Gestational Diabetes: Origins, Complications, and Treatment

236 Pages·2014·2.032 MB·English

by  Peter A M Weiss, Donald R Coustan

Nutrition
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DDiiaabbeetteess
Origins, Complications, and Treatment
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Edited by Clive J. Petry
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Given the rapid increase in the worldwide incidence of gestational diabetes,
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the need for defining the risks and effects associated with raised glucose con-
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centrations in pregnancy is great. Recent large studies are helping to define the
risks, as well as identify the benefits of reducing glucose intolerance. Written t
by an esteemed list of international authors, Gestational Diabetes: Origins, Com- i
plications, and Treatment presents timely reviews relating to some of the most o
important aspects of gestational diabetes, specifically its causes, consequences,
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and treatments.
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Divided into five sections, the book begins with a section on metabolism in
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pregnancy and gestational diabetes, dealing with maternal and foetal glucose
metabolism and the controversial area of what actually constitutes gestational
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diabetes. The next section examines risk factors and causes of gestational dia-
betes, including the obvious but often overlooked factors—being female and i
pregnant. The text also outlines environmental and genetic risk factors. The a
third section deals with the potential complications of gestational diabetes for
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both mother and offspring, considering short-term and long-term effects.
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The largest section in the book addresses treatments in an effort to improve t
the outcome for the mother and the baby. Chapters describe the nutritional
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approach, considered the cornerstone of treating gestational diabetes, as well
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as evidence for the role of exercise in its treatment and a useful strategy for
treating gestational diabetes pharmacologically. The final section discusses fu-
ture prospects in diagnosing and screening, prevention, pathophysiology, and
treatment of gestational diabetes.
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Gestational
Diabetes
Origins, Complications,
and Treatment

Edited by
Clive J. Petry
Gestational
Diabetes
Origins, Complications,
and Treatment
Boca Raton London New York
CRC Press is an imprint of the
Taylor & Francis Group, an informa business
CRC Press
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© 2014 by Taylor & Francis Group, LLC
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Version Date: 20131203
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Contents
Preface......................................................................................................................vii
About the Editor ........................................................................................................ix
Contributors ..............................................................................................................xi
Section i Gestational Diabetes
Chapter 1 Glucose, Foetal Growth, and Pregnancy ..............................................3
Xinhua Chen and Theresa O. Scholl
Chapter 2 What Is Gestational Diabetes? ...........................................................33
Robert Lindsay
Section ii origins
Chapter 3 Environmental Risk Factors for Gestational Diabetes .......................51
Eran Hadar and Moshe Hod
Chapter 4 Genetic Risk Factors for Gestational Diabetes ..................................69
Clive J. Petry
Section iii complications
Chapter 5 Complications of Gestational Diabetes ..............................................95
Liat Salzer and Yariv Yogev
Section iV treatments
Chapter 6 Dietary Therapy for Gestational Diabetes .......................................119
Colin A. Walsh and Fionnuala M. McAuliffe
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© 2010 Taylor & Francis Group, LLC
vi Contents
Chapter 7 Exercise and Gestational Diabetes ...................................................147
Michel Boulvain
Chapter 8 Pharmacological Treatment of Gestational Diabetes .......................157
David Simmons
Section V Future Prospects
Chapter 9 Future Prospects for Gestational Diabetes .......................................195
Clive J. Petry
© 2010 Taylor & Francis Group, LLC
Preface
Gestational diabetes, defined as diabetes that first develops in a pregnant woman,
is coming of age. Although this has been recognised as a distinct form of diabe-
tes since the 1960s, recent large studies such as the Hyperglycemia and Adverse
Pregnancy Outcome Study and the Australian Carbohydrate Intolerance Study in
Pregnant Women are only now helping to precisely define the risks associated with
having raised glucose concentrations in pregnancy, as well as the benefits that may
be gained by reducing such glucose intolerance. As such, they may end up making
the contribution to gestational diabetes that the Diabetes Control and Complications
Trial and the UK Prospective Diabetes Study have made to type 1 and 2 diabetes,
respectively. The need for this is great given that the worldwide incidence of gesta-
tional diabetes is increasing rapidly in line with the increased prevalence of obesity,
and the risks associated with a gestational diabetes pregnancy stretch beyond those
to the mother (such as a massively increased risk of developing type 2 diabetes) and
the newborn (e.g., macrosomia) to long-term, transgenerational risks in the offspring
(such as for obesity and type 2 diabetes, and in females for gestational diabetes). The
complications of these transmitted conditions could lead to potentially catastrophic
effects, such as the offspring’s generation being the first in modern times to die at
younger ages than their parents (Zimmet et al., 2007).*
This book therefore sets out to provide timely reviews relating to what may be
considered some of the most important aspects of gestational diabetes, in particular
its causes, consequences, and ways of treating it. The book is split into five main sec-
tions to encompass this. The initial section is based around metabolism in pregnancy
and gestational diabetes. The first chapter, by Dr. Chen and Professor Scholl, deals
with the important area of maternal and foetal glucose metabolism in pregnancy,
particularly in relation to insulin resistance. The second chapter, by Dr. Lindsay,
deals with the controversial topic of what actually constitutes gestational diabetes,
an area that is currently receiving much attention in the literature.
Section II contains chapters about risk factors and causes of gestational diabetes.
The most obvious risk factors for gestational diabetes, almost by definition but often
overlooked, are the subject being female and pregnant! However, whilst these factors
are sensitive for the development of gestational diabetes, they carry no specificity, as
only a fraction of pregnant women develop gestational diabetes. Environmental risk
factors with greater specificity for gestational diabetes are outlined in Chapter 3 by
Dr. Hadar and Professor Hod. In Chapter 4 I then outline the rapidly expanding field
of genetic risk factors for gestational diabetes and how these are closely linked to
genetic risk factors for other forms of diabetes.
Having outlined the causes of gestational diabetes, the succeeding section
then deals with the consequences of having this condition, namely, the potential
* Zimmet, P. et al. 2007. The International Diabetes Federation Consensus Definition of the Metabolic
Syndrome in Children and Adolescents. Brussels, Belgium: IDF Communications. Available at http://
www.idf.org/webdata/docs/Mets_definition_children.pdf.
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© 2010 Taylor & Francis Group, LLC
viii Preface
complications for both the mother and her offspring. In Chapter 5 Dr. Salzer and
Professor Yogev outline the potential short- and long-term effects of gestational dia-
betes for both the mother and her offspring, a vital consideration given the rising
prevalence of this condition and the potential risk of transmitting this condition and
type 2 diabetes on to the next generation.
The largest section in the book then deals with treating gestational diabetes in
an effort to improve the outcome for both the mother and baby. In Chapter 6 Dr.
Walsh and Professor McAuliffe deal with the nutritional approach to treating gesta-
tional diabetes, which has been described as the cornerstone of its treatment. Then
in Chapter 7 Dr. Boulvain examines the evidence for the role of exercise in treating
this condition, including what benefits it brings and its potential risks. In Chapter 8
Professor Simmons presents a highly useful strategy for treating gestational diabetes
pharmacologically, including recent advances in the use of insulin analogues and the
use of alternatives to insulin.
The final section contains a chapter in which I speculate on the future prospects
for the condition of gestational diabetes, including areas not covered by other chap-
ters in the book, such as how the need for screening correlates with maternal obesity.
Clearly in a volume of this size it is impossible to write about every clinical and
scientific aspect of gestational diabetes, but in this chapter I briefly try to fill in some
of the gaps and suggest likely areas of progress in the forthcoming years.
Each chapter of this book is therefore designed to provide a summary of the cur-
rent state of practice and knowledge in its particular subject area, with an emphasis
on highlighting key recent research. Key points are condensed into a single summary
diagram for each chapter to provide an aide mémoire for those trying to hold many
aspects of gestational diabetes in their mind at one time. Hopefully these may also
prove useful for those wanting to revise current knowledge about gestational diabe-
tes in preparation for exams. In addition, for those wanting greater detail than can be
provided in a book of this size, recent key references are bold (with an explanation as
to why) to help direct areas of further research. We hope that you will find it useful.
Clive J. Petry, PhD
Department of Paediatrics, University of Cambridge,
Addenbrooke’s Hospital, Cambridge, UK
© 2010 Taylor & Francis Group, LLC
About the Editor
Clive J. Petry, PhD, earned a BSc in biochemistry (medical) from
the University of Surrey, Guildford, UK, in 1991 and then an MSc
in clinical biochemistry in 1993 from the same institution. In 1998,
he earned a PhD in clinical biochemistry from the University of
Cambridge, Cambridge, UK. Since then, he has worked at the
University of Cambridge as a postdoctoral research associate,
first in the Department of Clinical Biochemistry (from 1997 to
2000) and then in the Department of Paediatrics (from 2001). In
2006, he was promoted to senior research associate. Dr. Petry has authored over
50 scientific publications and currently serves on the editorial board of the British
Journal of Nutrition, Journal of Nutritional Science, Human Reproduction, and
ISRN Obstetrics and Gynecology. He is a member of the Association for Clinical
Biochemistry, the Biochemical Society, the Nutrition Society, and the European
Association for the Study of Diabetes. His research involves trying to understand
the mechanisms and consequences of the link between altered foetal growth and the
short- and long-term risk of the development of diseases such as gestational and type
2 diabetes and hypertension.
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© 2010 Taylor & Francis Group, LLC