Skip to main content
SpringerLink
Log in

Diabetes in Pregnancy

  • Chapter
  • First Online:
Book cover Principles of Diabetes Mellitus

  • 3942 Accesses

Abstract

Based on the 2002 birth data in the United States,1 maternal diabetes affects more than 321,760 of the 4,022,000 pregnancies that result in birth, and is a significant cause of maternal and fetal morbidity.2 Gestational diabetes mellitus (GDM) makes up approximately 50% of maternal diabetes.3 The remaining cases are due to type 1 diabetes and diagnosed or undiagnosed type 2 diabetes, collectively referred to as pregestational diabetes. GDM affects up to 14% of pregnant women, depending on the population.4 In North America, the prevalence of GDM is higher in Asians, African-Americans, Native North Americans from Canada, and Hispanics than in non-Hispanic whites.5

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 199.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Martin JA, Hamilton BE, Sutton PD, et al. Births: final data for 2002. Natl Vital Stat Rep. 2003;52:1.

    PubMed  Google Scholar 

  2. Jovanovic L, Nakai Y. Successful pregnancy in women with type 1 diabetes: from preconception through postpartum care. Endocrinol Metab Clin North Am. 2006;35:79–97.

    Article  PubMed  Google Scholar 

  3. American Diabetes Association. Gestational diabetes. Available at: http://www.diabetes.org/gestational-diabetes.jsp. Accessed June 12, 2008.

  4. Coustan DR. Gestational diabetes. In: Harris MI, Cowie CC, Stern MP, Boyko EJ, Reiber GE, Bennett PH, eds. Diabetes in America. 2nd ed. Baltimore, MD: National Institutes of Health; 1995:703–717.

    Google Scholar 

  5. Hunt KJ, Schuller KL. The increasing prevalence of diabetes in pregnancy. Obstet Gynecol Clin North Am. 2007;34(2):173–199.

    Article  PubMed  Google Scholar 

  6. Mauricio D, Balsells M, Morales J, Corcoy R, Puig-Domingo M, de Leiva A. Islet cell autoimmunity in women with gestational diabetes and risk of progression to insulin-dependent diabetes mellitus. Diabetes Metab Rev. 1996;12(4):275–285.

    PubMed  CAS  Google Scholar 

  7. Ryan EA. Prevention and treatment of diabetes and its complications: pregnancy and diabetes. Medical Clinics of North America. 1998;82:823–845.

    Article  PubMed  CAS  Google Scholar 

  8. Boden G. Fuel metabolism in pregnancy and gestational diabetes mellitus. Obstet Gynecol Clin. 1996;23:1–10.

    Article  CAS  Google Scholar 

  9. Kuhl C. Etiology and pathogenesis of gestational diabetes. Diabetes Care. 1998;21(Suppl 2):B19.

    PubMed  Google Scholar 

  10. Desoye G, Hauguel-de Mouzon S, Shafrir E. The Placenta in diabetic pregnancy. In: Hod M, Jovanovic L, Di Renzo G, de Leiva A, Langer O, eds. Textbook of Diabetes and Pregnancy. New York: Martin Dunitz; 2003:126–149.

    Google Scholar 

  11. Setji T, Brown A, Feinglos M. Gestational diabetes mellitus. Clin Diabetes. 2005;23:17–22.

    Article  Google Scholar 

  12. Xiang AH, Peters RK, Trigo E, Kjos SL, Lee WP, Buchanan TA. Multiple metabolic defects during late pregnancy in women at high risk for type 2 diabetes. Diabetes. 1999;48:848–854.

    Article  PubMed  CAS  Google Scholar 

  13. Krampl E, Kametas NA, Nowotny P, Roden M, Nicolaides KH. Glucose metabolism in pregnancy at high altitude. Diabetes Care. 2001;24(5):817–822.

    Article  PubMed  CAS  Google Scholar 

  14. Yogev Y, Ben-Haroush A, Hod M. Pathogenesis of gestational diabetes mellitus. In: Hod M, Jovanovic L, Di Renzo G, de Leiva A, Langer O, eds. Textbook of Diabetes and Pregnancy. New York: Martin Dunitz; 2003:39–49

    Google Scholar 

  15. Lain K, Catalano P. Metabolic changes in pregnancy. Clin Obstet Gynecol. 2007;50(4):938–948.

    Article  PubMed  Google Scholar 

  16. Kirwan JP, Haugel-De Mouzon S, Lepercq J, et al. TNF-alpha is a predictor of insulin resistance in human pregnancy. Diabetes. 2002;51:2207–2213.

    Article  PubMed  CAS  Google Scholar 

  17. Barbour LA, Shao J, Qiao L, et al. Human placental growth hormone causes severe insulin resistance in transgenic mice. Am J Obstet Gynecol. 2002;186:512–517.

    Article  PubMed  CAS  Google Scholar 

  18. Metzger B, Buchanan T, Coustan D, et al. Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus. Diabetes Care. 2007;30(Suppl 2):S251–S260.

    Article  PubMed  CAS  Google Scholar 

  19. Buchanan TA. Pancreatic B cell defects in gestational diabetes: implications for pathogenesis and prevention of type 2 diabetes. J Clin Endocrinol Metab. 2001;86:989–993.

    Article  PubMed  CAS  Google Scholar 

  20. Miller HC. The effect of diabetic and prediabetic pregnancies on the fetus and newborn infant. J Pediatr. 1946;26:455–461.

    Google Scholar 

  21. O’Sullivan JB, Mahan CM. Criteria for the oral glucose tolerance test in pregnancy. Diabetes. 1964;13:285.

    Google Scholar 

  22. Coustan DR, Carpenter MW. The diagnosis of gestational diabetes. Diabetes Care. 1998;21:B5–B8.

    Article  PubMed  Google Scholar 

  23. Schmidt MI, Duncan BD, Reichelt AJ, Branchtein L, Matos MC, et al. Gestational diabetes mellitus diagnosed with a 2-h 75-g oral glucose tolerance test and adverse pregnancy outcomes. Diabetes Care. 2001;24:1151–1155.

    Article  PubMed  CAS  Google Scholar 

  24. The HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2001.

    Article  Google Scholar 

  25. Lindsay MK, Graves W, Klein L. The relationship of one abnormal glucose tolerance test value and pregnancy complications. Obstet Gynecol. 1989;73(1):103–106.

    PubMed  CAS  Google Scholar 

  26. Langer O, Anyaegbunam A, Brustman L, Divon M. Management of women with one abnormal oral glucose tolerance test value reduces adverse outcome in pregnancy. Am J Obstet Gynecol. 1989;161(3):593–599.

    PubMed  CAS  Google Scholar 

  27. American Diabetes Association. ADA position statement. Diabetes Care. 2001;24(Suppl 1):S77-S79.

    Article  Google Scholar 

  28. Brody SC, Harris R, Lohr K. Screening for gestational diabetes: a summary of the evidence for the U.S. Preventive Services Task Force. Obstet Gynecol. 2003;101(2):380–392.

    Article  PubMed  Google Scholar 

  29. Mikola M, Hiilesmaa V, Halttunen M, Suhonen L, Tiitinen A. Obstetric outcome in women with polycystic ovarian syndrome. Hum Reprod. 2001;16:226–229.

    Article  PubMed  Google Scholar 

  30. Moses R, Moses J, Davis W. Gestational diabetes: Do lean young caucasian women need to be tested?. Diabetes Care. 1998;21:1803–1807.

    Article  PubMed  CAS  Google Scholar 

  31. Pettitt D. GDM: Who to test, how to test. Diabetes Care. 1998;21:1789–1790.

    Article  PubMed  CAS  Google Scholar 

  32. U.S. Preventive Services Task Force. Screening for gestational diabetes mellitus: recommendations and rationale. Obstet Gynecol. 2003;101(2):393–395.

    Article  Google Scholar 

  33. Jovanovic L. American Diabetes Association’s fourth international workshop – conference on gestational diabetes mellitus: summary and discussion. Therapeutic interventions. Diabetes Care. 1998;21(Suppl 2):B131-B137.

    PubMed  Google Scholar 

  34. Oppermann W, Gugliucci C, O'Sullivan MJ, et al. Gestation diabetes and macrosomia. In: Camerini-Davalos RA, Cole HS, eds. Early Control in Early Life. New York: NY Academic; 1975:455–468.

    Google Scholar 

  35. Drexel H, Alefred B, Sigurd S, et al. Prevention of perinatal morbidity by tight metabolic control in gestational diabetes. Diabetes Care. 1988;11:761–776.

    Article  PubMed  CAS  Google Scholar 

  36. De Veciana M, Major C, Morgan M, Asrat T, et al. Postprandial versus preprandial blood glucose monitoring in women with gestational diabetes mellitus requiring insulin therapy. N Engl J Med. 1995;333:1237–1241.

    Article  PubMed  Google Scholar 

  37. Jovanovic-Peterson L, Bevier W, Peterson CM. The Santa Barbara County Health Care Services Program: birth weight change concomitant with screening for and treatment of glucose-intolerance of pregnancy: a potential cost-effective intervention?. Am J Perinat. 1997;14:221–227.

    Article  CAS  Google Scholar 

  38. Major CA, Henry MH, De Veciana M, Morgan MA. The effects of carbohydrate restriction in patients with diet controlled gestational diabetes. Obstet Gynecol. 1998;91:600–604.

    Article  PubMed  CAS  Google Scholar 

  39. Metzger B, Coustan D. Summary and recommendations of the fourth international workshop – conference on gestational diabetes mellitus. Diabetes Care. 1998;21(Suppl 2):B161.

    PubMed  Google Scholar 

  40. Jovanovic-Peterson L. Medical Management of Pregnancy Complicated by Diabetes. Alexandria, VA: American Diabetes Association; 1995.

    Google Scholar 

  41. Price N, Bartlett C, Gillmer MD. Use of insulin glargine during pregnancy: a case-control pilot study. BJOG. 2007;114:453–457.

    Article  PubMed  CAS  Google Scholar 

  42. Langer O, Conway DL, Berkus MD, et al. A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med. 2000;343:1134–1138.

    Article  PubMed  CAS  Google Scholar 

  43. Rowan JA, Hague WM, Gao W, Battin MR, Moore MP. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med. 2008;358:2003–2015.

    Article  PubMed  CAS  Google Scholar 

  44. Feig DS, Briggs GG, Kraemer JM, et al. Transfer of glyburide and glipizide into breast milk. Diabetes Care. 2005;28:1851–1855.

    Article  PubMed  CAS  Google Scholar 

  45. Hale TW, Kristensin JH, Hackett LP, et al. Transfer of metformin into human milk. Diabetologia. 2004;45:1509–1514.

    Google Scholar 

  46. Schaefer-Graf UM, Kjos SL, Fauzan OH, et al. A randomized trial evaluating a predominately fetal growth-based strategy to guide management of gestational diabetes in Caucasian women. Diabetes Care. 2004;27:297–302.

    Article  PubMed  Google Scholar 

  47. Jovanovic L. Medical emergencies in the patient with diabetes during pregnancy. Endocrinol Metab Clin North Am. 2000;29(4):771–787.

    Article  PubMed  CAS  Google Scholar 

  48. Reece EA, Eriksson UJ. The pathogenesis of diabetes associated congenital malformations. Obstet Gynecol Clin. 1996;23:29–45.

    Article  CAS  Google Scholar 

  49. Hod M, Star S, Passoneau J, et al. Effect of hyperglycemia on sorbitol and myo-inositol content of cultured rat conceptus: failure of aldose reductase inhibitors to modify myo-inositol and dysmorphogeneis. Biochem Biophys Res Commun. 1986;140:974–980.

    Article  PubMed  CAS  Google Scholar 

  50. Pinter E, Reece EA, Ogbum P, et al. Relative essential fatty acid deficiency in hyperglycemia – induced embryopathy. Am J Obstet Gynecol. 1988;159:1484–1490.

    PubMed  CAS  Google Scholar 

  51. Miller E, Hare JW, Cloherty JP, et al. Elevated maternal HBA1c and major congenital anomalies in infants of diabetic mothers. N Engl J Med. 1998;304:1331–1334.

    Article  Google Scholar 

  52. Karlsson K, Kjeller I. The outcome of diabetic pregnancies in relation to the mother’s blood glucose level. Am J Obstet Gynecol. 1972;112:213–220.

    PubMed  CAS  Google Scholar 

  53. Fuhrmann K, Reiker H, Semmler K, et al. The effect of intensified conventional insulin therapy before and during pregnancy on the malformation rate in offspring of diabetic mothers. Exp Clin Endocrinol. 1984;83:173–177.

    Article  PubMed  CAS  Google Scholar 

  54. Damm P, Molsted-Pederson L. Significant decrease in congenital malformations in newborn infants of an unselected population of diabetic women. Am J Obstet Gynecol. 1989;161:1163–1167.

    PubMed  CAS  Google Scholar 

  55. Willhoite MB, Benvert HW, Palomaki GE, et al. The impact of preconception counseling on pregnancy outcomes: the experience of the Maine Diabetes in Pregnancy Program. Diabetes Care. 1993;16:450–455.

    Article  PubMed  CAS  Google Scholar 

  56. American Diabetes Association. ADA position statement: preconception care of women with diabetes. Diabetes Care. 2001;24(Suppl 1):S66–S68.

    Article  Google Scholar 

  57. Chew E, et al. Metabolic control and progression of retinopathy, the diabetes in early pregnancy study. Diabetes Care. 1995;18:631–637.

    Article  PubMed  CAS  Google Scholar 

  58. Leguizamon G, Reece EA. Effect of medical therapy on progressive nephropathy: influence of pregnancy, diabetes, and hypertension. J Maternal Fetal Med. 2000;9:70–78.

    CAS  Google Scholar 

  59. Kitzmiller JL, Combs CA. Diabetic nephropathy and pregnancy. Obstet Gynecol Clin. 1996;23:173.

    Article  CAS  Google Scholar 

  60. Jovanovic-Peterson L, Peterson CM, Reed GF, et al. Maternal postprandial glucose levels predict birth weight: the diabetes in early pregnancy study. Am J Obstet Gynecol. 1991;164:103–111.

    PubMed  CAS  Google Scholar 

  61. Gabbe S. New concepts and applications in the use of the insulin pump during pregnancy. J Maternal Fetal Med. 2000;9:42–45.

    CAS  Google Scholar 

  62. Coustan DR, Reece RA, Sherwin RS, et al. A randomized trial of the insulin pump vs. intensive conventional therapy in diabetic pregnancies. JAMA. 1986;255:631–636.

    Article  PubMed  CAS  Google Scholar 

  63. Whiteman VE, Homko CJ, Reece EA. Management of hypoglycemia and diabetic ketoacidosis in pregnancy. Obstet Gynecol Clin. 1996;23:87–107.

    Article  CAS  Google Scholar 

  64. Kitzmiller JL. Diabetic ketoacidosis and pregnancy. Contemp Obstet Gynecol. 1982;20:141–148.

    Article  Google Scholar 

  65. AACE Guidelines. AACE medical guidelines for clinical practice for the management of diabetes mellitus. Endocr Pract. 2007;13(Suppl 1):59–63.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Mount Sinai School of Medicine, New York, NY, USA

    Adina E. Schneider M.D.

  2. Mount Sinai School of Medicine, New York, NY, USA

    Elliot J. Rayfield M.D.

  3. Division of Endocrinology and Metabolism, Albert Einstein College of Medicine, Beth Israel Medical Center, New York, NY, USA

    Agustin Busta

  4. Division of Endocrinology and Metabolism, Beth Israel Medical Center, New York, NY, USA

    Yuriy Gurevich D.O.

Authors
  1. Adina E. Schneider M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elliot J. Rayfield M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Agustin Busta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuriy Gurevich D.O.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Agustin Busta .

Editor information

Editors and Affiliations

  1. Div. Endocrinology & Metabolism, Beth Israel Medical Center, East 17th Street 317, New York, 10003, U.S.A.

    Leonid Poretsky

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Schneider, A.E., Rayfield, E.J., Busta, A., Gurevich, Y. (2010). Diabetes in Pregnancy. In: Poretsky, L. (eds) Principles of Diabetes Mellitus. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-09841-8_15

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-09841-8_15

  • Published:

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-0-387-09840-1

  • Online ISBN: 978-0-387-09841-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation