Diabetes and Pregnancy

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Abstract

Hyperglycemia during pregnancy is the most common metabolic problem of pregnancy today [ 1 ]. The prevalence of hyperglycemia during pregnancy may be as high as 13% [0.1% of the pregnant population per year have type 1 diabetes, 2–3% have type 2 diabetes, and up to 12% of the population have gestational diabetes mellitus (GDM)] [ 2 ]. Although all types of diabetes increase the risk of complications to the mother and the fetus, it is most important to distinguish among the types because each has a different impact on the course of pregnancy and the development of the fetus.

Keywords

Gestational Diabetes Mellitus Diabetic Woman Postprandial Glucose Level Pregestational Diabetes Severe Congenital Defect 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References

  1. 1.
    American Diabetes Association: Clinical practice recommendations 2001: gestational diabetes. Diabetes Care 2001, 24(suppl):S77–S79.Google Scholar
  2. 2.
    Hod M, Diamant YZ: Diabetes in pregnancy. Norbert Freinkel Memorial Issue. Isr J Med Sci 1991, 27:421–540.Google Scholar
  3. 3.
    Mills JL, Simpson JL, Driscoll SG, Jovanovi L, et al.: Incidence of spontaneous abortion among normal women and insulin dependent diabetic women whose pregnancies were identified within 21 days of conception. N Engl J Med 1988, 319:1617–1623.Google Scholar
  4. 4.
    Mills JL, Knopp RH, Simpson JL, Jovanovi L, et al.: Lack of relation of increased malformation roles in infants of diabetic mothers to glycemic control during organogenesis. N Engl J Med 1988, 318:671–676.Google Scholar
  5. 5.
    Petersen M, Pedersen SA, Greisen G, et al.: Early growth delay in diabetic pregnancy: relation to psychomotor development at age 4. Br Med J 1988, 296:598–600.Google Scholar
  6. 6.
    van Dijk DJ, Axer-Siegel R, Erman A, Hod M: Diabetic vascular complications and pregnancy. Diabetes Rev 1995, 3:632.Google Scholar
  7. 7.
    Catalano PM, Drago NM, Amini S: Maternal carbohydrate metabolism and its relationship to fetal growth and body composition. Am J Obstet Gynecol 1995, 172:1464–1470.Google Scholar
  8. 8.
    Hod M, Diamant YZ: The offspring of a diabetic mother—short- and long-range implications. Isr J Med Sci 1992, 28:81–86.Google Scholar
  9. 9.
    Pettitt DJ, Knowler WC: Long-term effects of the intrauterine environment, birth weight, and breast-feeding in Pima Indians. Diabetes Care 1998, 21:B138–B141.Google Scholar
  10. 10.
    Pedersen J: Fetal mortality in diabetes in relation to management during the latter part of pregnancy. Acta Endocrinol 1954, 15:282–294.Google Scholar
  11. 11.
    Freinkel N: Banting Lecture 1980: of pregnancy and progeny. Diabetes 1980, 29:1023–1035.Google Scholar
  12. 12.
    Jovanovi L, Peterson CM: Moment in history: turning point in blood glucose monitoring of diet and insulin dosing. Trans Am Soc Artif Intern Organs 1990, 36:799.Google Scholar
  13. 13.
    Buchanan TA, Unterman T, Metzger BE: The medical management of diabetes in pregnancy. Clin Perinatol 1985, 12:625–650.Google Scholar
  14. 14.
    Pedersen J, Pedersen LM: Diabetes mellitus and pregnancy: the hyperglycemia, hyperinsulinemia theory and the weight of the newborn baby. In Proceedings of the 7th Congress of the International Diabetes Federation. Edited by Rodriguez RR, Vallance-Owen J. Amsterdam: Excerpta Medica; 1971:678.Google Scholar
  15. 15.
    Jovanovi L, Druzin M, Peterson CM: Effect of euglycemia on the outcome of pregnancy in insulin-dependent diabetics as compared to normal controls. Am J Med 1981, 71:921–927.Google Scholar
  16. 16.
    Jovanovi L, Peterson CM: Rationale for prevention and treatment of glucose-mediated macrosomia: a protocol for gestational diabetes. Endocrinol Pract 1996, 2:118.Google Scholar
  17. 17.
    Jovanovi L, Peterson CM, Reed GF, et al.: Maternal postprandial glucose levels and infant birth weight: the Diabetes in Early Pregnancy Study. The National Institute of Child Health and Human Development—Diabetes in Early Pregnancy Study. Am J Obstet Gynecol 1991, 164:103–111.Google Scholar
  18. 18.
    de Veciana M, Major CA, Morgan MA, 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.Google Scholar
  19. 19.
    Mills JL, Baker L, Goldman A: Malformations in infants of diabetic mothers occur before the seventh gestational week: implications for treatment. Diabetes 1979, 23:292–293.Google Scholar
  20. 20.
    Steel JM, Johnstone FD, Hepburn DA, Smith AF: Can prepregnancy care of diabetic women reduce the risk of abnormal babies? Br Med J 1990, 301:1070–1074.Google Scholar
  21. 21.
    Kitzmiller JL, Gavin LA, Gin GD, Jovanovi L, et al.: Preconception care of diabetes: glycemic control prevents congenital anomalies. JAMA 1991, 265:731–736.Google Scholar
  22. 22.
    Metzger BE, Coustan DR: Proceedings of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 1998, 21(suppl):B1–B167.Google Scholar
  23. 23.
    HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, et al.: Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008, 358:1991–2002.Google Scholar
  24. 24.
    International Association of Diabetes and Pregnancy Study Groups Consensus Panel: International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010, 33:676–691.Google Scholar
  25. 25.
    Ylinen K, Aula P, Stenman UH, et al.: Risk of minor and major fetal malformations in diabetics with high hemoglobin A1C ­values in early pregnancy. Br Med J 1984, 289:345–346.Google Scholar
  26. 26.
    Jovanovi L, Peterson CM: Management of the pregnant diabetic woman. Diabetes Care 1980, 3:63–68.Google Scholar
  27. 27.
    Parretti E, Mecacci F, Papini M, et al.: Third trimester maternal glucose levels from diurnal profiles in non-diabetic pregnancies: correlation with sonographic parameters of fetal growth. Diabetes Care 2001, 24:1317–1323.Google Scholar
  28. 28.
    Murphy HR, Rayman G, Lewis, et al. Effectiveness of continuous glucose monitoring in pregnant women with diabetes: randomized clinical trial. Br Med J 2008, 337:a1680.Google Scholar
  29. 29.
    Jovanovi L, Saxena BB, Dawood MY, et al.: Feasibility of maintaining euglycemia in insulin-dependent diabetic women. Am J Med 1980, 68:105–112.Google Scholar
  30. 30.
    Greene MF, Hare JW, Cloherty JP, et al.: First-trimester hemoglobin A1 and risk for major malformation and spontaneous abortion in diabetic pregnancy. Teratology 1989, 39:225–231.Google Scholar
  31. 31.
    Jovanovi L, Knopp RH, Kim H, et al.: Elevated pregnancy losses at high and low extremes of maternal glucose in early normal and diabetic pregnancy: evidence for a protective adaptation in diabetes. Diabetes Care 2005, 28:1113–1117.Google Scholar
  32. 32.
    Jovanovic L: Medical Management of Pregnancy Complicated by Diabetes. Alexandria: American Diabetes Association; 1993, revised 1995, 2000, and 2009.Google Scholar
  33. 33.
    Jovanovi L, Crues J, Durak E, Peterson CM: Magnetic resonance imaging in pregnancies complicated by gestational diabetes predicts infant birth weight ratio and neonatal morbidity. Am J Perinatol 1993, 10:432–437.Google Scholar
  34. 34.
    Holden KP, Jovanovi L, Druzin ML, Peterson CM: Increased fetal activity with low maternal blood glucose levels in pregnancies complicated by diabetes. Am J Perinatol 1984, 1:161–164.Google Scholar
  35. 35.
    Wyatt JW, Frias JL, Hoyme HE, Jovanovi L, et al.: Congenital anomaly rate in offspring of pre-gestational diabetic women treated with insulin lispro during pregnancy. Diabetic Med 2004, 21:2001–2007.Google Scholar
  36. 36.
    Jovanovi L, Knopp RH, Brown A, et al.: Declining insulin requirements in the late first trimester of diabetic pregnancy. Diabetes Care 2001, 24:1130–1136.Google Scholar
  37. 37.
    Mathiesen ER, Kinsley B, Amiel SA, et al.: Maternal glycemic control and hypoglycemia in type 1 diabetic pregnancy. Diabetes Care 2007, 30:771–776.Google Scholar
  38. 38.
    Menon RK, Cohen RM, Sperling MA, et al.: Transplacental passage of insulin in pregnant women with insulin-dependent diabetes mellitus. Its role in fetal macrosomia. N Engl J Med 1990, 323:309–315.Google Scholar
  39. 39.
    Jovanovi L, Kitzmiller JL, Peterson CM: Randomized trial of human versus animal species insulin in diabetic pregnant women: improved glycemic control, not fewer antibodies to insulin, influences birth weight. Am J Obstet Gynecol 1992, 167:1325–1330.Google Scholar
  40. 40.
    Jovanovi L, Mills JL, Peterson CM: Anti-insulin titers do not influence control or insulin requirements in early pregnancy. Diabetes Care 1984, 7:68Google Scholar
  41. 41.
    Jovanovi L, Ilic S, Pettitt DJ, et al.: The metabolic and immunologic effects of insulin lispro in gestational diabetes. Diabetes Care 1999, 22:1422–1427.Google Scholar
  42. 42.
    Pettitt DJ, Ospina P, Kolaczynski JW, Jovanovi L: Comparison of an insulin analog, insulin aspart, and regular human insulin with no insulin in gestational diabetes mellitus. Diabetes Care 2003, 26:183–186.Google Scholar
  43. 43.
    Jovanovi L, Peterson CM: The art and science of maintenance of normoglycemia in pregnancies complicated by type 1 diabetes mellitus. Endocrinol Pract 1996, 2:130.Google Scholar
  44. 44.
    Buchanan TA, Kjos SL, Montoro MN, et al.: Use of fetal ultrasound to select metabolic therapy for pregnancies complicated by mild gestational diabetes. Diabetes Care 1994, 17:275–283.Google Scholar
  45. 45.
    Kjos SL, Schaefer-Graf U, Sardesi S, et al.: A randomized controlled trial using glycemic plus fetal ultrasound parameters versus glycemic parameters to determine insulin therapy in gestational diabetes with fasting hyperglycemia. Diabetes Care 2001, 24:1904–1910.Google Scholar
  46. 46.
    Schaefer-Graf UM, Kjos SL, Fauzan OH, et al.: A randomized trial evaluating a predominantly fetal growth-based strategy to guide management of gestational diabetes in Caucasian women. Diabetes Care 2004, 27:297–302.Google Scholar
  47. 47.
    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.Google Scholar
  48. 48.
    Jovanovi L: Nutritional management of the obese gestational diabetic woman [guest editorial]. J Am Coll Nutr 1992, 11:246–250.Google Scholar
  49. 49.
    Jovanovi L: Time to reassess the optimal dietary prescription for women with gestational diabetes [editorial]. Am J Clin Nutr 1999, 70:3–4.Google Scholar
  50. 50.
    Peterson CM, Jovanovi L: Percentage of carbohydrate and glycemia response to breakfast, lunch, and dinner in women with gestational diabetes. Diabetes 1991, 40(suppl):172.Google Scholar
  51. 51.
    Jovanovi L, Durak EP, Peterson CM: Randomized trial of diet versus diet plus cardiovascular conditioning on glucose levels in gestational diabetes. Am J Obstet Gynecol 1989, 161:415–419.Google Scholar
  52. 52.
    Jovanovi L, Bevier W: 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 Perinatol 1997, 14:221–228.Google Scholar
  53. 53.
    McCance DR, Pettitt DJ, Hanson RL, et al.: Birth weight and non-insulin dependent diabetes: thrifty genotype, thrifty phenotype, or surviving small baby genotype? Br Med J 1994, 308:942–945.Google Scholar
  54. 54.
    Zisser H, Jovanovi L, Thorsell A, et al.: The fidgety fetus hypothesis: fetal activity is an additional variable in determining birth weight of offspring of women with diabetes. Diabetes Care 2006, 29:63–67.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Sansum Diabetes Research InstituteSanta BarbaraUSA

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