 264 in high-cholesterol-fed rats. J Agric Food Chem 2010;58:2116-22 27 Shukla K, Narain JP, Puri P, Gupta A, Bijlani RL, Mahapatra SC, et al. Glycaemic response to maize, bajra and barley. Indian J Physiol Pharmacol 1991;35:249-54. 11. Shukla K, Narain JP, Puri P, Gupta A, Bijlani RL, Mahapatra SC, et al. Glycaemic response to maize, bajra and barley. Indian J Physiol Pharmacol 1991;35:249-54. 28 R H Singh. Charak Samhita of Agnivesha. Chawkhambha Surabharati Prakashana, Varanasi, 1 st edition, reprint, 2011; 2: 1042. 2. Narayanram. Sushrut Samhita. Chawkhambha Surabharati Prakashana, Varanasi, 2014; 452.) 29 Bedarkar PB, Ranpara N, Sawaliya V, Nariya MB, Prajapati PK, Patgiri B. Antihyperglycemic activity of Nishamalaki-An Ayurvedic formulation of Turmeric and Emblica officinalis. EJBPS. 2017;4(9):853-6. 30 Amrutha BS, Padmasaritha K. Ayurvedic Management of Gestational Diabetes Mellitus-A Case Study. Journal of Ayurveda and Integrated Medical Sciences (ISSN 2456-3110). 2020 Jul 8;5(3):176-9. ******************************* How to cite this article: Dr. Gayathri Bhat N.V., Dr. Deepthi G.B. A rationale approach to Gestational Diabetes Mellitus through Ayurveda - Case Series. J Ayurveda Integr Med Sci 2021;2:257-264. Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2021 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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