Diabetes in women : adolescence, pregnancy, and menopause

502 Pages·2004·11.28 MB·English

by  E. Albert Reece MD

Diabetes Mellitus in
Women Adolescence
Through Pregnancy
and Menopause 

3rd  Edition
2004
Lippincott Williams & Wilkins
Philadelphia
530 Walnut Street, Philadelphia, PA 19106 USA
978-0-7817-3861-3
0-7817-3861-X
Acquisitions Editor: Ruth Weinberg
Developmental Editor: Grace Caputo, Erin McMullan
Production Manager: Toni Ann Scaramuzzo
Production Editor: Michael Mallard
Manufacturing Manager: Benjamin Rivera
Cover Designer: Brian Crede
Compositor: Lippincott Williams & Wilkins Desktop Division
Printer: Maple Press
© 2004 by LIPPINCOTT WILLIAMS & WILKINS
530 Walnut Street
Philadelphia, PA 19106 USA
LWW.com
All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by
any means, including photocopying, or utilized by any information storage and retrieval system without written
permission from the copyright owner, except for brief quotations embodied in critical articles and reviews.
Materials appearing in this book prepared by individuals as part of their official duties as U.S. government
employees are not covered by the above-mentioned copyright.
Printed in the USA
Library of Congress Cataloging-in-Publication Data
ISBN: 0-7817-3861-X
Care has been taken to confirm the accuracy of the information presented and to describe generally accepted
practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any
consequences from application of the information in this book and make no warranty, expressed or implied, with
respect to the currency, completeness, or accuracy of the contents of the publication. Application of this
information in a particular situation remains the professional responsibility of the practitioner.
The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in
this text are in accordance with current recommendations and practice at the time of publication. However, in
view of ongoing research, changes in government regulations, and the constant flow of information relating to drug
therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in
indications and dosage and for added warnings and precautions. This is particularly important when the
recommended agent is a new or infrequently employed drug.
Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance
for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the
FDA status of each drug or device planned for use in their clinical practice.
10 9 8 7 6 5 4 3 2 1
AUTHORS
E. Albert Reece M.D., PH.D., M.B.A.
Vice Chancellor and Dean
Professor of Obstetrics & Gynecology, Internal Medicine and Biochemistry
University of Arkansas College of Medicine
Little Rock, Arkansas
Donald R. Coustan M.D.
Chace/Joukowsky Professor and Chair
Department of Obstetrics and Gynecology
Brown Medical School
Obstetrician and Gynecologist in Chief
Women and Infants Hospital of Rhode Island
Providence, Rhode Island
Steven G. Gabbe M.D.
Dean, Vanderbilt University School of Medicine
Professor of Obstetrics and Gynecology
Vanderbilt University Medical Center
Nashville, Tennessee
CONTRIBUTORS
Frederick C. Battaglia M.D.
Professor of Pediatrics, Department of Pediatrics, University of Colorado Health Sciences Center, Aurora,
Colorado
Peter H. Bennett M.D., F.R.C.P.
Senior Investigator, Phoenix Epidemiology and Clinical Research Branch, NIDDK, NIH, Phoenix, Arizona
Wendy J. Brickman M.D.
Assistant Professor of Pediatrics, Northwestern University Feinberg School of Medicine, Children's Memorial
Hospital, Chicago, Illinois
Thomas A. Buchanan M.D.
Departments of Obstetrics and Gynecology and Medicine, Keck School of Medicine, University of Southern
California, Los Angeles, California
Marshall W. Carpenter M.D.
Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
Patrick Catalano M.D.
Professor of Reproductive Biology, Case Western Reserve University; Chairman, Department of Obstetrics and
Gynecology, Metro-Health Medical Center, Cleveland, Ohio
Nam H. Cho M.D., Ph.D., C.C.D.
Professor of Preventive Medicine, Ajou University School of Medicine; Director of Clinical Epidemiology, Ajou
University Hospital, Suwon, Korea
Larry Cousins M.D.
Division of Perinatology, Mary Birch Hospital for Women, San Diego, California
Donald R. Coustan M.D.
Chace/Joukowsky Professor and Chair, Department of Obstetrics and Gynecology, Brown Medical School;
Obstetrician and Gynecologist in Chief, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
Dana Dabelea M.D., Ph.D.
Assistant Professor, Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver,
Colorado
Gernot Desoye Ph.D.
Clinic of Obstetrics and Gynecology, Karl-Franzens-University, Vienna, Austria
Esther Eisenberg M.D., M.P.H.
Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
Steven C. Elbein M.D.
Department of Endocrinology, John L. McClellan Veterans Hospital, Little Rock, Arkansas
Ulf J. Eriksson M.D.
Professor, Department of Medical Cell Biology, University of Uppsala, Uppsala, Sweden
Steven G. Gabbe M.D.
Dean, School of Medicine, Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tennessee
Sandro Gabrielli M.D.
Cattefra Frisiopatologia Prenatale, Clinica Obstetrica e Ginecologia, Universita de Bologna, Bologna, Italy
Henry L. Galan M.D.
Assistant Professor, Department of Obstetrics and Gynecology, Division of Perinatal Medicine, University of
Colorado Health Sciences Center, Aurora, Colorado
Philip A. Goldberg M.D.
Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven,
Connecticut
Andrea C. Hinton M.D.
Maternal Fetal Medicine Fellow, Department of Obstetrics and Gynecology, University of Cincinnati School of
Medicine, Cincinnati, Ohio
Irl B. Hirsch M.D.
Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington School of
Medicine; Diabetes Care Center, University of Washington Medical Center, Seattle, Washington
Carol J. Homko Ph.D., R.N.
Temple University Hospital, Philadelphia, Pennsylvania
Lois Jovanovic M.D.
Director and Chief Scientific Officer Sansum Medical Research Institute; Clinical Professor of Medicine, University
of Southern California, Los Angeles, California; Adjunct Professor of Biomolecular Science and Engineering,
University of California-Santa Barbara, Santa Barbara, California
John L. Kitzmiller M.D.
Los Gatos, California
Siri L. Kjos M.D.
Professor, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California,
Los Angeles, California
Mark B. Landon M.D.
Professor and Vice Chairman, Department of Obstetrics and Gynecology, Ohio State University School of Medicine,
Columbus, Ohio
Oded Langer M.D.
Babcock Professor and Chairman, Department of Obstetrics and Gynecology, St. Lukes-Roosevelt Hospital Center,
University Hospital of Columbia University, New York, New York
Gustavo F. Leguizamón M.D.
Assistant Professor, Department of Obstetrics and Gynecology, CEMIC University, Chief High Risk Pregnancy Unit,
CEMIC University Hospital, Buenos Aires, Argentina
Ginny Lewis M.N., A.R.N.P., C.D.E.
Diabetes Care Center, University of Washington Medical Center, Seattle, Washington
Barbara Luke Sc.D., M.P.H., R.D.
Department of Epidemiology and Public Health, University of Miami School of Medicine, Miami, Florida
Jorge H. Mestman M.D.
Professor of Medicine and Obstetrics and Gynecology, Keck School of Medicine, University of Southern California,
Los Angeles, California
Boyd E. Metzger M.D.
Tom D. Spies Professor of Medicine, Division of Endocrinology, Northwestern University Feinberg School of
Medicine; Attending Physician, Northwestern Memorial Hospital, Chicago, Illinois
Menachem Miodovnik M.D.
Professor and Chair, Department of Obstetrics and Gynecology, Washington Hospital Center, Washington, D.C.
Martin N. Montoro M.D.
Division of Maternal-Fetal Medicine, Women's and Children's Hospital, Los Angeles, California
Leslie Myatt Ph.D.
Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
William Oh M.D.
Professor of Pediatrics, Brown University, Rhode Island Hospital, Providence, Rhode Island
David J. Pettitt M.D.
Senior Scientist, Clinical Research Department, Sansum Medical Research Institute, Santa Barbara, California
Gianluigi Pilu M.D.
Attending Physician, Department of Obstetrics and Gynecology, University of Bologna School of Medicine, Bologne,
Italy
Neda Rasouli M.D.
Instructor, Division of Endocrinology, University of Arkansas for Medical Sciences, Little Rock VA Hospital, Little
Rock, Arkansas
E. Albert Reece M.D., Ph.D.
Vice Chancellor and Dean, Professor of Obstetrics & Gynecology, Internal Medicine and Biochemistry, University of
Arkansas College of Medicine, Little Rock, Arkansas
Barak M. Rosenn M.D.
Associate Professor of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons;
Director of Obstetrics and Maternal-Fetal Medicine, St. Luke's Roosevelt Hospital Center, New York, New York
Robert S. Sherwin M.D.
Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven,
Connecticut
Gerald I. Shulman M.D.
Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven,
Connecticut
Baha M. Sibai M.D.
Professor and Chairman, Department of Obstetrics/Gynecology, University of Cincinnati, Cincinnati, Ohio
Kathryn M. Thrailkill M.D.
Associate Professor of Pediatrics, University of Arkansas College of Medicine, Little Rock, Arkansas
A Tribute to Dr. Priscilla White
(March 17, 1900 to December 16, 1989)

Dr. White in 1987.
The past half-century has seen dramatic changes in the management of pregnancy complicated by diabetes, and
equally dramatic improvements in outcomes. We of a younger generation of researchers have come late upon the
scene, at a time when many of the major advances of the past are taken for granted. For this reason, we feel it
appropriate to credit the formative work of early investigators, particularly Dr. Priscilla White, who is
acknowledged to be one of the outstanding contributors to the study of diabetes in pregnancy.
In the course of working on the first edition of this book, we were privileged to confer with Dr. White and to hear
her personal recollections of 50 years of research and patient care, in which Dr. White captured quite vividly the
sadness and gloom, and the dismal reproductive prognosis for diabetic women. As Dr. White remembered:
Diabetic women were discouraged from becoming pregnant, and termination of
pregnancy was often recommended for those who did. Before insulin was available,
patients often died during the course of their pregnancy, or their fetuses often died
before birth, or as infants Any successful pregnancy was remarkable, so doctors spent
almost the entire pregnancy with their patients. We saw them weekly, practically.
When they came in labor, I was notified immediately and stayed with them through
the entire labor. Delivery was often done prematurely, because if patients were
allowed to go to term, the babies would die. We did see, however, fewer mothers
die following the introduction of insulin.
Dr. White spent virtually all her distinguished career in Boston, primarily at the Joslin Clinic caring for pregnant
women with diabetes. Her writings have been extensive and have served as mileposts chronically the advances in
management and outcome from the early 1920s through the late 1970s. Her system of classification of diabetes
among pregnant women was the international standard by which such patients were described.
Her descriptions of the hardships experienced by diabetic individuals prior to the discovery of insulin underscore
the tremendous contribution made by Dr. White and her contemporaries. Dr. White will always be respected and
remembered with affection by diabetologists, obstetricians, and others who care for diabetic women during their
pregnancies. Without the immense strides made by these forerunners, today's advancements might still be out of
reach. We presented a copy of the first edition of this book to Dr. White. She graciously accepted our tribute. In
1989, Dr. White died at the age of 89. Fortunately, her contribution lives on!
E. Albert Reece M.D., Ph.D., M.B.A.
Donald R. Coustan M.D.
Steven G. Gabbe M.D.
PREFACE
The third edition of Diabetes in Women provides an updated educational and therapeutic resource for those who
care for women with diabetes during adolescence, pregnancy and beyond. While continuing to provide information
about diabetes in pregnancy for the healthcare professional, we have widened our scope in this new edition. The
risk factors for diabetes are growing in epidemic proportions, and, as a result, it has become more and more
common in the United States. We are witnessing an alarming increase of diabetes in the adolescent. Diabetes is
now characterized as a major women's health issue and we recognize that diabetes poses particular challenges for
women.
As healthcare makes remarkable strides in the control of diabetes, we also recognize that the increase of a
woman's life expectancy with the disease presents new challenges. Accordingly, we have expanded this third
edition to include the full-spectrum of diabetes in women. The prognosis for women with diabetes continues to
improve as does that of their offspring. The revised and current state of knowledge in this edition continues to
stress the importance of closely monitored metabolic control in the management of diabetes in pregnancy, but
also addresses the entire life cycle of diabetes in adolescence, pregnancy and menopause. The changes
recommended by our contributors for the diagnosis of diabetes should prove beneficial to patients, and the value
of continued research, innovation and monitoring will constantly change the diabetes landscape.
The enormous increase in both our understanding and knowledge has proved beneficial in fostering new
management strategies for women of all ages with diabetes. Technology, monitoring, quality of care, and up-to-
date guidance and information expand the scope of this edition. The data included have served as the bases for
the many new medical considerations and guidelines for managing diabetes throughout a woman's life. This third
edition recognizes the educational programs, risk assessments and support for quality care and self-management
that should assist in increasing the lifespan of women with diabetes.
In aggregate, we have seen overall health improvement for women with diabetes, largely due to better risk
assessment, screening, monitoring and management. This edition presents new and updated information on the
best treatment options and on dietary management, patient education, genetics, perinatal counseling, diabetes
prevention, long-term care of complications, postpartum and menopause. Appropriate care and disease
management must be promoted across the span of a woman's life stages. It is our hope that in the ever-changing
landscape of information and research, this edition continues to contribute to meet the expanding needs of
healthcare professionals.
Gratefully, we acknowledge the contributions of many outstanding experts whose efforts and authoritative reviews
and guidance make this publication one which reflects new strategies and practices that will bring new advances in
understanding and preventing diabetes.
E. Albert Reece M.D., Ph.D., M.B.A.
Donald R. Coustan M.D.
Steven G. Gabbe M.D.
P.xi
ACKNOWLEDGMENTS
We would like to express our gratitude to our contributors, who have painstakingly written comprehensive, highly
informative, and scholarly chapters. Efforts like these can only be described as labors of love. In addition, all our
secretaries and administrative assistants collectively deserve much praise and commendation for the many hours
devoted to typing, reviewing, correcting, copying and mailing the many versions of the manuscripts. Finally, we
remain indebted to the editors of Lippincott Williams & Wilkins, especially Ms. Lisa McAllister and Ms. Grace
Caputo. Overall, their persistent demeanor enabled the timely publication of this book.
We are deeply grateful to all those who collaborated in bringing this project to fruition, from the first edition
through the current one.
E. Albert Reece M.D., Ph.D., M.B.A.
Donald R. Coustan M.D.
Steven G. Gabbe M.D.
Contents
PREFACE
ACKNOWLEDGMENTS
A Tribute to Dr. Priscilla White
Contents
Section I. General Medical and Primary Care for Women with Diabetes
1 The History of Diabetes Mellitus
2 The Rising Tide of Diabetes Mellitus: Implications for Women of All Ages
3 Management of Diabetes Mellitus
4 Diabetes Care for Adolescents
5 Genetics, Perinatal Counseling, and Diabetes Education
6 Preconceptional Care of Women with Diabetes
7 Long-Term Care of Medical Complications of Diabetes
8 Menopause and Diabetes
Section II. Metabolic Considerations
9 Carbohydrate, Lipid, and Amino Acid Metabolism
10 Metabolic Changes During Normal and Diabetic Pregnancies
11 The Placenta
12 The Biology of Normal and Abnormal Fetal Growth and Development
Section III. The Fetus and Placenta
13 Congenital Malformations: Epidemiology, Pathogenesis, and Experimental Methods of Induction and
Prevention
14 Perinatal Mortality and Morbidity
Section IV. Pregnancy Complicated by Gestational Diabetes
15 Testing for Gestational Diabetes
16 Management of Gestational Diabetes
17 Interaction Between Pregnancy, Gestational Diabetes, and Long-Term Maternal Outcome
Section V. Pregnancy Complicated by Pre-Existing Diabetes
18 Glucose Evaluation and Control
19 Insulin Treatment of the Pregnant Patient with Diabetes Mellitus
20 Dietary Management
21 Exercise in Normal and Diabetic Pregnancies
22 Prenatal Diagnosis and Management of Congenital Malformations in Pregnancies Complicated by Diabetes
23 Diagnosis and Management of Abnormal Fetal Growth
24 Fetal Biophysical and Biochemical Testing
25 Diabetic Ketoacidosis in Pregnancy
26 Obstetric Complications in Diabetic Pregnancies
27 Hypertensive Disorders in Pregnancy
28 Diabetic Retinopathy
29 Clinical Diabetic Nephropathy Before and During Pregnancy*
30 Diabetic Neuropathy and Coronary Heart Disease
Section VI. Peripartum and Neonatal Care
31 Delivery: Timing, Mode, and Management
32 Postpartum Management, Lactation, and Contraception
33 Neonatal Outcome and Care
34 Long-Term Outcome of Infants of Diabetic Mothers
Appendix
SUBJECT INDEX