Diabetes in Pregnancy: The Complete Guide to Management PDF
Preview Diabetes in Pregnancy: The Complete Guide to Management
Lisa E. Moore Editor Diabetes in Pregnancy The Complete Guide to Management 123 Diabetes in Pregnancy Lisa E. Moore Editor Diabetes in Pregnancy The Complete Guide to Management Editor Lisa E. Moore Texas Tech Health Sciences Center Paul L. Foster School of Medicine El Paso, TX USA ISBN 978-3-319-65517-8 ISBN 978-3-319-65518-5 (eBook) https://doi.org/10.1007/978-3-319-65518-5 Library of Congress Control Number: 2017963057 © Springer International Publishing AG 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduc- tion on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of pub- lication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Contents 1 Pathophysiology of Insulin Resistance � � � � � � � � � � � 1 Lisa E. Moore 2 Fetal and Neonatal Consequences of Maternal Diabetes � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 7 Lisa E. Moore 3 Preconception Counseling � � � � � � � � � � � � � � � � � � � � � 17 Lisa E. Moore 4 Type 1 Diabetes � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 25 Lisa E. Moore 5 Type 2 Diabetes � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 37 Lisa E. Moore 6 Screening, Diagnosis, and Management of Gestational Diabetes � � � � � � � � � � � � � � � � � � � � � � � � 45 Lisa E. Moore 7 Prenatal Care for the Pregnant Diabetic Patient � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 61 Lisa E. Moore 8 Patient Education � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 69 Diana Clokey and Lisa E. Moore 9 The Diabetic Diet � � � � � � � � � � � � � � � � � � � � � � � � � � � � 81 Diana Clokey 10 Insulin � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 87 Lisa E. Moore v vi Contents 11 Oral Hypoglycemic Agents � � � � � � � � � � � � � � � � � � � � � 103 Lisa E. Moore 12 B asic Insulin Pump Management � � � � � � � � � � � � � � � 111 Lisa E. Moore 13 Diabetic Ketoacidosis � � � � � � � � � � � � � � � � � � � � � � � � � 127 Lisa E. Moore 14 I ntrapartum and Postpartum Management of Diabetes � � � � � � � � � � � � � � � � � � � � � � 137 Lisa E. Moore 15 Fetal Macrosomia � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 143 Ellen Mozurkewich 16 T he Ultrasound Evaluation of the Diabetic Pregnancy � � � � � � � � � � � � � � � � � � � � � � � � � � � 163 Carla Ann Martinez 17 Antepartum Testing � � � � � � � � � � � � � � � � � � � � � � � � � � � 183 Valerie Rappaport 18 C ontraception for Women with Diabetes � � � � � � � � � 209 Sushila Arya and Sanja Kupesic 19 Diabesity � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 235 Lisa E. Moore Index � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 247 About the Editor Dr� Lisa Moore is professor and chief of the division of maternal–fetal medicine at the Paul L Foster School of Medicine at Texas Tech Health Sciences center in El Paso, Texas. She is also the director of the diabetes in pregnancy program and has ongoing research in the medical manage- ment of diabetes in pregnancy. She received her medical degree from Duke University medical school followed by a residency in obstetrics and gynecology at the Medical College of Georgia and Fellowship in Maternal–Fetal medicine at the University of Mississippi. vii List of Contributors Sushila Arya, MD, FACOG Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA Diana Clokey, MSRD, RPH, CDE Albuquerque, NM, USA Sanja Kupesic, MD, PhD Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA Carla Ann Martinez, MD Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center El Paso Paul L. Foster School of Medicine, El Paso, TX, USA Lisa E� Moore, MD, FACOG Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, USA Ellen Mozurkewich, MD, MS Obstetrics and Gynecology, University of New Mexico, MSC 10 5580, 1 University of New Mexico, Albuquerque, NM, USA Valerie Rappaport, MD Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA ix Chapter 1 Pathophysiology of Insulin Resistance Lisa E. Moore Fast Facts • All women have a 50–60% decrease in insulin sensi- tivity as the pregnancy progresses. Women who develop gestational diabetes have preexisting glu- cose intolerance upon which this normal pregnancy effect is superimposed. • Increased insulin resistance helps with glucose trans- fer to the fetus. • The placentas of women with gestational diabetes are larger in both size and weight and histologically demonstrate ischemic changes, immature villi, and fibrinoid necrosis of villi. L.E. Moore, MD, FACOG Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, USA e-mail: [email protected] © Springer International Publishing AG 2018 1 L.E. Moore (ed.), Diabetes in Pregnancy, https://doi.org/10.1007/978-3-319-65518-5_1 2 L.E. Moore 1.1 Introduction The World Health Organization (WHO) classifies diabetes as DM type 1 characterized by autoimmune destruction of the beta cells of the pancreas, DM type 2 characterized by insulin resistance and relative insulin insufficiency, gestational diabe- tes (GDM) which is carbohydrate intolerance identified dur- ing pregnancy and is also characterized by insulin resistance and relative insulin insufficiency, and rare types of diabetes such as drug-induced diabetes or abnormalities of beta cell function. Gestational diabetes and type 2 diabetes are gener- ally considered to be the same disease manifesting at different times in life. The pregnancy is believed to unmask the tendency toward type 2 diabetes, and it should be noted that the 5-year risk of developing type 2 diabetes in women with GDM is as high as 60% [1]. To understand how gestational diabetes develops, it is nec- essary first to understand when and how glucose is used by maternal-fetal-placental unit. Glucose and amino acids are the primary nutrients for the developing fetus. During human pregnancy, several metabolic changes occur to promote efficient glucose transport, from the mother, across the placenta, to the developing conceptus. It is likely that during human evolution, these changes were effective and not harmful. When this physiologic process interacts with the modern lifestyle with a carbohydrate-rich diet and an obesity epidemic, gestational diabetes is the result. 1.2 Insulin Resistance Insulin release from beta cells is stimulated by the presence of high glucose levels in the blood. Insulin then stimulates the entry of that glucose into muscle cells and adipose cells as well as other types of tissues. As blood glucose levels fall, insulin secretion also decreases or stops. The action of insulin is mediated by the insulin receptor which is found in the plasma membrane. The insulin receptor is made up of two
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