Gestational Diabetes During and After Pregnancy

382 Pages·2010·2.62 MB·English

Gestational Diabetes During and After Pregnancy
Catherine Kim • Assiamira Ferrara (Editors)
Gestational Diabetes
During and After
Pregnancy
Dr. Catherine Kim Dr. Assiamira Ferrara
Department of Obstetrics Division of Research,
and Gynecology, Kaiser Permanente Northern California,
University of Michigan, Oakland, CA,
Ann Arbor, MI, USA
USA
ISBN: 978-1-84882-119-4 e-ISBN: 978-1-84882-120-0
DOI: 10.1007/978-1-84882-120-0
Springer Dordrecht Heidelberg London New York
A catalogue record for this book is available from the British Library
Library of Congress Control Number: 2010933596
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We dedicate this book to Bob Knopp, a pioneer in GDM. He died
unexpectedly, shortly after the completion of his chapter. His work is
especially relevant now, given the increasing recognition that lipids
play a crucial role in the effects of GDM upon the offspring. We
would also acknowledge Yeong, Sofia, Sam, Stephen and Stella.
Many thanks to Samantha Ehrlich for her patience and thoroughness
in assisting with this book.
Preface
Gestational diabetes (GDM), or glucose intolerance first identified during pregnancy, is a
disease of our times. While diabetes as a disease has been recognized for thousands of
years, GDM is a relatively new condition that has been identified as recently as the nine-
teenth century. Recognition of the full impact of GDM is only possible because of the
declines in maternal and child mortality, increases in obesity and chronic disease, and
increased delivery of prenatal care, GDM screening, and infertility services that are unique
to modern society.
One of the reasons that GDM fascinates us is that it represents the intersection of both
the mother’s and her child’s health trajectory, and the management of it can affect not only
perinatal health but also the development of disease even decades into the future. Our
understanding of these relationships has grown over the past several decades, fed by
progress made in other areas of diabetes research, particularly genetics, diabetes preven-
tion in high-risk populations, and inflammatory biomarkers.
This book is our attempt to summarize the exciting developments in our understanding
of this unique entity. Our book begins with an overview by Dr. Jack Kitzmiller, who guides
us through the changing face of GDM over the past several decades. His chapter delves
into the randomized trials published over the past several years and the diagnostic strate-
gies advocated as recently as 2009. This overview is followed by a detailed description of
the landmark Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study, unique in
its size and international setting. The current state of GDM screening worldwide is sum-
marized by Dr. Agarwal, who provides a comprehensive overview of the several coexist-
ing guidelines.
The next section discusses the current burden that GDM poses and the reasons why we
expect that GDM will affect ever larger portions of the population. Dr. Lawrence discusses
the prevalence of GDM and its overlap with diabetes which preceded pregnancy. Dr. Zhang
gives a detailed summary of risk factors for GDM, informed by her extensive work in
cohort studies, most notably the Nurses’ Health Study. Importantly, GDM is not a “west-
ern” condition but has increasing importance for rapidly industrializing countries. Drs.
Yang and Shou discuss how GDM has increased in China, a matter of particular concern
considering the million-plus births which occur in China annually.
Our understanding of the genetics and pathophysiology of GDM has grown rapidly
over the past decade. The role of the placenta, a powerful but still poorly understood endo-
crine organ, is discussed by Drs. Desoye and Hiden in their chapter. Drs. Buchanan and
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viii Preface
Xiang review their key insulin clamp studies in GDM women, which furthered our under-
standing of the overlap between GDM and type 2 diabetes. Drs. McCurdy and Friedman
discuss their work on insulin resistance during GDM, particularly in skeletal muscles. Drs.
Knopp and colleagues review their lipid work and also introduce several exciting new
findings regarding the evolution of lipids during pregnancy. The coexistence of hyperten-
sive disorders of pregnancy and carbohydrate intolerance of pregnancy has long been rec-
ognized and is summarized by Drs. Sibai and Habli in the following chapter.
As the number of women with GDM increases, so do perinatal comorbidities. Dr.
Nicholson reviews obesity during pregnancy and its impact on perinatal complications,
particularly for the GDM pregnancy. Her chapter is followed by a detailed discussion of
the other obstetrical complications that accompany GDM by Drs. Kjos and Guberman. Dr.
Dabelea reviews how GDM can have longer-term complications through “imprinting” in
the intrauterine environment, exemplifying how GDM continues to affect child health
even years after delivery.
Thus, we have set the stage for current management options of GDM, both during and
after pregnancy. Drs. Artal, Zavorsky, and Catanzaro discuss current exercise recommen-
dations and studies illustrating the strength of evidence behind physical activity limitations
during pregnancy. Drs. King and Sacks extend this to a valuable review of the myriad
recommendations regarding nutrition and weight management during the GDM pregnancy.
This section on management is accompanied by Dr. Langer’s chapter on pharmacologic
treatment options, both regarding oral medications and insulin.
GDM was first defined by O’Sullivan and Mahan by maternal diabetes risk, and Dr.
Kim discusses this risk and other factors contributing this risk in the next chapter. Dr.
Hedderson reviews the interaction between hormonal and non-hormonal family planning
with GDM in the following chapter. Dr. Gunderson discusses the fascinating literature
regarding breast-feeding, a behavior that affects chronic disease risk decades into the
future, even when engaged in over only several months.
Interventions to prevent GDM and to target GDM for future diabetes prevention are
few. Dr. Chasan-Taber reviews her own work on GDM prevention during pregnancy, fol-
lowed by Dr. Ferrara and Dr. Ehrlich, who review intervention science for diabetes preven-
tion in GDM women.
Our book concludes with a discussion of where key medical organizations stand on
management of GDM. The lack of uniformity across organizations leaves room for
improvement. Consensus would aid in a more effective plan to address the many health
implications raised by GDM and the multiple areas for future research raised in these
chapters.
There are several obvious problems caused by the lack of uniform GDM definitions,
tracking, and management recommendations. Given the extensive overlap between GDM
and diabetes, the advances in diabetes pathophysiology, epidemiology, and healthcare
delivery could serve as a template for further development of GDM infrastructure. In the
United States, the fragmentation of health care and its accompanying variation in GDM
screening strategies hamper the compilation of a large cohort of GDM women. Globally,
this fragmentation is accompanied by variation between countries. In turn, this has ham-
pered genetic studies, which require larger numbers particularly for genome-wide associa-
tion work. National tracking systems or registries are currently limited regarding their
Preface ix
sensitivity and specificity for GDM, and more work should be done to refine these tools. It
has also limited our understanding of how future diabetes develops in these women and
their children. Cohort studies which acknowledge the onset of time between GDM devel-
opment and future disease are difficult, but could be modeled on prospective cohort studies
that have examined cardiovascular risk. Such studies would need to follow children as well
as mothers.
Ann Arbor, MI, USA Catherine Kim
Oakland, CA, USA Assiamira Ferrara
Contents
 1   An Overview of Problems and Solutions in  
the Diagnosis and Treatment of Gestational Diabetes ..................................... 1
John L. Kitzmiller
Section I  Screening for and Identification of GDM During Pregnancy
 2   Hyperglycemia and Adverse Pregnancy Outcome  
(HAPO) Study: An Overview ............................................................................ 17
Lynn P. Lowe, Boyd E. Metzger, Alan R. Dyer, Donald R. Coustan,
David R. Hadden, Moshe Hod, Jeremy J. N. Oats, Bengt Persson,
Elisabeth R. Trimble G and the HAPO
Study Cooperative Research Group
 3   Evolution of Screening and Diagnostic  
Criteria for GDM Worldwide ............................................................................ 35
Mukesh Agarwal
Section II  Burden of GDM in US Populations
 4  Prevalence of GDM ............................................................................................. 53
Jean M. Lawrence
 5   Risk Factors for Gestational Diabetes: from  
an Epidemiological Standpoint .......................................................................... 71
Cuilin Zhang
Section III  Burden of GDM in Developing Countries
 6  Burden of GDM in Developing Countries ........................................................ 85
Chong Shou and HuixiaYang
Section IV  Pathophysiology and Genetics of GDM
 7  Insulin and the Placenta in GDM ...................................................................... 97
Ursula Hiden and G. Desoye
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 8  What Causes Gestational Diabetes? .................................................................. 113
Thomas A. Buchanan and Anny H. Xiang
 9   Mechanisms Underlying Insulin Resistance  
in Human Pregnancy and Gestational Diabetes Mellitus................................ 125
Carrie E. McCurdy and Jacob E. Friedman
10  Inflammation, Adipokines, and Gestational Diabetes Mellitus ...................... 139
Ravi Retnakaran
11  Lipids in Gestational Diabetes: Abnormalities and Significance .................... 155
Robert H. Knopp, Elizabeth Chan, Xiaodong Zhu,
Pathmaja Paramsothy, and Bartolome Bonet
12  Blood Pressure in GDM ...................................................................................... 171
Baha Sibai and Mounira Habli
13  Genetics of Gestational Diabetes Mellitus and Type 2 Diabetes ..................... 181
Richard M. Watanabe
Section V  Comorbidities of GDM
14   Maternal Obesity and Epidemiological  
Review of Pregnancy Complications ................................................................. 197
Wanda K. Nicholson
15   Maternal Comorbidities During Gestational Diabetes Mellitus:  
Obstetrical Complications, Prematurity, and Delivery ................................... 215
Cristiane Guberman and Siri L. Kjos
16   The Diabetic Intrauterine Environment: Short  
and Long-Term Consequences ........................................................................... 227
Dana Dabelea
Section VI  Management of GDM During Pregnancy
17   Exercise Recommendations in Women  
with Gestational Diabetes Mellitus .................................................................... 243
Gerald S. Zavorsky, Rosemary B. Catanzaro, and Raul Artal
18   Nutrition and Weight Recommendations  
for Treating Gestational Diabetes Mellitus ....................................................... 259
Janet C. King and David A. Sacks
19  Pharmacological Treatment Options for Gestational Diabetes ...................... 281
Oded Lange