Gestational diabetes is a type of diabetes that develops during pregnancy. It occurs when a woman’s body is unable to produce enough insulin to regulate her blood sugar levels. This condition affects around 2-10% of pregnant women. While most pregnant women experience some degree of insulin resistance, gestational diabetes is diagnosed when blood sugar levels are higher than normal.
The exact cause of gestational diabetes is still unknown, but there are several risk factors that can increase a woman’s likelihood of developing the condition. These include being overweight or obese, having a family history of diabetes, previous history of gestational diabetes, and being older than 25 years old. Hormonal changes that occur during pregnancy can also contribute to insulin resistance, leading to gestational diabetes.
Symptoms of gestational diabetes can vary, but they may include increased thirst, frequent urination, fatigue, and blurred vision. Some women may not experience any symptoms at all, which is why it is important to have regular prenatal check-ups and blood sugar screenings during pregnancy. If left untreated, gestational diabetes can lead to complications for both the mother and the baby.
The good news is that gestational diabetes can be managed with diet, exercise, and medication if necessary. A healthy diet that is low in sugar and carbohydrates can help regulate blood sugar levels. Regular physical activity, such as walking or swimming, can also help improve insulin sensitivity. In some cases, insulin injections may be needed to keep blood sugar levels under control. With proper management, most women with gestational diabetes are able to have healthy pregnancies and deliver healthy babies.
In conclusion, gestational diabetes is a common condition that affects pregnant women. While the exact cause is unknown, there are several risk factors that can increase a woman’s chances of developing the condition. It is important for pregnant women to be aware of the symptoms and to receive regular prenatal care to ensure the health of both themselves and their babies. With proper management, gestational diabetes can be controlled, and most women can have successful pregnancies.
Overview of Gestational Diabetes
Gestational diabetes is a form of diabetes that occurs during pregnancy. Diagnosed between the 24th and 28th weeks of gestation, it affects approximately 5% to 10% of pregnant women. Unlike other types of diabetes mellitus, gestational diabetes usually resolves after childbirth.
During pregnancy, the body releases a hormone called insulin, which regulates blood sugar levels. However, in some cases, the body’s insulin production cannot keep up with the increased demands of pregnancy, leading to gestational diabetes.
Women with gestational diabetes may experience symptoms such as frequent urination, excessive thirst, and fatigue. However, these symptoms are often mild and easily dismissed as normal pregnancy discomforts.
Managing gestational diabetes involves careful monitoring of blood glucose levels and making healthy lifestyle choices. This includes following a balanced diet, engaging in regular physical activity, and sometimes using insulin or other medications as prescribed by a healthcare provider.
Gestational diabetes can increase the risk of complications during pregnancy and childbirth, including high blood pressure, preeclampsia, and the need for a cesarean delivery. It can also impact the baby’s health, increasing the likelihood of macrosomia (a large birth weight), hypoglycemia (low blood sugar), and an increased risk of developing type 2 diabetes later in life.
With proper management and monitoring, most women with gestational diabetes are able to have a healthy pregnancy and delivery. However, it is important to work closely with a healthcare provider to ensure the best possible outcomes for both the mother and the baby.
Overall, gestational diabetes is a temporary condition that requires careful attention and management during pregnancy. By staying informed and proactive, women with gestational diabetes can minimize the potential risks and ensure a healthy start for their newborn.
Risk Factors for Gestational Diabetes
Gestational diabetes mellitus is a condition that develops during pregnancy and affects the way a woman’s body processes glucose. While the exact cause of gestational diabetes is unknown, there are several risk factors that can increase a woman’s likelihood of developing the condition.
Family History
A family history of gestational diabetes or type 2 diabetes can increase the risk of developing gestational diabetes during pregnancy. If your mother, father, or siblings have a history of these conditions, it is important to be aware of the increased risk and take appropriate measures to manage your blood sugar levels.
Obesity
Being overweight or obese before pregnancy can also increase the risk of developing gestational diabetes. Excess weight puts added stress on the body’s ability to use insulin effectively, leading to higher blood sugar levels. Maintaining a healthy weight and adopting a balanced diet and regular exercise routine can help reduce the risk.
Age
Women who are older than 25 years have a higher risk of developing gestational diabetes compared to younger women. As a woman ages, her body’s ability to use insulin effectively may decline, increasing the likelihood of developing gestational diabetes.
Other risk factors for gestational diabetes include a history of polycystic ovary syndrome (PCOS), previous gestational diabetes during a past pregnancy, and a previous delivery of a baby weighing more than 9 pounds (4.1 kilograms).
It is important for women who have one or more of these risk factors to work closely with their healthcare provider during pregnancy to monitor blood sugar levels and manage gestational diabetes effectively. By taking the necessary precautions and following the recommended treatment plan, women with gestational diabetes can successfully manage their condition and have healthy pregnancies and babies.
Causes of Gestational Diabetes
Gestational diabetes mellitus (GDM) is caused by hormonal changes that occur during pregnancy. These hormonal changes can make it harder for the body to use insulin effectively, resulting in high blood sugar levels.
During pregnancy, the placenta produces hormones that help the baby develop and grow. However, these hormones can also interfere with the action of insulin, a hormone that regulates blood sugar levels. As a result, the insulin resistance increases, leading to gestational diabetes.
Other factors that can contribute to the development of gestational diabetes include:
- Being overweight or obese before pregnancy
- A family history of diabetes
- Prediabetes or glucose intolerance
- Previous history of giving birth to a baby weighing more than 9 pounds
- Being older than 25 years
- Having polycystic ovary syndrome (PCOS)
While these factors increase the risk of developing gestational diabetes, it is important to note that any pregnant woman can develop the condition regardless of her risk factors.
If you have been diagnosed with gestational diabetes, it is important to work closely with your healthcare team to manage your blood sugar levels and ensure the health of both you and your baby.
Impact of Gestational Diabetes on Pregnancy
Gestational diabetes mellitus (GDM) is a type of diabetes that develops during pregnancy. It is characterized by high blood sugar levels and impaired glucose tolerance. GDM can have various effects on both the mother and the baby during pregnancy.
Effects on the mother:
- Increased risk of high blood pressure and preeclampsia
- Increased risk of developing type 2 diabetes later in life
- Higher likelihood of requiring a cesarean section
- Infections, such as urinary tract infections and yeast infections, may be more common
- Increased risk of gestational hypertension
Effects on the baby:
- Macrosomia (large birth weight), which can make delivery difficult
- Increased risk of birth injuries, such as shoulder dystocia
- Higher likelihood of developing obesity and type 2 diabetes later in life
- In some cases, the baby may require treatment for low blood sugar levels after birth
- Increased risk of respiratory distress syndrome
Proper management of gestational diabetes is important to minimize these risks. This may include monitoring blood sugar levels, following a balanced diet, engaging in regular physical activity, and in some cases, using insulin or other medications to control blood sugar levels. Regular prenatal check-ups are also necessary to monitor the health of both the mother and the baby.
It is important for pregnant women to work closely with their healthcare provider to effectively manage gestational diabetes and reduce the potential impact on the pregnancy. With appropriate management and care, women with gestational diabetes can have healthy pregnancies and deliver healthy babies.
Common Symptoms of Gestational Diabetes
Gestational diabetes mellitus, or GDM, is a type of diabetes that occurs during pregnancy. While many women may not experience any symptoms, some common signs of gestational diabetes include:
- Excessive thirst
- Frequent urination
- Unexplained weight loss or gain
- Constant fatigue
- Nausea or vomiting
- Frequent infections, such as urinary tract infections or yeast infections
- Blurred vision
- Slow-healing cuts or sores
- Tingling or numbness in the hands or feet
If you are experiencing any of these symptoms during pregnancy, it is important to consult with your healthcare provider. They can perform tests to diagnose gestational diabetes and develop a management plan to ensure the health of both you and your baby.
Diagnosing Gestational Diabetes
Gestational diabetes mellitus (GDM) is a condition that occurs during pregnancy when a woman develops high blood sugar levels. It is important to diagnose GDM as early as possible to prevent complications for both the mother and the baby.
The diagnosis of gestational diabetes usually involves a glucose challenge test (GCT) and a follow-up oral glucose tolerance test (OGTT). During the GCT, the woman is given a sugary drink and her blood sugar levels are measured after one hour. If her blood sugar levels are higher than normal, she will need to undergo the OGTT.
The OGTT is a more thorough test that involves fasting for at least eight hours before blood samples are taken. The woman will then be given a sugary drink and have her blood sugar levels measured at different intervals over a three-hour period.
If the woman’s blood sugar levels are higher than normal during the GCT or OGTT, she will be diagnosed with gestational diabetes. It is important for women who are diagnosed with GDM to work closely with their healthcare team to manage their blood sugar levels through diet, exercise, and possibly medication.
Regular monitoring of blood sugar levels throughout the pregnancy is also essential to ensure the health of both the mother and the baby. With proper diagnosis and management, women with gestational diabetes can have a healthy pregnancy and delivery.
Management of Gestational Diabetes
Gestational diabetes mellitus (GDM) is a condition that occurs during pregnancy and is characterized by high blood sugar levels. It is important for women with GDM to closely manage their condition to ensure a healthy pregnancy and minimize risks to both the mother and baby.
Diet and exercise play a key role in the management of gestational diabetes. It is important for women with GDM to eat a well-balanced diet that includes complex carbohydrates, lean proteins, and healthy fats. Regular physical activity, such as walking or swimming, can help regulate blood sugar levels and promote overall health during pregnancy.
In some cases, medication may be necessary to manage gestational diabetes. Insulin is the most common medication used, as it helps regulate blood sugar levels. Women with GDM should work closely with their healthcare provider to determine the appropriate medication and dosage.
Regular monitoring of blood sugar levels is essential for managing gestational diabetes. Women with GDM may need to check their blood sugar levels several times a day using a glucose meter. This helps determine if blood sugar levels are within the target range and allows for adjustments to diet, exercise, or medication if needed.
Regular prenatal care is crucial for women with gestational diabetes. Healthcare providers will monitor the progress of both the mother and baby, and provide guidance on managing the condition. This may include adjusting medication dosages, making dietary changes, or recommending additional tests or screenings.
Managing gestational diabetes is important for the health and well-being of both the mother and baby. By following a healthy diet, maintaining regular physical activity, monitoring blood sugar levels, and receiving proper prenatal care, women with GDM can successfully manage their condition and have a healthy pregnancy.
Dietary Recommendations for Gestational Diabetes
During pregnancy, women with gestational diabetes mellitus need to pay extra attention to their diet to manage their condition. By following certain dietary recommendations, women can help control their blood sugar levels and promote a healthy pregnancy.
Here are some important dietary guidelines for women with gestational diabetes:
- Monitor carbohydrate intake: It is important to keep track of the amount and type of carbohydrates consumed. Avoiding sugary foods and opting for complex carbohydrates, such as whole grains, fruits, and vegetables, can help maintain blood sugar levels.
- Include lean proteins: Including lean proteins, such as chicken, fish, tofu, and legumes, in meals can help provide essential nutrients and help with blood sugar control.
- Eat regular meals and snacks: Spreading out meals and snacks throughout the day can prevent blood sugar spikes. Aim to have three meals and two to three snacks per day.
- Avoid skipping meals: Skipping meals can lead to low blood sugar levels, which can be harmful to both the mother and the baby. It is important to have regular meals to keep blood sugar levels stable.
- Choose healthy fats: Opt for sources of healthy fats, such as avocados, nuts, and olive oil, over saturated and trans fats. These fats provide important nutrients and can help improve insulin sensitivity.
- Limit sugary beverages: Sugary drinks can quickly raise blood sugar levels. It is best to replace sugary beverages with water, unsweetened tea, or sparkling water with a squeeze of lemon or lime.
- Stay hydrated: Drinking plenty of water throughout the day can help maintain proper hydration and support overall health.
- Consult with a registered dietitian: A registered dietitian specializing in gestational diabetes can help create an individualized meal plan that meets specific nutritional needs.
It is important for women with gestational diabetes to follow these dietary recommendations to ensure a healthy pregnancy and minimize the risk of complications.
Importance of Regular Exercise
Gestational diabetes mellitus (GDM) is a type of diabetes that occurs during pregnancy. It affects approximately 7% of all pregnancies and can have serious health implications for both the mother and the baby. One of the most effective ways to manage gestational diabetes is through regular exercise.
Regular physical activity plays a crucial role in managing gestational diabetes. It helps lower blood sugar levels, improve insulin sensitivity, and control weight gain during pregnancy. Exercise also helps to reduce the risk of complications such as preeclampsia and cesarean delivery.
Benefits of Regular Exercise for Women with Gestational Diabetes
Regular exercise provides numerous benefits for women with gestational diabetes. It can:
- Control blood sugar levels: Physical activity helps to lower blood sugar levels by increasing insulin sensitivity and helping the body use glucose effectively. This can reduce the need for insulin medication and help to manage gestational diabetes.
- Manage weight gain: Pregnancy often leads to weight gain, which can increase the risk of complications for women with gestational diabetes. Regular exercise helps to control weight gain, maintain a healthy body weight, and reduce the risk of complications.
- Boost mood and energy levels: Pregnancy can sometimes be emotionally and physically challenging. Regular exercise releases endorphins, which are natural mood boosters, and can help reduce fatigue and increase energy levels.
Safe and Effective Exercises for Women with Gestational Diabetes
It is important for women with gestational diabetes to consult with their healthcare provider before starting any exercise routine. However, some safe and effective exercises for women with gestational diabetes include:
- Walking: Walking is a low-impact exercise that can be done at any stage of pregnancy. It helps to improve cardiovascular health, control blood sugar levels, and maintain a healthy weight.
- Swimming: Swimming is a great option for pregnant women as it provides a full-body workout without putting pressure on the joints. It can help improve cardiovascular fitness, muscle tone, and overall strength.
- Prenatal yoga: Prenatal yoga focuses on gentle stretches, relaxation, and breathing exercises. It can help improve flexibility, reduce stress, and promote overall well-being during pregnancy.
- Strength training: Light strength training exercises, under the guidance of a qualified professional, can help maintain muscle tone, improve strength, and support overall fitness during pregnancy.
In conclusion, regular exercise is of utmost importance for women with gestational diabetes. It helps to control blood sugar levels, manage weight gain, and improve overall well-being during pregnancy. However, it is important to consult with a healthcare provider before beginning any exercise routine to ensure it is safe and appropriate for individual circumstances.
Monitoring Blood Sugar Levels
During pregnancy, it is important for women with gestational diabetes to monitor their blood sugar levels regularly. This helps to ensure that blood sugar levels remain within a healthy range and helps to prevent complications.
Self-Monitoring
One of the key approaches to monitoring blood sugar levels is through self-monitoring. This involves using a small device called a glucometer to measure blood sugar levels at home.
Women with gestational diabetes are usually advised to check their blood sugar levels several times a day, typically before meals and after meals. This allows them to track how their blood sugar levels fluctuate throughout the day and make any necessary adjustments to their diet or medication.
Continuous Glucose Monitoring
In some cases, a healthcare provider may recommend the use of a continuous glucose monitor (CGM). This device measures blood sugar levels automatically throughout the day and provides real-time data.
CGM can be particularly helpful for women who have difficulty maintaining stable blood sugar levels or who experience frequent fluctuations.
Women with gestational diabetes should work closely with their healthcare provider to determine the most appropriate method of monitoring blood sugar levels for their specific situation. Regular monitoring, along with appropriate dietary changes and medication if necessary, can greatly improve management of gestational diabetes and reduce the risk of complications.
Insulin Therapy for Gestational Diabetes
Gestational diabetes mellitus (GDM) is a condition that develops during pregnancy and is characterized by high blood sugar levels. It can lead to complications for both the mother and the baby if not properly managed.
One of the main treatment options for gestational diabetes is insulin therapy. Insulin is a hormone that helps regulate blood sugar levels. In the case of gestational diabetes, insulin therapy is used to control blood sugar levels and prevent complications.
Insulin therapy involves injecting insulin into the body. This can be done using a syringe or an insulin pen. The injection is usually given subcutaneously, which means it is injected into the fatty tissue just under the skin.
When is Insulin Therapy Recommended?
Insulin therapy for gestational diabetes is typically recommended if blood sugar levels cannot be controlled through diet and exercise alone. It may also be recommended if blood sugar levels remain elevated despite using oral medications.
Additionally, insulin therapy may be recommended if there are concerns about the baby’s growth and development or if other complications arise during pregnancy.
How is Insulin Therapy Managed?
Managing insulin therapy for gestational diabetes involves regularly monitoring blood sugar levels and adjusting insulin doses as needed. This typically involves checking blood sugar levels multiple times a day, such as before meals and at bedtime.
The insulin doses will be adjusted based on the blood sugar levels and individual needs. The healthcare provider will determine the appropriate insulin regimen and dosage for each individual.
It is important for women with gestational diabetes to work closely with their healthcare providers to ensure that their blood sugar levels are well-controlled. This may involve making dietary changes, getting regular exercise, and closely monitoring blood sugar levels.
Overall, insulin therapy is an effective treatment option for managing gestational diabetes. It helps to control blood sugar levels and reduce the risk of complications for both the mother and the baby.
Complications Associated with Gestational Diabetes
Gestational diabetes is a type of diabetes that occurs during pregnancy. It is caused by hormonal changes that affect how the body uses insulin, resulting in high blood sugar levels. While gestational diabetes typically goes away after pregnancy, it can have several complications that affect both the mother and the baby.
Complications for the Mother:
- Increased risk of preeclampsia: Women with gestational diabetes have a higher risk of developing preeclampsia, which is a condition characterized by high blood pressure and damage to organs such as the liver and kidneys.
- Higher chance of cesarean section: Gestational diabetes increases the likelihood of needing a cesarean section delivery due to concerns about the baby’s size or other complications during labor.
- Risk of developing type 2 diabetes: Women who have had gestational diabetes are at an increased risk of developing type 2 diabetes later in life. It is important for them to maintain a healthy lifestyle and monitor their blood sugar levels regularly.
Complications for the Baby:
- Macrosomia: Babies of mothers with gestational diabetes are at risk of being larger than average, a condition known as macrosomia. This can make vaginal delivery difficult and increase the risk of birth injuries.
- Hypoglycemia: Babies born to mothers with gestational diabetes may experience low blood sugar levels after birth. This can lead to jitteriness, seizures, and other complications if not promptly treated.
- Respiratory distress syndrome: Babies born to mothers with gestational diabetes may have immature lungs, resulting in respiratory distress syndrome. They may require extra care and monitoring in the neonatal intensive care unit.
Managing gestational diabetes through proper diet, regular exercise, and monitoring blood sugar levels can help reduce the risk of complications for both the mother and the baby. It is essential for pregnant women to work closely with their healthcare team to ensure a healthy pregnancy and delivery.
Preventing Gestational Diabetes in Future Pregnancies
Gestational diabetes mellitus (GDM) is a condition that affects pregnant women, causing high blood sugar levels during pregnancy. If you have been diagnosed with GDM during your pregnancy, it is important to take steps to prevent it in future pregnancies.
Understand the Risk Factors
To prevent gestational diabetes in future pregnancies, it is crucial to understand the risk factors associated with the condition. These include:
– Previous history of gestational diabetes
– Family history of diabetes
– Being overweight or obese
– Polycystic ovary syndrome
– Age (being older than 25 years)
– Ethnicity (certain ethnic groups are more prone to developing gestational diabetes)
Lifestyle Changes
Adopting a healthy lifestyle is key to preventing gestational diabetes in future pregnancies. Here are some important steps to consider:
– Maintain a healthy weight before and during pregnancy
– Follow a balanced diet rich in fruits, vegetables, whole grains, and lean proteins
– Limit your intake of sugary drinks and processed foods
– Engage in regular physical activity, such as walking or swimming, with your healthcare provider’s approval
Additionally, it is important to manage any pre-existing medical conditions, such as polycystic ovary syndrome or obesity, before getting pregnant again. Talk to your healthcare provider about the best ways to manage these conditions and reduce the risk of gestational diabetes.
Remember, preventing gestational diabetes in future pregnancies requires proactive steps to maintain a healthy lifestyle and manage any underlying risk factors.
Effects on the Baby
Gestational diabetes is a condition that affects pregnant women, causing high blood sugar levels. This condition can have significant effects on the baby’s health and development.
Increased Birth Weight
Babies born to mothers with gestational diabetes are more likely to have a higher birth weight compared to babies born to mothers without the condition. This is because the excess glucose in the mother’s blood crosses the placenta and is transferred to the baby. The baby’s pancreas then produces more insulin to process the glucose, resulting in increased growth and weight.
Hypoglycemia
After birth, babies of mothers with gestational diabetes may experience low blood sugar levels, known as hypoglycemia. This is because the baby’s body continues to produce high levels of insulin to process glucose, even without the excess glucose from the mother. Symptoms of hypoglycemia in babies include shakiness, difficulty feeding, irritability, and in severe cases, seizures.
It is important for healthcare providers to closely monitor the baby’s blood glucose levels after birth and provide any necessary treatment to prevent complications from hypoglycemia.
Type 2 Diabetes Risk
Babies born to mothers with gestational diabetes also have an increased risk of developing type 2 diabetes later in life. This is because they have been exposed to high blood sugar levels during the pregnancy, which can affect their glucose metabolism and insulin production. It’s important for these children to maintain a healthy lifestyle and be regularly screened for diabetes as they grow up.
In conclusion, gestational diabetes can have various effects on the baby, including increased birth weight, hypoglycemia, and an increased risk of developing type 2 diabetes. By managing blood sugar levels during pregnancy, women with gestational diabetes can help minimize these risks and ensure the health and well-being of their babies.
Long-Term Effects on the Mother
During pregnancy, some women develop a condition known as gestational diabetes mellitus (GDM). This type of diabetes occurs when the body is unable to properly regulate blood sugar levels during pregnancy. While GDM typically goes away after delivery, it can have significant long-term effects on the mother’s health.
Risk of Developing Type 2 Diabetes
Women who have had gestational diabetes are at a higher risk of developing type 2 diabetes later in life. Research shows that about 50-70% of women with GDM will develop type 2 diabetes within the next 5-10 years. This risk can be decreased with a healthy lifestyle that includes regular exercise, a balanced diet, and weight management.
Cardiovascular Disease
Gestational diabetes is also associated with an increased risk of developing cardiovascular diseases later in life. Women who have had GDM are more likely to develop high blood pressure, elevated cholesterol levels, and an increased risk of heart attacks and strokes. Regular check-ups, managing weight, and adopting heart-healthy habits can help reduce the risk of cardiovascular disease.
Diabetes Prevention Strategies
Women who have had gestational diabetes can take several steps to reduce their risk of developing type 2 diabetes and minimize the long-term effects. These strategies include:
- Following a balanced diet rich in fruits, vegetables, whole grains, and lean proteins.
- Engaging in regular physical activity, such as brisk walking or swimming, for at least 30 minutes a day.
- Maintaining a healthy weight through a combination of diet and exercise.
- Monitoring blood sugar levels regularly.
- Quitting smoking and avoiding excessive alcohol consumption.
In conclusion, gestational diabetes during pregnancy can have long-term effects on the mother’s health. The risk of developing type 2 diabetes and cardiovascular diseases is increased for women who have had gestational diabetes. However, adopting healthy lifestyle habits can help mitigate these risks and promote overall well-being.
Support and Resources for Women with Gestational Diabetes
During pregnancy, gestational diabetes mellitus can cause anxiety and concern for many women. However, it’s important to know that there are support and resources available to help manage this condition and ensure a healthy pregnancy.
Here are some support options and resources for women with gestational diabetes:
- Healthcare Team: Your healthcare team, including your doctor, nurse, and dietitian, will be your primary source of support. They can provide you with information about managing your diabetes, help create a personalized meal plan, and answer any questions or concerns you may have.
- Gestational Diabetes Education: Many hospitals and healthcare organizations offer gestational diabetes education programs. These programs can provide you with in-depth information about the condition, tips for managing blood sugar levels, and strategies for maintaining a healthy pregnancy.
- Online Communities: Joining online communities and support groups can connect you with other women who are going through similar experiences. These communities can provide a platform for sharing experiences, asking questions, and offering support and encouragement.
- Mobile Apps: There are several mobile apps designed specifically for women with gestational diabetes. These apps can help you track your blood sugar levels, monitor your diet, and provide reminders for medication or doctor’s appointments.
- Dietary Resources: Many resources are available to help you plan and prepare healthy meals during pregnancy. This can include recipe books, meal planning guides, and online resources that provide nutritional information and tips for managing blood sugar levels.
- Exercise Programs: Regular physical activity is an important part of managing gestational diabetes. Your healthcare team can provide you with guidance on suitable exercise programs and resources that can help you stay active during pregnancy.
Remember, gestational diabetes is a temporary condition that can often be managed through lifestyle changes and support. By utilizing the available resources and seeking support from your healthcare team and other women with gestational diabetes, you can have a healthy pregnancy and give your baby the best start in life.