Diabetes In Pregnancy, An Issue Of Obstetrics And Gynecology Clinics (the Clinics: Internal Medicine)

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. 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 Provides advice from leaders in the field of diabetes in pregnancy. Topics in this book 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; and, obstetric management of the diabetic pregnancy at term.