Gestational Diabetes

In developed countries the incidence of gestational diabetes lies between 1 and 8%. With the general decrease of perinatal mortality and morbidity, the complications arising from gestational diabetes have become more striking and significant. Moreover, impaired maternal carbohydrate metabolism may lead to non genetic fuel mediated disposition to diabetes in the offspring. The renewed topicality has greatly stimulated research in this field. This book provides both a general survey and the current thinking on special questions of gestational diabetes. It also deals with related topics such as epidemiology, prognosis, follow-up, contraception, etc. The book is addressed to obstetricians and other physicians engaged in prenatal care as well as to internists and neonatologists.

Gestational Diabetes — Survey.- 1 Gestational Diabetes: A Survey and the Graz Approach to Diagnosis and Therapy.- Nomenclature and classification.- Physiology and pathophysiology.- Metabolic changes in pregnancy.- Endocrine effects of pregnancy on carbohydrate metabolism.- Insulin homeostasis in the fetoplacental unit.- Insulin homeostasis in the fetoplacental unit of normal pregnancy.- Insulin homeostasis in the fetoplacental unit of the diabetic woman.- Screening for disorders of carbohydrate metabolism.- Target groups.- Period of screening.- Methods of glucose tolerance testing.- Further diagnostic procedures.- Monitoring blood glucose.- Amniotic fluid insulin determination.- Methods of determining amniotic fluid insulin.- The determination of glucose in the amniotic fluid.- Treatment.- Dietary treatment.- Insulin treatment.- Metabolic control during insulin treatment.- Quality of metabolic control.- Monitoring blood glucose.- Glycosylated hemoglobin.- Patient education.- Monitoring pregnancy, labor and the puerperium.- Arrest of preterm labor with ?-mimetic tocolytic agents.- Induction of fetal lung maturation.- Birth weight.- Sonographic estimation of fetal weight and ultrasound diagnosis of diabetogenic fetopathy.- Postpartal screening for diabetes.- Newborns of diabetic mothers.- Assessment of the quality of metabolic management during pregnancy by the condition of the newborn.- Selected Topics on Gestational Diabetes.- A. The Significance of Gestational Diabetes.- 2 The World Scope of Gestational Diabetes.- Determinant biological factors of pathologic childbearing.- Determinants of diabetes.- Diabetic patterns during pregnancy.- Diabetes health care in pregnancy in tropical and subtropical zones.- B. On Physiologic and Pathophysiologic Features of Gestational Diabetes.- 3 Pathophysiological Background for Gestational Diabetes.- Plasma insulin in pregnancy.- Serum proinsulin in pregnancy.- Insulin degradation in pregnancy.- Glucagon secretion in pregnancy.- Insulin resistence in pregnancy.- Concluding remarks.- Summary.- 4 The Human Placenta in Gestational Diabetes.- Histopathology.- Histomorphometry.- Immunpathology.- Carbohydrate metabolism.- Lipid metabolism.- Nucleic acids, amino acids and proteins.- The placenta as affector of fetal growth.- Miscellaneous.- 5 Prevention of Placental Insufficiency Syndrom in Diabetic Pregnancies.- Materials and methods.- Results.- Discussion.- C. On Screening and Diagnostics in Gestational Diabetes.- 6 Gestational Diabetes, Significance of Risk Factors and Results of a Follow-up Study 8 Years After Delivery.- Methods.- Result and discussion.- Screening using random blood glucose values.- Conclusions.- 7 The Oral 100 g-Glucose-Tolerance Test—Special Criteria for Evaluation in Late Pregnancy.- Methods.- Results.- Discussion.- Summary.- 8 Glucosylated Proteins in Normal and Diabetic Pregnancy.- Biochemistry of glucosylation and Browning reactions.- Studies on methods of measurement.- Studies on the role of glucosylation in the problems of pregnancy complicated by diabetes mellitus.- Studies on the clinical utility of glucosylated protein.- Measurements during pregnancy.- Conclusions.- 9 Glycosylated Haemoglobins and Neonatal Macrosomia.- Glycosylated haemoglobins (GHb).- GHb and pregnancy.- Problem formulation.- Methods.- Results.- Discussion.- Summary.- 10 Recurrence of Gestational Diabetes in Subsequent Pregnancies.- Materials and methods.- Results.- Discussion.- Summary.- D. On Prophylaxis and Therapy in Gestational Diabetes.- 11 Preconceptional Diabetes Counseling in Gestational Diabetes.- Material and methods.- Results.- Discussion.- 12 The Use of Prophylactic Insulin in Women with Gestational Diabetes.- Diagnosis of gestational diabetes.- Indications for therapeutic insulin.- Theoretical causes of fetal macrosomia despite relative maternal euglycemia.- Prophylactic insulin—results of randomized trials.- Retrospective data.- Clinical strategy.- Risks.- Conclusions.- 13 Insulin Treatment of Gestational Diabetes. The Basal Bolus Concept.- Patients and methods.- Initial planning of the insulin-schedule.- Results.- E. On the Fetus and Newborn of Gestational Diabetic Women.- 14 Fetal Consequences of Maternal Diabetes.- The human fetal pancreas.- The morphology of the endocrine pancreas.- The fetal endocrine pancreas in diabetes.- Fetal consequences in experimental diabetes induced by streptozotocin.- The fetal endocrine pancreas in the diabetic BB rat.- Conclusions.- Summary.- 15 Macrosomia and Birth Trauma in Infants of Diet Treated Gestational Diabetic Women.- Material and methods.- Results.- Discussion.- 16 Fetal Hemoglobin in the Infant of Gestational Diabetic Mothers (IGDM).- Patients and methods.- Results.- Discussion and conclusions.- 17 Somatometric Study in the Infant of Gestational Diabetic Mother.- Patients and methods.- Results.- Discussion and conclusions.- 18 The Impact of Diet-induced Ketosis During Pregnancy on the Offspring.- Case report.- Discussion.- Summary.- F. On Oral Contraception in Gestational Diabetes.- 19 Oral Contraceptives in Women with Previous Gestational Diabetes: Influence on Glucose Metabolism.- Influence of low dose oral contraceptives on glucose metabolism in normal women and women with previous gestational diabetes mellitus.- Oral contraceptives in normal women and women with previous GDM: Effect of estrogen/ progestogen ratio on glucose tolerance.- Low dose oral contraceptives and insulin receptor binding in normal women and women with previous GDM.- G. On the Further Fate of Women Who Had Gestational Diabetes.- 20 Follow-up Studies in Women with Gestational Diabetes Mellitus. The Experience at Los Angeles Country/University of Southern California Medical Center.- Materials and methods.- Discussion.- Conclusions.- Summary.- 21 The Emergence of Diabetes and Impaired Glucose Tolerance in Women Who Had Gestational Diabetes.- Materials and methods.- Results.- Incidence according to severity of gestational diabetes.- Family history.- Subsequent pregnancies.- Postnatal tests.- Age at diagnosis.- Interval from index pregnancy to diagnosis.- Body mass index.- Discussion.- Summary.- References.- Acknowledgements and Grants.