Traditions are dangerous; doubly so in science. Traditions are unchanging; science is about change. This was the 4th International Colloquium on Carbohydrate Metabolism in Pregnancy and the Newborn to be held in Aberdeen, and by now the form is set. How much its content has changed is a matter of nice judgement and not under the control of the organizers. It is not within their power to bring news of revolution, if there has been no revolution. Certainly many of the speakers had kent faces from previous Aberdeen meetings, but so they would be at any meeting on diabetes anywhere in the world. The written proceedings of scientific conferences have purposes other than to record changes: sometimes they need to state a consensus. The 3rd Colloquium came to an agreement about the importance of prepregnancy recognition and control of abnormalities of carbohydrate metabolism. The 4th set out to examine what results it had achieved. Much of this book is taken up with follow-up studies of the applications of similar regimes in different parts of the world. Since the first Aberdeen meeting in 1973, progress in the manage ment of diabetic pregnancy has been slow and steady, but the change in the city and the society where the meetings took place has been fast.
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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 leve…