Carbohydrate Metabolism in Pregnancy and the Newborn 1978

551 Pages·1979·9.648 MB·English

by  N. Freinkel, R. L. Phelps, B. E. Metzger (auth.), Dr. H. W. Sutherland, Dr. J. M. Stowers (eds.)

Carbohydrate
Metabolism
in Pregnancy
and the
Newborn 1918
Edited by
H. W Sutherland and J. M. Stowers
With 95 Figures
Springer-Verlag Berlin Heidelberg New York 1979
H.W. Sutherland, Department of Obstetrics and Gynaecology, University
of Aberdeen, Foresterhill, Aberdeen, AB9 2ZD, Great Britain
J.M. Stowers, Diabetic Out-Patient Department, Aberdeen Royal Infir
mary, Woolmanhill, Aberdeen, AB9 1GS, Great Britain
ISBN-13: 978-3-540-08798-4 e-ISBN-13: 978-3-642-66972-9
DOI: 10.1007/978-3-642-66972-9
Library of Congress Cataloging in Publication Data. International Colloquium on
Carbohydrate Metabolism in Pregnancy and the Newborn, 2d, Aberdeen, Scot., 1978.
Carbohydrate metabolism in pregnancy and the newborn 1978. Bibliography: p. Includes
index. 1. Diabetes in pregnancy--Congresses. 2. Carbohydrate metabolism--Congresses.
I. Sutherland, Hamish W. II. Stowers, John M. III. Title. RG580.D5157 1979 618.3'2
79-10956
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© Springer-Verlag Berlin Heidelberg 1979
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even in the absence of a specific statement, that such names are exempt from the
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Typesetting: SatzStudio Pfeifer, Germering.
Printing and binding: Beltz, Hemsbach/BergstraBe
2120/3321 543210
IV
Contents
Speakers at the 2nd Aberdeen Colloquium ........................ IX
Foreword ....................................................... XI I I
Preface ........................................................ XV
Realignments of Metabolism
1.1 Intermediary Metabolism During Normal Pregnancy
N. Freinkel, R.L. Phelps, B.E. Metzger .................... .
1.2 Metabolic Changes in Pregnancy Relevant to Diabetes
T. Lind, Julia M. Burne, C. Kuhl ........................... 32
1.3 Insulin Response Studies in Normal Pregnancy and Chemical
Gestational Diabetes
P.M. Fisher, H.W. Sutherland, P.O. Bewsher ................. 47
2 Placental Structure Function and Blood Flow
2.1 Utero-Placental Blood Supply in Maternal Diabetes.
W.B. Robertson ....................•........................ 63
2.2 Placental Handling of Glucose
F.E. Hytten ................................................ 76
2.3 Utero-Placental Blood Flow. Methods of Determination, Clini
cal Application and the effect of Beta-Mimetic Agonists
N. 0. Lunell, B. Sarby ...................................... 86
2.4 Placental Changes in Gestational Diabetes
H. Fox ............................•........................ 102
3 Endocrine Pancreas
3.1 The Maternal Endocrine Pancreas.
F.A. Van Assche, L. Aerts .................................. 115
3.2 Amino Acids and Development of the Beta Cell
R.D.G. Milner, M. de Gasparo, G.R. Milner, P.K. Wirdnam .... 132
v
3.3 The Relationship Between Glucagon and Hypocalcaemia in In
fants of Diabetic Mothers
J.M. Stowers, L.G. Heding, P.M. Fisher, I.A.L. Treharne,
I.S. Ross, H.W. Sutherland, P.O. Bewsher, G. Russell,
H.V. Price 152
3.4 Pregnancy Related Factors Affecting Insulin Secretion.
Irene C. Green ............................................. 163
4 Fetal Nutrition and Macrosomia
4.1 Experimental Contributions to the Physiology of Fetal
Macrosomia
R.A. Chez ................................................. 173
4.2 Heavy-for-Dates Babies
H.W. Sutherland, B. Mary Campbell-Brown, P.M. Fisher
I .A. L. Treharne ........................................... 188
4.3 Controlling Factors of Fetal Nutrition
B. Reusens, M. de Gasparo, E.R. Kuhn, J.J. Hoet ........... 208
5 Fetal Anomalies Related to Metabolism
5.1 Fetal Anomalies Related to Carbohydrate Metabolism: The
Epidemiological Approach
J. Malins ................................................. 229
5.2 Experimental Evidence Relating Fetal Anomalies to Diabetes
Elizabeth M. Deuchar ...................................... 247
5.3 Congenital Malformations in Newborns of Diabetic Mothers
J. Pedersen ............................................... 264
6 Antenatal Fetal Monitoring
6.1 Evaluation of Placental Steroids in Diabetic Pregnancy
R. de Hertogh 277
6.2 Fetal Assessment in Diabetic Pregnancy Using Non-steroid
Assessments
Catherine Tchobroutsky .................................... 304
6.3 Management of the Pregnant Diabetic - When and How to
Deliver R.W. Beard ........................................ 334
6.4 The Role of Pregnancy-Specific B1-Glycoprotein in the
Management of Pregnancies Complicated by Diabetes
M.S. Beebeejaun, V. Jandial, C.M. Towler, H.W. Sutherland,
C . H . W. Horne .............................................. 347
VI
7 Symptomatic Diabetes
7.1 Management of Maternal Diabetes in Pregnancy
Nina L. Essex, D.A. Pyke ................................... 357
7.2 Sulphonylureas for Chemical Diabetes in Pregnancy
J .M. Stowers ............................................... 369
7.3 Management of Diabetes During Delivery with an Artificial
Pancreas
M. Nattrass, A.T. Letchworth, K.G.M.M. Alberti,
A.L.J. Buckle .............................................. 370
7.4 Neonatal Problems
B. Persson, J. Gentz, M. Stangenberg ....................... 376
7.5 Preterm Labour and Perinatal Mortality in Diabetic
Pregnancy - Obstetric Considerations
L. M¢lsted-Pedersen ........................................ 392
8 Asymptomatic Diabetes
8.1 Asymptomatic Diabetes in Pregnancy
D. R. Hadden ................................................ 407
8.2 Gestational Diabetes: Factors Influencing the Rates of
Subsequent Diabetes
J.B. O'Sullivan ............................................ 425
8.3 Detection of Chemical Gestational Diabetes
H.W. Sutherland, J.M. Stowers, P.M. Fisher ................. 436
8.4 Qualitative Assessment of Children of Known Gestational
Diabetec Mothers
J. Anne Reid, G. Russell ................................... 462
9 Maternal Weight
9.1 Reproduction in Obese Women
I.A.L. Treharne, H.W. Sutherland, J.M. Stowers, M. Samphier 479
9.2 Weight and Weight Gain in Pregnant Women
I. MacGillivray ............................................ 500
9.~ Glucose Tolerance in Complicated Pregnancies
Doris M. Campbell .......................................... 509
9.4 Dieting in Pregnancy. A Study of the Effect of a High
Protein Low Carbohydrate Diet on Birthweight on an
Obstetric Population
J.F. Kerr-Grieve, B. Mary Campbell-Brown, F.D. Johnstone ... 518
Subject Index ................................................... 535
VII
Speakers at the Aberdeen Colloquium
2nd
Professor R.W. Beard, Gynaecology, University of Aber
Department of Obstetrics and deen, Maternity Hospital,
Gynaecology, St. Mary's Hospital Foresterhill, Aberdeen, AB9 2ZD
Medical School, London, W2 1PG
Professor H. Fox,
Dr. Doris Campbell, Department of Pathology, Univer
Department of Obstetrics and sity of Manchester, Stopford
Gynaecology, University of Aber Building, Oxford Road, Man
deen, Maternity Hospital, chester, M13 9PT
Foresterhill, Aberdeen, AB9 2ZD
Professor N. Freinkel,
Dr. B. Mary Campbell-Brown, Center for Endocrinology Metabo
Department of Obstetrics and lism and Nutrition, Northwestern
Gynaecology, University of Aber University, The Medical School,
deen, Maternity Hospital, 303 East Chicago Avenue,
Foresterhill, Aberdeen, AB9 2ZD Chicago, Illinois 60611
Professor R.A. Chez, Dr. Irene C. Green,
Department of Obstetrics and School of Biological Sciences,
Gynaecology, Howard University The University of Sussex Biology
College of Medicine, Howard Uni Building, Falmer, Brighton,
versity Hospital, Suite 3C-01, Sussex, BN1 9QG
Washington, D.C. 20060
Dr. D. Hadden,
Dr. Elizabeth Deuchar., Royal Victoria Hospital, Grosve
Department of Biological Scien nor Road, Belfast, BT12 6BA
ces, University of Exeter,
Hatherly Laboratories Prince of Dr. R. De Hertogh,
Wales Road, Exeter, EX4 4PS Universite Catholique de
Louvain, Cliniques Universitai
Dr. P.M. Fisher, res Saint-Luc, Avenue Hippocrate
Department of Obstetrics and 10, 1200 Bruxelles
IX
Professor J.J. HOet, Professor R.D.G. Milner,
Endocrinology and Nutrition Unit Department of Paediatrics, Uni
Universite Catholique de Louvain versity of Sheffield, Children's
Endi 5429 Hospital, Sheffield, SLO 2TH
Avenue Hippocrate 54
Brussels Belgium Dr. L. M¢lsted-Pedersen,
Diabetes Centre, Department of
Dr. F.E. Hytten, Obstetrics and Gynaecology, Rigs
Clinical Research Centre, Divi hospitalet, University of Copen
sion of Perinatal Medicine, Wat hagen, Copenhagen
ford Road, Harrow, Middlesex,
HA1 3UJ Dr. M. Nattrass,
University Chemical Pathology &
Dr. V. Jandial, Human Metabolism, Level D South
Department of Obstetrics and Laboratory & Pathology Block, Ge
Gynaecology, University of Aber neral Hospital, Southampton S09
deen, Maternity Hospital, 4XY
Foresterhill, Aberdeen, AB9 2ZD
Dr. J. O'Sullivan,
Dr. T. Lind,
Boston University Medical Center,
MRC Reproduction and Growth
Diabetes and Arthritis Unit, 408
Unit, Princess Mary Maternity
Atlantic Avenue, Rrn. 815, Boston,
Hospital, Great North Road, New
MA 02110
castle upon Tyne, NE2 3 BD
Professor J. Pedersen,
Dr. N-O. Lunell,
Bispebjerg Hospital, Med. afd. T,
Department of Obstetrics and
Bispebjerg, Bakke 23, 2400 Koben
Gynaecology, Karolinska Institu
havn NV
tet, Huddinge University Hospi
tal, S-141 86 Huddinge
Dr. B. Persson,
Professor I. MacGillivray, Karolinska Institute, Department
Department of Obstetrics and of Pediatrics, St. Goran's
Gynaecology, University of Aber Children's Hospital Box 12500,
deen, Maternity Hospital, S-112 81 Stockholm
Foresterhill, Aberdeen, AB9 2ZD
Professor J.M. Malins, Dr. D.A. Pyke,
Central Birmingham Health Kings Health District (Teaching)
District, The General Hospital, Diabetic Clinic King's College
Steelhouse Lane, Birmingham B4 Hospital, Denmark Hill, London
6NH SE5 9RS
x
Dr. Anne Reid, Dr. H.W. Sutherland,
Department of Child Health, Uni Department of Obstetrics and
versity of Aberdeen, Medical Gynaecology, University of Aber
School, Foresterhill, Aberdeen, deen, Maternity Hospital,
AB9 2ZD Foresterhill, Aberdeen, AB9 2ZD
Dr. B. Reusens, Dr. Catherine Tchobroutsky,
Unit for Endocrinology and Maternite Port-Royal, 123 Bd. de
Nutrition Medical Faculty of the Port-Royal, 75014 Paris
University of Louvain, 1200
Brussels
Dr. I.A.L. Treharne,
St. Mary's Hospital
Professor W.B. Robertson,
Harrow Road
Department of Histopathology,
London, W9 3RL
St. George's Hospital Medical
School, University of London,
Dr. A. Van Assche,
Cranmer Terrace, Tooting, Lon
Academisch Ziehenhuis, Sint
don, SW17 ORE
Rafael, 3000 Leuven, Kapucijnen
voer 33
Dr. J.M. Stowers,
Diabetic Clinic, Woolmanhill,
Royal Infirmary, Aberdeen
AB9 1GS
XI
Forevvord
In the rush of events when one is organising a conference or giving
a paper, it is sometimes difficult to see the wood for the trees.
The non-combatant sees the battle in a different light. Which is
perhaps what John Stowers and Hamish Sutherland had in mind by
asking someone on the fringe of the subject to write the foreword to
their record of the second Aberdeen International Colloquium on Car
bohydrate Metabolism in Pregnancy and the Newborn. A dangerous
enterprise, - unprejudiced judgment can also be inexpert.
Those familiar with the volume which followed the first colloquium
three years ago will recognise some of the protagonists, but there
are many new names, reflecting new ideas and the remarkable progress
which has been made in this short while. At this rate there will be
reason for another meeting in a few years. And another. We are
perilously close to establishing a tradition. The Aberdeen setting
is conducive to that. King's College may not have the soft appeal of
other, younger, establishments in the south but the lovely crown
tower has brooded over six centuries of academic comings and goings
and with a little help from Houston will continue to do so for a
while yet.
It is not my intention to review the meeting or to comment on the
papers in this volume, but to examine how far a scientific confe
rence and the report of the conference can be reconciled. There are
essential differences between the spoken and the written word which
cannot be ignored. Of course a book cannot give the excitement of
the rub of mind against mind, and it would be only a pale shadow of
the occasion if it set out just to record the meeting. The editors
have encouraged speakers to set forth their presentation as an
organised piece of writing and have tried to produce a volume in
its own right; of value to those with no particular interest in the
conference from which it sprang.
XIII