Main description:

As I read this unique volume on diabetes and pregnancy edited by Lois Jovanovic, I was struck by two themes that run throughout these collected chapters. First, this volume provides an excellent assessment of past problems, present management, and future challenges presented by dia betes in pregnancy. Orury's unique, longitudinal experience with diabetes iIi pregnancy provides the reader with an important overview, as does Coetzee's discussion of gestational diabetes. Current problems-deter mining the etiology and prevention of congenital malformations in infants of diabetic mothers (10M), assessment of antepartum fetal condition, management of pregnant patients with diabetic retinopathy, recognition of thyroid dysfunction in the pregnant diabetic woman, and understanding the multitude of metabolic sequelae observed in the 10M-are thoroughly reviewed. Finally, important considerations for future treatment and ther apy such as the adaptation of the fetal pancreas to the disordered intra uterine environment often seen in maternal diabetes, the use of fetal pan creatic tissue for transplantation, the application of exercise in the management of the pregnant woman with diabetes, and the long-term con sequences for the 10M provide an exciting glimpse into the future. The second important theme that emerges is the critical role the problem of diabetes in pregnancy has played in our understanding of maternal and fetal physiology. Clinical observations supported by basic research have emphasized the role of fetal fuels in teratogenesis.

Contents:

I Animal Models for the Study of Diabetes and Pregnancy.- 1. Experimental Studies of Congenital Malformations in Diabetic Pregnancy.- Maternal Diabetes.- Increased Levels of Different Sugars In vivo.- In vitro Studies.- Etiologic Reflections.- Conclusions.- II Islet Ontogeny: Fetal Pancreatic Ontogeny and Maternal Substrates.- 2. Adaptation of the Fetal Pancreas to Maternal Diabetes.- 3. The Use of Human Fetal Pancreatic Tissue for Transplantation.- History.- Studies of Isolation, Storage, Shipment, and Function In vitro.- Studies of Function In vivo.- Conclusions and Implications for the Infant of the Woman With Diabetes Mellitus.- III Optimal Management.- 4. Oral Hypoglycemic Agents in the Treatment of Gestational Diabetes.- Definitions.- Biochemical Criteria for Gestational Diabetes.- The Significance of Gestational Diabetes.- Treatment of Gestational Diabetes.- History of the Oral Antidiabetic Agents.- Use of the Sulfonylureas in Pregnancy: Survey of the Literature.- Biguanides in Pregnancy.- The Cape Town Trial.- Discussion.- Conclusion.- 5. Diabetic Retinopathy During Pregnancy.- Background.- Clinical Cases.- Risk Factors for Retinopathy.- Considerations for Study Design.- The Role of Glycemic Control in Pregnancy.- When to Treat Diabetic Retinopathy in Pregnancy.- 6. Thyroid Disorders in Pregnant Women With Type I Diabetes.- Diabetes Mellitus and Thyroid Disorders.- Thyroid Disorders During Pregnancy.- Thyroid Disorders in Diabetic Pregnant Women.- Treatment of Thyroid Disease During Pregnancy in Women With IDD.- Conclusion.- 7. Exercise in Gestational Diabetes.- Maternal Physiologic Responses to Exercise in Pregnancy.- Fetal Responses to Maternal Exercise.- Exercise in the Pregnant Diabetic Woman.- IV Obstetrics Management.- 8. Methods of Fetal Surveillance in Pregnancies Complicated by Diabetes.- Methods of Fetal Surveillance.- Conclusion.- 9. Diabetes in Pregnancy: Considerations for the Management of Delivery.- Gestational Diabetes Mellitus.- Detection of Gestational Diabetes.- Follow-Up of Women with GDM.- Criteria for the Diagnosis of Diabetes During Pregnancy.- Effect of Pregnancy on Insulin Requirements.- Alteration in Standards of Control.- Significance of Gestational Diabetes.- Clinical Diabetes and Pregnancy.- Problems of Pregnancy in Women With Clinical Pregestational.- Diabetes.- Fetal Surveillance, Timing of Delivery, and Third Trimester.- Management-According to the Experts.- Timing of Delivery and Third Trimester Management-According to Drury.- Results of Conservative Management.- Perinatal Mortality.- Conclusions.- V Infant Outcome of Pregnancies Complicated by Diabetes.- 10. The Metabolic Sequelae in the Infant of the Diabetic Mother.- Perinatal Mortality and Morbidity.- Effects of Maternal Diabetes on the Fetus.- Kinetic Analysis of Glucose Metabolism in IDM.- Congenital Anomalies.- Macrosomia, Birth Injury, and Asphyxia.- Respiratory Distress Syndrome.- Hypoglycemia.- Insulin Counterregulation.- Hypocalcemia and Hypomagnesemia.- Hyperbilirubinemia and Erythremia.- Renal Vein Thrombosis.- Long-Term Prognosis and Follow-Up.- Conclusion.- 11. Long-Term Outlook for the Offspring of the Diabetic Woman.- Obesity in Infants of Diabetic Mothers.- Insulin Concentrations in the Offspring of Diabetic Mothers.- Glucose Tolerance in the Offspring of Diabetic Women.- Future Directions.