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Carbohydrate Metabolism in Pregnancy and the Newborn · IV

  • Kartonierter Einband
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4th International Colloquium on Carbohydrate Metabolism in Pegnancy and the Newborn 1988Traditions are dangerous; doubly so in sci... Weiterlesen
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4th International Colloquium on Carbohydrate Metabolism in Pegnancy and the Newborn 1988

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.


This book assembles present knowledge of the different aspects of human reproduction complicated by diabetes. The contributions are based on the Fourth Quinquennial Aberdeen Colloquium held in 1988 and update the results of the three previous meetings. Many new topics are covered, such as maternal nutrition, obesity, infertility, abortion, retinopathy, and so forth. Care has been taken to include clinical practice guidelines and protocols for the management of diabetic pregnancy and the infant of the diabetic mother. The book is, therefore, designed as much to suit the practicing clinician as the specialist or research worker wishing to keep abreast of contemporary knowledge that has been collected, collated and distilled by internationally recognized experts.

4th International Colloquium on Carbohydrate Metabolism in Pegnancy and the Newborn 1988


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.


Titel: Carbohydrate Metabolism in Pregnancy and the Newborn · IV
EAN: 9781447116820
ISBN: 1447116828
Format: Kartonierter Einband
Genre: Medizin
Anzahl Seiten: 404
Gewicht: 687g
Größe: H242mm x B170mm x T21mm
Jahr: 2012
Auflage: Softcover reprint of the original 1st ed. 1989



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