Carbohydrate Metabolism in Pregnancy and the Newborn · IV

1 The Development of Diabetes and its Relation to Pregnancy: The Long-Term and Short-Term Historical Viewpoint.- Insulin-Dependent Diabetes.- Non-Insulin-Dependent Diabetes.- Gestational Diabetes, or the Onset of Hyperglycaemia in Pregnancy.- 2 Polyendocrinopathy.- 3 Obesity and Fat Distribution.- Metabolic Aspects of Obesity.- Genetics.- Metabolic Factors Causing Obesity.- Biochemical Effects of Obesity on Carbohydrate Tolerance.- Effect of Pregnancy on Obesity and Body Fat Content.- Metabolic Association of Body Fat Distribution.- Effect of Obesity and Fat Distribution on Carbohydrate Tolerance in Pregnancy and Effects on the Newborn.- Conclusions.- 4 Nutrition in Pregnancy.- Protein Requirements in Pregnancy.- Direct Assessment of Nutritional Status.- Iron Requirements in Pregnancy.- Plasma Vitamin Concentrations.- Placental Transfer of Water-Soluble Vitamins.- Dietary Fibre.- Trace Elements.- Calcium.- Conclusions.- 5 The Metabolic Basis for Birth Defects in Pregnancies Complicated by Diabetes Mellitus.- Studies with Rat Embryo Culture.- Clinical Extrapolation.- The “Honeybee Syndrome” and Implications for Periconceptional Management of Diabetes.- General Summary.- 6 Diabetes in Pregnancy: Genetic and Temporal Relationships of Maldevelopment in the Offspring of Diabetic Rats.- Genetic Predisposition.- Teratogenic Period.- Organ Maldevelopment.- Methods.- Results and Discussion.- Conclusions.- 7 Diabetes Mellitus and Infertility.- Endocrine Abnormalities and Defects of Ovulation.- Problems of Oocyte Pick-up.- Unexplained Infertility.- Secondary Infertility.- Survey of Diabetic Women.- Male Infertility.- Impotence.- Retrograde Ejaculation.- 8 Epidemiology of Spontaneous Abortion in Insulin-Dependent Diabetic Women.- Pathogenesis of Spontaneous Abortion in Insulin-Dependent Diabetic Women.- Problems of Data Collection and Analysis.- Definition.- Methods of Detection.- Characteristics of the Study Population.- The Frequency of Spontaneous Abortion.- Conclusions.- 9 Ultrasound Studies on Fetal Growth.- Early Growth Delay.- Summary and Conclusions on Early Growth Delay.- Fetal Growth in the Second and Third Trimesters.- Growth of Head and Trunk.- The Population Growth Curve.- Detection of Manifest Macrosomia.- Detection of Developing Macrosomia.- 10 Magnetic Resonance Imaging of the Feto-placental Unit.- Physical Principles.- Patients and Methods.- Observations.- Discussion.- 11 The Placenta in Diabetes Mellitus.- Morphology of the Placenta in Diabetes Mellitus.- Macroscopic Appearances.- Histological Findings.- Ultrastructural Changes.- Morphometric Studies.- Immunopathology of the Placenta in Diabetes Mellitus.- Relationship Between Placental Abnormalities, Severity of the Diabetic State and Degree of Diabetic Control.- Pathogenesis of Placental Abnormalities in Diabetes Mellitus.- Functional Significance of Placental Changes in Diabetes Mellitus.- Conclusions.- 12 Amniotic Fluid Levels of Insulin and C-Peptide in Pregnancies Complicated by Diabetes Mellitus.- Levels of Insulin and C-Peptide in Amniotic Fluid.- Amniotic Fluid C-Peptide/Insulin and Substrate Levels.- Amniotic Fluid C-Peptide/Insulin and Fetal Size.- Amniotic Fluid C-Peptide and other Hormones in Amniotic Fluid.- Amniotic Fluid C-Peptide/Insulin and Perinatal Outcome.- 13 Prepregnancy Preparation.- Congenital Abnormalities.- Relevance of Hyperglycaemia.- Possible Relevance of Hypoglycaemia.- Complications of Diabetes.- Retinopathy.- Nephropathy.- Attendance at Prepregnancy Clinic.- Infertility.- Conclusion.- 14 Management of the Insulin-Dependent Diabetic Woman: Problems with Pregnancy.- and Historical Perspective.- The Problem of Increasing Numbers: Epidemiology of Diabetes and Diabetic Pregnancy.- Organization of Diabetic Care: The Combined Clinic Approach.- Problems with Metabolic Control.- Social and Psychological Aspects of Management.- Newly Diagnosed Insulin-Dependent Diabetes Mellitus (IDDM) in Pregnancy.- Management of Established Diabetes Mellitus in Pregnancy.- Insulin Therapy.- Poor Glycaemic Control.- Problems with Diet.- Hypoglycaemia.- Problems in Monitoring Control.- Other Endocrine Disorders in Diabetic Pregnancy.- Problems Associated with the Complications of Diabetes Mellitus.- Cardiovascular Adaptation to Pregnancy and Hypertension.- Diabetic Nephropathy.- Diabetic Retinopathy.- Ischaemic Heart Disease.- Delivery.- Problems in the Future.- 15 Intensified Insulin Treatment in Diabetic Pregnancy.- Congenital Malformations.- Copenhagen Study of Continuous Subcutaneous Insulin Infusion (CSII) Treatment in Diabetic Pregnancy.- Study Design.- Results.- Conclusions.- Discussion.- General Conclusion.- 16 Nephropathy in Pregnancy.- Microalbuminuria in Diabetic Pregnancy: An Early Marker of Complications.- Patients and Methods.- Discussion of Urinary Albumin Excretion.- Renal Size in Diabetic Pregnancy.- Methods.- Discussion of Renal Volume.- Relation Between Kidney Size and Microalbuminuria in Diabetic Pregnancy.- Final Conclusions.- 17 Pregnancy and Diabetic Retinopathy.- Clinical Manifestations of Diabetic Retinopathy.- Pathogenesis of Diabetic Retinopathy.- Epidemiology of Diabetic Retinopathy.- Epidemiology of Diabetic Retinopathy in Pregnancy.- Approach to Management of Diabetic Retinopathy in Pregnancy.- Conclusion.- 18 Screening and Management of Gestational Diabetes Mellitus.- Screening for Gestational Diabetes.- Glycosuria.- Potential Diabetic Features.- Response to Glucose Load.- Random Blood Glucose.- Potential Diabetic Features and Fasting Blood Glucose.- Glycated Haemoglobin and Proteins.- Conclusion.- The Management of Gestational Diabetes.- To Treat or Not?.- Dietary Advice.- Insulin Therapy.- Oral Hypoglycaemic Drugs.- The Obstetric Management of Gestational Diabetes.- Postnatal Management.- 19 A Prospective Multicentre Study to Determine the Influence of Pregnancy upon the 75-g Oral Glucose Tolerance Test (OGTT).- The Population Studied.- Gestation at Testing.- Types of Blood Sample Obtained.- Number of Tests Undertaken.- Maternal Characteristics.- Social Details.- Outcome of Present Pregnancy.- Gestation at Delivery.- Birthweights.- Method of Delivery.- Infant Outcome.- Test Procedure.- The Test.- Assay Methods.- Assay Comparability.- Relation of Venous and Capillary Blood Glucose Levels.- Conclusions Concerning Methodology.- Oral Glucose Tolerance Test (OGTT) Results.- Venous Plasma Glucose Values.- Capillary Whole Blood Glucose Values.- Capillary Plasma Glucose Values.- Factors Possibly Influencing the 75-g Oral Glucose Tolerance Test (OGTT) Response.- Family History of Diabetes.- Smoking Habit.- Parity.- Characteristics of Women with a 2-h Value of 8 mmol/l or More.- Adopting a 2-h level of 9 mmol/1 as the Cut-off.- Conclusions.- 20 Targets in Oral Glucose Tolerance Testing.- Methods.- Results and Discussions.- Screening Using Fasting Blood Glucose Values.- Screening by Glucose Challenge.- Conclusions.- 21 The Spectrum of Glucose Tolerance During Pregnancy.- 22 Further Observations in Lean and Obese Women with Gestational Diabetes During a 400-Kilocalorie Meal Tolerance Test.- Methods.- Patients.- Treatment of Gestational Diabetes.- Diet.- Insulin.- 400-Kilocalorie Meal Tolerance Test (MTT).- Results.- Patients.- Diagnosis of Gestational Diabetes.- Treatment.- Metabolic Observations.- Glucose.- Insulin and C-Peptide.- Glucagon.- Human Chorionic Somatomammotropin (hCS).- Lipids.- Infants of Mothers with Gestational Diabetes.- Anthropometric Measurements.- Discussion.- 23 Standardized Test Meal in Human Pregnancy.- Methodology.- Study A.- Study B.- Study C.- Study D.- Study E.- Results.- Discussion.- 24 Breakfast Tolerance Test in Pregnancy.- Aberdeen Study of the Breakfast Tolerance Test (BTT) and the Oral Glucose Tolerance Test (OGTT) in Pregnancy.- Clinical Outcome.- Conclusions.- 25 Diabetes Diagnosed During Pregnancy: Follow-up Studies.- Material and Methods.- Selection of Patients and Classification.- Principles of Treatment.- Follow-up Studies.- Results.- Data from the Index Pregnancy.- State of Glucose Tolerance at Follow-up.- Discussion.- Conclusions.- 26 The Boston Gestational Diabetes Studies: Review and Perspectives.- 27 The Obstetrician’s Role in the Management of Diabetic Pregnancy: The Aberdeen Approach.- The Nature of the Maternity Service.- Prepregnancy Care.- Pre (Ante)-natal Care.- Labour.- The Puerperium.- 28 Management of Diabetes Mellitus in Pregnancy: Survey of Maternal-Fetal Medicine Subspecialists in the United States.- Materials and Methods.- Results.- Gestational Diabetes Mellitus.- Insulin-Dependent Diabetes Mellitus.- Estimation of Fetal Weight.- Discussion.- Conclusions.- 29 Oral Contraceptives in Diabetic Women.- The Pharmacological Profile of Sex Steroids in Oral.- Contraceptives.- Oral Contraceptives and Glucose Metabolism in Women with Previous Gestational Diabetes Mellitus.- Glycaemic Control and Clinical Effects of Oral Contraceptives in Women with Insulin-Dependent Diabetes Mellitus.- Conclusion.- 30 The Infant of the Diabetic Mother: Recent Experience.- Patients.- Management.- Management of Hypoglycaemia.- Results.- Discussion.- 31 The Future for Infants of Diabetic Mothers.- Respiratory Distress Syndrome.- Hypoxaemia.- Macrosomia.- Summary.- 32 Status at 4–5 Years in 90 Children of Insulin-Dependent Diabetic Mothers.- Material and Methods.- Results.- Discussion.- 33 Diabetes and Pregnancy: Consensus and Controversy.- Pregestational Diabetes.- Therapeutic Strategies.- Congenital Malformations.- Glycaemic Control: Targets.- Gestational Diabetes.- Diagnosis.- Screening.- Classification.- Interventions.- Concluding Comments.