Diabetology of Pregnancy (Frontiers in Diabetes)

Cover......Page 1
Contents......Page 6
Preface......Page 10
Introduction: Diabetes mellitus Incidence and Prevalence Trends......Page 12
Problems in Epidemiological Estimates of Gestational Diabetes......Page 13
GDM Incidence and Risk Factors......Page 14
Maternal Risks of GDM......Page 15
References......Page 16
Fuel-Mediated ‘Functional Teratogenesis’ and Primary Prevention......Page 20
References......Page 27
Pregnancy-Associated Insulin Resistance......Page 29
Insulin Secretion......Page 37
Release of Proinsulin and Islet Amyloid Pancreatic Polypeptide......Page 40
References......Page 42
Changes Occurring in the Mother during Pregnancy Affecting Fetal Growth......Page 45
Carbohydrate Metabolism......Page 47
Amino Acid Metabolism......Page 48
Adipose Tissue Metabolism......Page 49
Maternal Hyperlipidemia......Page 50
Placental Transfer of Lipid Metabolites......Page 51
Conclusion......Page 53
References......Page 54
Leptin in the Diabetic Pregnancy......Page 57
The Origin of Circulating Leptin......Page 58
Function of Leptin in the Mother......Page 59
Function of Leptin in the Fetus......Page 60
Maternal Leptin in Diabetes......Page 61
Regulation of Leptin Synthesis......Page 62
Molecular Mechanisms for Placental Leptin Action......Page 63
Consequences of High Leptin in the Fetoplacental Unit......Page 64
References......Page 65
Maternal Diabetes and Embryonic Development......Page 69
Maternal Diabetes......Page 70
Glucose......Page 71
Role of Oxidative Stress......Page 72
Fibroblast Growth Factor-4......Page 73
Maternal Diabetes and the Peri-Implantation Phase......Page 74
Arachidonic Acid and Prostaglandins......Page 75
Diabetes-Induced Embryopathy: A Unifying Hypothesis......Page 76
Conclusions......Page 78
References......Page 80
Intrauterine Growth......Page 83
Determinants of Fetal Nutrition......Page 84
Abnormal Fetal Growth......Page 86
Evaluation of Fetal Growth and Fetal Body Composition......Page 89
Fetal Growth as a Criterion for Managing Diabetic Pregnancies......Page 90
References......Page 91
Effect of Nutrition on Fetal Development: A View on the Pancreatic beta-Cells......Page 94
Severely Diabetic Mothers......Page 95
Maternal Malnutrition:The Low Protein Rat Model......Page 96
Fetal Nutrition and Pancreas Development......Page 97
Mild Hyperglycemia......Page 98
LP Diet......Page 99
GFR and Glucocorticoids......Page 100
Conclusion......Page 102
References......Page 103
The Human Placenta in Diabetes......Page 105
Morphology and Development......Page 106
Oxidative and Nitrative Stress of the Placenta in Diabetes......Page 112
Antioxidant Capacity......Page 113
Lipid Peroxidation......Page 114
Conclusion......Page 115
References......Page 116
Vasculogenesis and Angiogenesis in the Diabetic Placenta......Page 121
Vasculogenesis......Page 122
Angiogenesis and Vascular Remodelling......Page 125
Functional Implications of Changes in Vascular Anatomy and Arrangement......Page 129
Acknowledgements......Page 132
References......Page 133
Morphological Findings in Infants and Placentas of Diabetic Mothers......Page 138
The Placenta in Overt Diabetes mellitus......Page 144
The Placenta in Gestational Diabetes......Page 149
References......Page 151
Principles of Evidence-Based Medicine......Page 155
Where Does Evidence-Based Medicine Come from?......Page 156
Converting the Need for Information into Focused Questions......Page 157
Efficiently Tracking down the Best Evidence with Which to Answer the Question......Page 158
Critically Appraising the Evidence for Validity and Clinical Usefulness......Page 160
Applying the Results in Clinical Practice......Page 162
References......Page 163
The Graz Approach to Diabetes in Pregnancy......Page 164
References......Page 169
Perinatal Mortality......Page 172
Congenital Malformations......Page 173
Influence of Hyperglycaemia of the Mother on the Growth of the Fetus......Page 174
Complications of Diabetic Pregnant Women......Page 175
Care of Diabetic Pregnant Women during the First Trimester......Page 177
Care during the Second Trimester......Page 179
Care of Diabetic Pregnant Women in the Third Trimester......Page 180
Completion of Pregnancy......Page 181
Conclusions......Page 182
References......Page 183
Reducing the Risk of Having a Diabetic Pregnancy......Page 185
General Nutritional Advice before Pregnancy......Page 186
Folic Acid......Page 187
General Vitamin Supplementation......Page 188
Fish Oils......Page 189
Dietary Advice for Women with Diabetes during Pregnancy......Page 190
Energy Requirements in Pregnancy......Page 191
The Amount and Type of Dietary Carbohydrate......Page 193
The Amount and Type of Dietary Fat......Page 195
Meal Planning and Avoidance of Hypoglycaemia......Page 196
Recommended Maternal Weight Gain in Pregnancy......Page 197
Weight Loss in the Obese Diabetic Women during Pregnancy......Page 198
Exercise......Page 199
References......Page 200
Gestational Diabetes mellitus......Page 206
General and High-Risk Populations......Page 208
Influence of Pregnancy on DRA......Page 209
Transplacental Passage of DRA......Page 210
DRA and Risk of Type 1 DM in the Fetus......Page 211
References......Page 212
Insulin......Page 217
Insulin Analogues......Page 218
Oral Hypoglycemics......Page 220
References......Page 222
Continuous Glucose Monitoring for the Evaluation and Improved Treatment Adjustment in Gravid Women with Diabetic Pregnancy......Page 225
CGM for Clinical Use Not in Pregnancy......Page 226
CGM in Pregnancy......Page 228
Detection of Hypoglycemia......Page 229
The Potential Use of CGM to Prevent Adverse Fetal Outcome......Page 230
References......Page 231
Perinatal Mortality......Page 233
Fetal Factors......Page 235
Fetal Monitoring......Page 237
References......Page 238
Ultrasound in Estimating Gestational Age......Page 241
Ultrasound in Preimplantation Period and the First Trimester......Page 242
Abdominal Circumference......Page 246
Macrosomia......Page 247
Monitoring Fetal Condition in Diabetic Pregnancy by Colour Doppler and Power Doppler......Page 249
Congenital Malformations......Page 252
Spina bifida......Page 253
Face......Page 254
Heart Anomalies......Page 256
Anomalies of Gastrointestinal System......Page 258
Polyhydramnios......Page 259
Biochemical Screening Test in the First and the Second Trimester for Fetal Chromosomopathies and the Neural Tube Defect......Page 260
References......Page 261
Diabetic Pregnancy: Maternal Metabolic and Microvascular Complications in Type 1 Diabetes mellitus......Page 265
Preconception Care: Glycaemic Control and General Health Issues......Page 266
Diabetic Retinopathy......Page 269
Renal Disease in Diabetes......Page 272
Neuropathy......Page 275
Hypoglycaemia......Page 276
Diabetic Ketoacidosis......Page 279
Acknowledgement......Page 280
References......Page 281
Diabetes Complications and Pre-Eclampsia......Page 282
Metabolic Control......Page 283
Pathogenesis......Page 285
Treatment Modalities......Page 286
References......Page 287
Premature Labour......Page 289
Prediction of Fetal Macrosomia......Page 291
Timing of Delivery......Page 292
Management of Diabetes during Labour......Page 293
Induction of Labour......Page 294
Analgesia......Page 295
Postpartum......Page 296
References......Page 297
Offspring of Diabetic Pregnancy......Page 299
Clinical Aspects......Page 300
Experimental Aspects: Genetic and Environmental Factors......Page 301
Perinatal Mortality......Page 305
Size at Birth......Page 306
Metabolic Abnormalities......Page 308
Neonatal Hypoglycemia......Page 309
Type 1 Diabetes......Page 310
Type 2 Diabetes......Page 311
References......Page 312
Glucose Tolerance after Pregnancy......Page 321
The Impact of Overweight......Page 322
Predictors for Subsequent Diabetes......Page 324
The Metabolic Syndrome after GDM......Page 326
References......Page 328
Author Index......Page 331
C......Page 332
D......Page 333
F......Page 334
G......Page 335
L......Page 336
P......Page 337
V......Page 338