Diabetes mellitus is one of the most common medical problems complicating pregnancy. Achieving optimal outcomes for diabetic women and their fetuses requires that care providers employ the best data available. In this issue we have collected expert opinions and reviews from leaders in the field of diabetes in pregnancy to provide the most up-to-date information. Topics include: use of oral anti-diabetic agents for treatment of gestational diabetes, the association between diabetes and stillbirth, fetal monitoring strategies, identification of the overgrown fetus, obstetric management of the diabetic pregnancy at term, and the postpartum and lifetime implications of gestational diabetes.
Author(s): D. Conway
Series: The Clinics: Internal Medicine
Edition: 1
Publisher: Saunders
Year: 2007
Language: English
Pages: 240
Cover......Page 1
Foreword......Page 2
Preface......Page 4
The Increasing Prevalence of Diabetes in Pregnancy......Page 6
Diabetes and gestational diabetes mellitus, screening, and definitions......Page 8
Population-based studies......Page 10
Hospital-based studies......Page 12
Trends in the prevalence of gestational diabetes mellitus......Page 18
Discussion......Page 22
References......Page 27
In Utero Exposure to Maternal Obesity and Diabetes: Animal Models That Identify and Characterize Implications for Future Health......Page 33
Mechanisms by which maternal obesity and gestational diabetes produce their unwanted effects on lifetime offspring health......Page 34
Experimental animal models......Page 36
Altered regulation of appetite and physical activity......Page 37
Altered insulin secretion and resistance......Page 39
Implications for the future......Page 40
References......Page 41
Glucose metabolism in normal pregnancy......Page 45
Pathophysiology of gestational diabetes mellitus......Page 46
Cytokines and insulin resistance......Page 48
Obesity, inflammation, and insulin resistance......Page 49
Pregnancy and the immune system......Page 50
Gestational diabetes mellitus and inflammation......Page 51
Immunomodulation and improved glucose metabolism......Page 52
References......Page 53
Periconceptional Care of Women with Diabetes Mellitus......Page 57
Significance......Page 58
Effectiveness of preconception care in reducing the incidence of congenital malformations......Page 59
Does pregnancy accelerate the progression of renal disease?......Page 61
Does pregnancy increase the development or progression of diabetic retinopathy?......Page 63
Coronary heart disease: class H diabetes......Page 64
Does pregnancy accelerate the progression or induce the occurrence of diabetic neuropathy among diabetic women?......Page 65
Does diabetic autonomic neuropathy affect pregnancy outcome?......Page 66
Guidelines for preconception care......Page 67
References......Page 68
Glucose monitoring during pregnancy: from glucosuria to continuous glucose monitoring......Page 72
The use of self-blood glucose monitoring......Page 73
Continuous glucose monitoring system......Page 74
Glucose monitoring using continuous glucose monitoring system in nondiabetic pregnancy: understanding normal glycemic profile in pregnancy......Page 75
Postprandial glycemic profile: a hint for improved management?......Page 76
Using continuous glucose monitoring for treatment assessment......Page 77
Glycemic control and adverse events in nonpregnancy......Page 78
Potential disadvantages and side effects in using insulin pumps......Page 79
The use of subcutaneous continuous insulin infusion in pregnancy complicated by diabetes......Page 80
References......Page 81
Oral Anti-Hyperglycemic Agents for the Management of Gestational Diabetes Mellitus......Page 85
The role of pharmacology in the treatment of gestational diabetes mellitus......Page 86
Oral antidiabetic drugs in gestational diabetes mellitus treatment......Page 87
Oral hypoglycemic agents......Page 89
Sulfonylureas......Page 90
Biguanides......Page 93
Thiazolidenediones......Page 96
alpha-Glucosidase inhibitors......Page 98
References......Page 99
Rationale for the use of nonimmunogenic insulins during pregnancy......Page 105
Insulin therapy during pregnancy......Page 106
Insulin glulisine......Page 107
Insulin lispro......Page 108
Insulin aspart......Page 109
Detemir......Page 112
Insulin and IGF-1 receptor binding affinity......Page 114
Summary......Page 116
References......Page 117
Definitions......Page 122
Historical perspective......Page 123
Stillbirth in women who have type 1 diabetes mellitus......Page 124
Stillbirth in women who have gestational diabetes mellitus......Page 126
Human studies......Page 128
Animal studies......Page 129
Comprehensive care......Page 130
Antepartum fetal surveillance......Page 131
Timing of delivery......Page 133
References......Page 134
Detection and Prevention of Macrosomia......Page 137
Early detection and implications for treatment/prevention......Page 138
Detection-is ultrasound better than physician or maternal perception?......Page 141
Detection-ultrasound accuracy......Page 142
Detection-timing and adjustments......Page 143
Detection-altered fetal growth and new ultrasound horizons......Page 144
Closing statements......Page 147
References......Page 148
Labor and Delivery Management for Women With Diabetes......Page 151
Fetal overgrowth......Page 152
Preeclampsia......Page 153
Congenital malformations......Page 154
Insulin-treated diabetes......Page 155
When to perform a cesarean delivery......Page 156
Intrapartum/peripartum glycemic management......Page 157
References......Page 158
Management of glucose during hospitalization......Page 163
Education......Page 165
Education and medical care for women with type 1 and 2 diabetes......Page 166
Education and medical care in women with prior gestational diabetes......Page 167
Lifestyle intervention......Page 169
Breastfeeding and contraception......Page 170
Hormonal contraception and diabetes......Page 171
Summary......Page 172
References......Page 173
