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Gestational Diabetes: Origins, Complications, and Treatment

2014 Edition, February 7, 2014

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Active, Most Current

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ISBN: 978-1-4398-7996-2
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Product Details:

  • Revision: 2014 Edition, February 7, 2014
  • Published Date: February 7, 2014
  • Status: Active, Most Current
  • Document Language: English
  • Published By: CRC Press (CRC)
  • Page Count: 236
  • ANSI Approved: No
  • DoD Adopted: No

Description / Abstract:


Gestational diabetes, defined as diabetes that first develops in a pregnant woman, is coming of age. Although this has been recognised as a distinct form of diabetes since the 1960s, recent large studies such as the Hyperglycemia and Adverse Pregnancy Outcome Study and the Australian Carbohydrate Intolerance Study in Pregnant Women are only now helping to precisely define the risks associated with having raised glucose concentrations in pregnancy, as well as the benefits that may be gained by reducing such glucose intolerance. As such, they may end up making the contribution to gestational diabetes that the Diabetes Control and Complications Trial and the UK Prospective Diabetes Study have made to type 1 and 2 diabetes, respectively. The need for this is great given that the worldwide incidence of gestational diabetes is increasing rapidly in line with the increased prevalence of obesity, and the risks associated with a gestational diabetes pregnancy stretch beyond those to the mother (such as a massively increased risk of developing type 2 diabetes) and the newborn (e.g., macrosomia) to long-term, transgenerational risks in the offspring (such as for obesity and type 2 diabetes, and in females for gestational diabetes). The complications of these transmitted conditions could lead to potentially catastrophic effects, such as the offspring's generation being the first in modern times to die at younger ages than their parents (Zimmet et al., 2007).*

This book therefore sets out to provide timely reviews relating to what may be considered some of the most important aspects of gestational diabetes, in particular its causes, consequences, and ways of treating it. The book is split into five main sections to encompass this. The initial section is based around metabolism in pregnancy and gestational diabetes. The first chapter, by Dr. Chen and Professor Scholl, deals with the important area of maternal and foetal glucose metabolism in pregnancy, particularly in relation to insulin resistance. The second chapter, by Dr. Lindsay, deals with the controversial topic of what actually constitutes gestational diabetes, an area that is currently receiving much attention in the literature.

Section II contains chapters about risk factors and causes of gestational diabetes. The most obvious risk factors for gestational diabetes, almost by definition but often overlooked, are the subject being female and pregnant! However, whilst these factors are sensitive for the development of gestational diabetes, they carry no specificity, as only a fraction of pregnant women develop gestational diabetes. Environmental risk factors with greater specificity for gestational diabetes are outlined in Chapter 3 by Dr. Hadar and Professor Hod. In Chapter 4 I then outline the rapidly expanding field of genetic risk factors for gestational diabetes and how these are closely linked to genetic risk factors for other forms of diabetes.

Having outlined the causes of gestational diabetes, the succeeding section then deals with the consequences of having this condition, namely, the potential complications for both the mother and her offspring. In Chapter 5 Dr. Salzer and Professor Yogev outline the potential short- and long-term effects of gestational diabetes for both the mother and her offspring, a vital consideration given the rising prevalence of this condition and the potential risk of transmitting this condition and type 2 diabetes on to the next generation.

The largest section in the book then deals with treating gestational diabetes in an effort to improve the outcome for both the mother and baby. In Chapter 6 Dr. Walsh and Professor McAuliffe deal with the nutritional approach to treating gestational diabetes, which has been described as the cornerstone of its treatment. Then in Chapter 7 Dr. Boulvain examines the evidence for the role of exercise in treating this condition, including what benefits it brings and its potential risks. In Chapter 8 Professor Simmons presents a highly useful strategy for treating gestational diabetes pharmacologically, including recent advances in the use of insulin analogues and the use of alternatives to insulin.

The final section contains a chapter in which I speculate on the future prospects for the condition of gestational diabetes, including areas not covered by other chapters in the book, such as how the need for screening correlates with maternal obesity. Clearly in a volume of this size it is impossible to write about every clinical and scientific aspect of gestational diabetes, but in this chapter I briefly try to fill in some of the gaps and suggest likely areas of progress in the forthcoming years.

Each chapter of this book is therefore designed to provide a summary of the current state of practice and knowledge in its particular subject area, with an emphasis on highlighting key recent research. Key points are condensed into a single summary diagram for each chapter to provide an aide mémoire for those trying to hold many aspects of gestational diabetes in their mind at one time. Hopefully these may also prove useful for those wanting to revise current knowledge about gestational diabetes in preparation for exams. In addition, for those wanting greater detail than can be provided in a book of this size, recent key references are bold (with an explanation as to why) to help direct areas of further research. We hope that you will find it useful.

* Zimmet, P. et al. 2007. The International Diabetes Federation Consensus Definition of the Metabolic Syndrome in Children and Adolescents. Brussels, Belgium: IDF Communications. Available at http:// www.idf.org/webdata/docs/Mets_definition_children.pdf.