1: Diabetes Care 25:S94-S96, 2002 [Texto completo]
Gestational Diabetes Mellitus
American Diabetes Association
2: Diabetes Metab Res Rev 2001 Nov;17(6):422-8
Autoimmune gestational diabetes mellitus: a distinct clinical entity?
Mauricio D, de Leiva A.
Unit of Endocrinology and Nutrition, Hospital de Sabadell, Institut Universitari Parc Tauli, Sabadell, Spain.
This review gives an update of the present knowledge on what is defined here as autoimmune gestational diabetes mellitus (GDM). Autoimmune phenomena associated with type 1 diabetes mellitus (DM) can be detected in a subgroup of women with GDM. Islet autoantibodies are present in sera from women with GDM with variable frequency. Distinct phenotypic and genotypic features may be recognised in this subset of women with GDM, which are representative of a distinct clinical entity. Furthermore, these women are at increased risk of developing type 1 DM after pregnancy. However, the eventual progression of the autoimmune destruction of beta-cells in these subjects may follow different time-course patterns thus leading to variable forms of presentation of autoimmune DM. As a high-risk group for type 1 diabetes, women with previous autoimmune GDM may be candidates for potential immune intervention strategies. Copyright 2001 John Wiley & Sons, Ltd.
3: JAMA 2001 Nov 28;286(20):2516-8
Gestational diabetes mellitus.
Jovanovic L, Pettitt DJ.
Sansum Medical Research Institute, 2219 Bath St, Santa Barbara, CA 93105, USA. [email protected]
4: Gynecol Obstet Fertil 2001 Jul-Aug;29(7-8):534-7[Placental leptin and pregnancy pathologies] [Article in French]
Hauguel-de Mouzon S, Lepercq J.
Institut Cochin de genetique moleculaire, department d’endocrinologie, 24, rue du Faubourg Saint-Jacques, 75014 Paris, France.
Leptin, the protein encoded by the Ob gene, is produced by the white adipose tissue and by the placenta during pregnancy. Placental leptin production makes a substantial contribution to maternal circulating levels during pregnancy which rapidly decrease and return to normal after delivery. Leptin has been detected in fetal plasma as early as week 18 of gestation, and umbilical leptin concentrations are closely related to birth weight. This has led to the hypothesis that fetal fat mass mainly determines fetal circulating leptin. Placental leptin production is increased in choriocarcinoma, preeclampsia and type 1 diabetes. Estrogens, hypoxia and insulin have been suggested as positive regulators of placental leptin production. Maternal leptinemia might act as a sensor of energy balance during pregnancy. The presence of both leptin and leptin receptors in the placenta suggests that leptin can act by autocrine or endocrine pathways in the human placenta. The roles of fetal leptin and consequences of increased placental leptin production in pathological pregnancies have yet to be elucidated.
5: Diabet Med 2001 May;Suppl 3:1-5
Critical appraisal of published research evidence: treatment of gestational diabetes.
Dornan T, Hollis S.
6: Obstet Gynecol Clin North Am 2001 Sep;28(3):513-36
Diabetes complicating pregnancy.
Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA. [email protected]
Despite the well-documented relationship between morbidity in pregnancy and pregestational maternal diabetes, the corrected perinatal outcome is, in most series, equal to or better than that of the general reference obstetric population. No single aspect or element of contemporary management is responsible for this improvement; rather, a combination of interventions seems responsible. Targeting delivery early in term, improved compliance, better glycemic control during pregnancy, improved control at conception, improved neonatal care, family planning, and early screening for fetal abnormalities all likely contribute to improved outcome. The currently observed rates of perinatal mortality suggest that an irreducible minimum mortality rate may be reached; however, large disparities in access to care and treatment continue to result in a wide range in rates of morbidity and mortality, a fact that pertains to outcomes in general as well as to pregnancies complicated by diabetes. The identification of women with lesser degrees of hyperglycemia as diabetic by lowering the thresholds for glucose tolerance test abnormality suggests an importance of the diagnosis that is not supported by evidence of either related morbidity or therapeutic benefit. The extrapolation of risk to women with lesser degrees of hyperglycemia seems to have little basis, and the management of women with mild glucose intolerance as if they had overt diabetes is unwarranted. The excess of resources dedicated to the identification and monitoring of an increasing number of women with mild abnormalities of glucose metabolism should prompt a reevaluation of these practices. Perinatal benefits of this expenditure are difficult to document or nonexistent, and there is a predictable increase in iatrogenic morbidities associated with the diagnosis. The exception in the most recent recommendations is the addition of a random glucose measure to screen for the rare women with overt undiagnosed diabetes who presents for prenatal care, because these women are at increased risk of morbidities related to diabetes. A curious statement was made in the summary and recommendations of the fourth International Congress on Gestational Diabetes: «There remains a compelling need to develop diagnostic criteria for GDM [gestational diabetes mellitus] that are based on the specific relationships between hyperglycemia and risk of adverse outcome.» If these relationships are undefined, what is the import of the diagnosis? At the author’s center, application of the new diagnostic thresholds for the diagnosis of gestational diabetes mellitus has increased the incidence to over 6%. Without a clear expectation of benefit, this increase represents an unsupportable investment of resources. What are the prospects for improving understanding of the relationships between glucose intolerance and pregnancy risks? The direction of new guidelines and recommendations seems to be moving away from resolution of the relationships. The new criteria result in the diagnosis of gestational diabetes in an increasing number of women who were previously normal. It is easier to differentiate women at an extreme of hyperglycemia from normal. Investigations will be even less able to identify attributable effects of glucose intolerance in pregnancy with the inclusion of women with lesser degrees of hyperglycemia. As evidenced in O’Sullivan’s original series, women with fasting hyperglycemia in pregnancy are still presumed to be at increased risk of fetal death. This risk factor remains important in clinical management if insulin treatment, fetal surveillance, and early term delivery can reduce the risk of fetal loss. At the author’s center, the relationships among outpatient measures of fasting glycemia, glucose tolerance testing results, and perinatal outcomes are evaluated. Preliminary results suggest that fasting glycemia measured at the time of a 50-g glucose tolerance test is significantly correlated with and as sensitive and predictive of morbidity as the glucose tolerance test diagnosis of gestational diabetes. If these results are confirmed, it will be difficult to rationalize continued glucose tolerance testing.
7: Cochrane Database Syst Rev 2001;2:CD001997
Elective delivery in diabetic pregnant women (Cochrane Review).
Boulvain M, Stan C, Irion O.
Unite de Developpement en Obstetrique, Maternite Hopitaux Universitaires de Geneve, Departement de Gynecologie et d’Obstetrique, Boulevard de la Cluse, 32, Geneva 14, SWITZERLAND, CH-1211. [email protected]
BACKGROUND: In pregnancies complicated by diabetes the major concerns during the third trimester are fetal distress and the potential for birth trauma associated with fetal macrosomia. OBJECTIVES: The objective of this review was to assess the effect of a policy of elective delivery, as compared to expectant management, in term diabetic pregnant women, on maternal and perinatal mortality and morbidity. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register (last searched February 2001). SELECTION CRITERIA: All available randomized controlled trials of elective delivery, either by induction of labour or by elective caesarean section, compared to expectant management in diabetic pregnant women at term. DATA COLLECTION AND ANALYSIS: The reports of the only available trial were analysed independently by the three co-reviewers to retrieve data on maternal and perinatal outcomes. Results are expressed as relative risks (RR) and 95% confidence intervals (CI). MAIN RESULTS: The participants in the one trial included in this review were 200 insulin-requiring diabetic women. Most had gestational diabetes, except 13 women with type 2 pre-existing diabetes (class B). The trial compared a policy of active induction of labour at 38 completed weeks of pregnancy, to expectant management until 42 weeks. The risk of caesarean section was not statistically different between groups (relative risk (RR) 0.81, 95% confidence interval (CI) 0.52 – 1.26). The risk of macrosomia was reduced in the active induction group (RR 0.56, 95% CI 0.32 – 0.98) and three cases of mild shoulder dystocia were reported in the expectant management group. No other perinatal morbidity was reported. REVIEWER’S CONCLUSIONS: There is very little evidence to support either elective delivery or expectant management at term in pregnant women with insulin-requiring diabetes. Limited data from a single randomized controlled trial suggest that induction of labour in women with gestational diabetes treated with insulin reduces the risk of macrosomia. Although the small sample size does not permit one to draw conclusions, the risk of maternal or neonatal morbidity was not modified. Women’s views on elective delivery and on prolonged surveillance and treatment with insulin should be assessed in future trials.
8: Clin Lab Med 2001 Mar;21(1):173-92
Gestational diabetes mellitus.
Sweeney AT, Brown FM.
Department of Medicine, Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, Massachusetts, USA.
In summary, much controversy exists surrounding the diagnosis, treatment, and even existence of GDM. At present, there is not enough evidence to advocate the Carpenter and Coustan criteria over the NDDG criteria. In univariate analysis, the Toronto Tri-Hospital Study demonstrated an increased incidence of cesarean section, macrosomia, and preeclampsia with increasing carbohydrate intolerance in those who did not meet NDDG criteria for GDM. Multivariate analysis, however, showed that this contribution is small relative to other nonmodifiable risk factors. A shift to the Carpenter and Coustan criteria would identify a larger population of patients with GDM and increase treatment costs. In addition, although treatment of these borderline GDM patients might reduce macrosomia, there is no evidence to indicate that it reduces the cesarean section rate. The precise threshold at which glucose intolerance adversely affects pregnancy outcomes and increases the risk for the development of type 2 diabetes in the mother is unknown. The perinatal risks associated with hyperglycemia seem to increase continuously with increasing maternal hyperglycemia. More randomized intervention trials are needed to define the effects of graded increases in glucose intolerance on maternal and fetal morbidity.
9: Curr Opin Obstet Gynecol 2001 Apr;13(2):103-7
Diabetes in pregnancy.
St Mary’s Hospital for Women and Children, Manchester, UK. [email protected]
The following review considers briefly most aspects of the care of the woman with established diabetes, gestational diabetes and impaired glucose tolerance. Where possible, reference is made to recent publications, but much of our current practice is based on old research and opinions. However, a review of current practice clearly shows that existing research is not being put into practice. The controversies surrounding the relevance of impaired glucose tolerance are discussed, and the results of existing clinical trials are eagerly awaited.
10: J Am Osteopath Assoc 2001 Feb;101(2 Suppl):S10-3
J Am Osteopath Assoc 2001 Aug;101(8):478
Diabetes in pregnancy.
University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine, Stratford, NJ, USA. [email protected]
Diabetes mellitus is one of the most common medical complications of pregnancy. Two percent to 5% of pregnancies are complicated by diabetes, of which 90% are classified as gestational diabetes mellitus. Prevention of the fetal and maternal complications of diabetes presents unique challenges to all providers of healthcare to reproductive-aged diabetic women. The management of diabetes before, during, and after pregnancy can serve as a model of preventive healthcare. Preconception counseling and metabolic control before pregnancy reduce the rate of congenital malformations and the burden of suffering in offspring.
11: Endocrinol Metab Clin North Am 2000 Dec;29(4):771-87
Medical emergencies in the patient with diabetes during pregnancy.
Sansum Medical Research Institute, Santa Barbara, California. [email protected]
Although the outcome of pregnancies complicated by diabetes is now approaching the success seen in the normal healthy pregnant population, this improvement is only realized when careful attention is paid to the metabolic, hemodynamic, and vascular perturbations associated with the changes of pregnancy. The diabetic woman must not only pay attention to nutrition but also blunt moment-to-moment swings in blood glucose by taking frequent does of insulin. In addition, she must be under constant surveillance for a host of other complications of pregnancy, such as hypertension, retinopathy, infection, acidosis, thyroid dysfunction, nephropathy, and sudden death in utero. Any or all of these problems become medical emergencies if left untreated. Rigorous vigilance to sustain normoglycemia and normotension, examination of the retina, culture of urine, assays for ketosis, measurements of thyroid function, and monitoring of renal function and fetal status are paramount in the management of pregnancy complicated by diabetes.
12: Am J Obstet Gynecol 2000 Jun;182(6):1283-91
Benefits, risks, costs, and patient satisfaction associated with insulin pump therapy for the pregnancy complicated by type 1 diabetes mellitus.
Gabbe SG, Holing E, Temple P, Brown ZA.
Diabetes in Pregnancy Program, Departments of Obstetrics and Gynecology, University of Washington Medical Center, Seattle 98195-6460, USA.
OBJECTIVE: Glycemic control, perinatal outcome, and health care costs were evaluated among women with type 1 diabetes mellitus who began insulin pump therapy during pregnancy (group 1, n = 24), were treated with multiple insulin injections (group 2, n = 24), or were already using an insulin pump before pregnancy (group 3, n = 12). Patient satisfaction and continuation of pump therapy post partum were assessed. STUDY DESIGN: A retrospective review of maternal and neonatal medical records was performed, and a questionnaire was sent to patients after delivery. Patients in groups 1 and 2 were matched for age, age at onset and duration of diabetes mellitus, White class, and date of delivery. RESULTS: No differences in glycosylated hemoglobin A levels were observed among groups 1, 2 or 3 in the first, second, or third trimester. Patients in group 1 started pump therapy at a mean of 16.8 weeks’ gestation, and 17 (70.8%) began therapy as outpatients. No deterioration in glycemic control was noted during the 2- to 4-week period after the start of pump treatment. Among the women in group 1 eight had at least one episode of severe hypoglycemia before starting pump therapy, but only one had such an episode after this treatment was begun. Two episodes of ketoacidosis occurred in group 1, and no episodes occurred in groups 2 and 3. No significant differences in perinatal outcomes or health care costs were observed among groups 1, 2, and 3. After delivery 94. 7% of the women in group 1 continued to use the pump because it provided better glycemic control and a more flexible lifestyle. Postpartum glycosylated hemoglobin A values were 7.2% in group 1 and 9.1% in group 2, a significant difference. CONCLUSIONS: Insulin pump therapy was initiated during pregnancy without a deterioration of glycemic control and was associated with maternal and perinatal outcomes and health care costs comparable to those among women who were already using the pump before pregnancy or who received multiple-dose insulin therapy. Women who began pump therapy in pregnancy were highly likely to continue pump use after delivery and preferred the flexible lifestyle that this treatment allowed.
13: Diabetes Care 2000 Jan;23(1):15-7
Diabetes Care. 2000 Mar;23(3):425-6.
Gestational diabetes: is a higher cesarean section rate inevitable?
Moses RG, Knights SJ, Lucas EM, Moses M, Russell KG, Coleman KJ, Davis WS. Illawarra Area Health Service, Wollongong, Australia. [email protected]
OBJECTIVE: To determine the rate of and indication for cesarean section for women with gestational diabetes mellitus (GDM) compared with glucose-tolerant women. RESEARCH DESIGN AND METHODS: From a consecutive series of women with GDM seen over a 9-year period for medical management, women who had had a cesarean section were identified and the reason for the section determined from a review of the medical record. A control group of women who had had a section were obtained from an existing database of glucose-tolerant women. RESULTS: The section rate for women with GDM was higher at 19.8% than the 15.6% for glucose-tolerant women. However, after adjustment for age and parity, no significant differences were found. There were also no differences found for the primary indication for section. CONCLUSIONS: In our health area of New South Wales, Australia, women with GDM do not have a higher section rate compared with glucose-tolerant women. Concerns about the diagnosis of GDM leading to an increased rate of obstetric intervention should not be generalized.
14: Am J Obstet Gynecol 2000 May;182(5):1024-6
Gestational diabetes screening in subsequent pregnancies of previously healthy patients.
Young C, Kuehl TJ, Sulak PJ, Allen SR.
Departments of Obstetrics and Gynecology, Scott and White Memorial Hospital and Clinic, Texas A&M University Health Science Center College of Medicine, Temple 76508, USA.
OBJECTIVE: Our purpose was to evaluate women without gestational diabetes mellitus in an index pregnancy for the likelihood that gestational diabetes would develop and for risk factors for carbohydrate intolerance in a subsequent pregnancy.Study Design: A retrospective review of medical records at a teaching hospital universally screening for gestational diabetes identified multiparous women who had been delivered twice between 1994 and 1997 and who, in the first (index) pregnancy, had had a normal result on a screening test with 50 g of glucose used in a «glucola» beverage (< or =140 mg/dL). RESULTS: In this population with normal glucose screening values in the index pregnancy, 352 (92.4%) of 381 women had at least one risk factor for gestational diabetes. However, none of the 381 women had gestational diabetes in the subsequent pregnancy (0/381, 95% confidence interval < or =1%), including 45 (12. 4%) who had an abnormal result on the 50-g glucose screening test. Regression analysis showed this test result in the index pregnancy (P =.001) to be the only studied variable significantly associated with the 50-g glucose value in the subsequent pregnancy. CONCLUSION: Despite a high rate of risk factors for gestational diabetes, women in our population with a normal glucose value in an index pregnancy have a minimal risk (<1%) that gestational diabetes will develop in a subsequent singleton pregnancy within 4 years. This factor may be included in determining whether women should undergo screening for gestational diabetes. 15: Cochrane Database Syst Rev 2000;(2):CD001997 Elective delivery in diabetic pregnant women. Boulvain M, Stan C, Irion O. Departement de Gynecologie et d'Obstetrique, Hopitaux Universitaires de Geneve, Boulevard de la Cluse, 32, Geneve, Switzerland, CH-1205. [email protected] BACKGROUND: In pregnancies complicated by diabetes the major concerns during the third trimester are fetal distress and the potential for birth trauma associated with fetal macrosomia. OBJECTIVES: The objective of this review was to assess the effect of a policy of elective delivery, as compared to expectant management, in term diabetic pregnant women, on maternal and perinatal mortality and morbidity. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register (last searched July 1999). SELECTION CRITERIA: All available randomized controlled trials of elective delivery, either by induction of labour or by elective caesarean section, compared to expectant management in diabetic pregnant women at term. DATA COLLECTION AND ANALYSIS: The reports of the only available trial were analysed independently by the three co-reviewers to retrieve data on maternal and perinatal outcomes. Results are expressed as relative risks (RR) and 95% confidence intervals (CI). MAIN RESULTS: The participants in the one trial included in this review were 200 insulin-requiring diabetic women. Most had gestational diabetes, except 13 women with type 2 preexisting diabetes (class B). The trial compared a policy of active induction of labour at 38 completed weeks of pregnancy, to expectant management until 42 weeks. The risk of caesarean section was not statistically different between groups (RR 0.81, 95% CI 0.52 - 1.26). The risk of macrosomia was reduced in the active induction group (RR 0.56, 95%CI 0.32 - 0. 98) and 3 cases of mild shoulder dystocia were reported in the expectant management group. No other perinatal morbidity was reported. REVIEWER'S CONCLUSIONS: There is very little evidence to support either elective delivery or expectant management at term in pregnant women with insulin-requiring diabetes. Limited data from a single randomized controlled trial suggest that induction of labour in women with gestational diabetes treated with insulin reduces the risk of macrosomia. Although the small sample size does not permit one to draw conclusions, the risk of maternal or neonatal morbidity was not modified. Women's views on elective delivery and on prolonged surveillance and treatment with insulin should be assessed in future trials. Publication Types: Review 16: Cochrane Database Syst Rev 2000;(2):CD000070 Dietary regulation for 'gestational diabetes'. Walkinshaw SA. Fetal Centre, Liverpool Women's Hospital NHS Trust, Crown Street, Liverpool, UK, L8 7SS. [email protected] BACKGROUND: Impaired glucose metabolism in pregnancy may be associated with adverse pregnancy outcomes. Primary dietary therapy is used in the management of diabetes, including gestational diabetes. OBJECTIVES: The objective of this review was to assess the effects of primary dietary therapy in women identified as having gestational diabetes on fetal growth and neonatal outcomes. SEARCH STRATEGY: I searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised trials of primary dietary therapy compared with no specific treatment in pregnant women with abnormal glucose tolerance test results. DATA COLLECTION AND ANALYSIS: Trial quality was assessed. MAIN RESULTS: Four studies involving 612 women were included. Trials were small and of variable quality. No differences were detected between primary dietary therapy and no primary dietary therapy for birthweight greater than 4000 grams (odds ratio 0.78, 95% confidence interval 0.45 to 1.35) or caesarean deliveries (odds ratio 0.97, 95% confidence interval 0.65 to 1.44). REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate the use of primary dietary therapy for women who show impaired glucose metabolism during pregnancy. Publication Types: Review 17: Clin Obstet Gynecol 2000 Mar;43(1):140-53 Cost analysis of diagnosis and treatment of gestational diabetes mellitus. Kitzmiller JL. Good Samaritan Hospital, San Jose, California 95124, USA. Publication Types: Review 18: Clin Obstet Gynecol 2000 Mar;43(1):127-39 The infant of the woman with gestational diabetes mellitus. Uvena-Celebrezze J, Catalano PM. MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109, USA. Publication Types: Review 19: Clin Obstet Gynecol 2000 Mar;43(1):116-26 Placental glucose transport in diabetic pregnancy. Illsley NP. Department of Obstetrics, Gynecology, and Women's Health, UMD-New Jersey Medical School, Newark 07103-2714, USA. Publication Types: Review 20: Clin Obstet Gynecol 2000 Mar;43(1):106-15 Management of gestational diabetes. Langer O. Department of OB/GYN, St. Lukes Roosevelt Hospital Centers, New York, NY 10019, USA. Publication Types: Review 21: Clin Obstet Gynecol 2000 Mar;43(1):99-105 Making the diagnosis of gestational diabetes mellitus. Coustan DR. Brown University School of Medicine, Providence, Rhode Island, USA. Publication Types: Review 22: Clin Obstet Gynecol 2000 Mar;43(1):87-98 Physiologic and molecular alterations in carbohydrate metabolism during pregnancy and gestational diabetes mellitus. Yamashita H, Shao J, Friedman JE. Department of Nutrition, Case Western Reserve University, School of Medicine 44106-4935, USA. Recent progress suggests that postreceptor mechanisms that contribute to insulin resistance of pregnancy appear to be multifactorial, but are exerted at the beta-subunit of the insulin receptor and at the level of IRS-1. Gestational diabetes mellitus represents the combination of acquired and intrinsic abnormalities of insulin action. The resistance to insulin-mediated glucose transport appears to be greater in skeletal muscle from GDM subjects than from pregnancy alone. There is also a modest but significant decrease in maximal insulin receptor tyrosine phosphorylation in muscle from obese GDM subjects. Results also suggest that increased insulin receptor serine/threonine phosphorylation and PC-1 could underlie the insulin resistance of pregnancy and pathogenesis of GDM. Whether additional defects are exerted further downstream from IRS-1 remains to be investigated. Publication Types: Review 23: Clin Obstet Gynecol 2000 Mar;43(1):75-86 Postpartum care of the woman with diabetes. Kjos SL. Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles 90033, USA. The postpartum period in women with diabetes or GDM allows both the physician and mother to relax from the intensive medical and obstetric management that has permitted, in most cases, a successful and joyous outcome. The role of the physician, however, must switch to a proactive and preventive mode to formulate a reproductive health plan for women with diabetes and GDM. The plan should be individualized to address glycemic management and surveillance, nutritional management, contraception prescription, future pregnancy planning, and lifestyle changes. Essential to the development of a reproductive health plan is the active participation of the patient, who through education gains an understanding of the far-reaching effects her active participation will have on her subsequent health and possibly on that of her future children. Publication Types: Review 24: Clin Obstet Gynecol 2000 Mar;43(1):65-74 Obstetric management of pregnancies complicated by diabetes mellitus. Landon MB. Department of Obstetrics and Gynecology, Ohio State University, College of Medicine, Columbus, USA. Publication Types: Review 25: Clin Obstet Gynecol 2000 Mar;43(1):56-64 The role of exercise in pregnant women with diabetes mellitus. Carpenter MW. Women & Infants Hospital, Providence, RI 02905, USA. Publication Types: Review 26: Clin Obstet Gynecol 2000 Mar;43(1):46-55 Role of diet and insulin treatment of diabetes in pregnancy. Jovanovic L. Sansum Medical Research Foundation, Santa Barbara, California 93105, USA. Publication Types: Review 27: Clin Obstet Gynecol 2000 Mar;43(1):32-45 Why do diabetic women deliver malformed infants? Reece EA, Homko CJ. Department of Obstetrics, Gynecology, and Reproductive Sciences, Temple University School of Medicine, Philadelphia, PA 19140, USA. Publication Types: Review 28: Clin Obstet Gynecol 2000 Mar;43(1):17-31 Medical complications of diabetes mellitus in pregnancy. Rosenn BM, Miodovnik M. Department of Obstetrics and Gynecology, University of Cincinnati, OH 45267-0526, USA. Many women with diabetes develop complications of their chronic disease that may have a tremendous impact on their quality of life and their ultimate prognosis. Because Type 1 diabetes often begins at a very early age, it is quite common for women in their child-bearing years to be affected by these complications. As described in this article, diabetic complications and pregnancy may significantly affect each other, but it is not always easy to predict the course of either and to counsel these patients accordingly. Nevertheless, it appears that only in rare occasions should women with diabetes be advised against pregnancy, and that in most situations, with careful and knowledgeable management, a favorable outcome of pregnancy can be expected both for the mother and her infant. Publication Types: Review 29: Curr Opin Obstet Gynecol 1999 Dec;11(6):557-62 Advances in management of Type 1 diabetes and pregnancy. Hadden DR, McCance DR. Royal Maternity Hospital and Royal Victoria Hospital, Belfast, Northern Ireland, UK. [email protected] Obstetricians will need to update themselves on the recent changes in terminology and in diagnostic criteria for Type 1 diabetes mellitus. This still remains a high-risk obstetric situation, in spite of optimistic reports from centres of excellence. Pregnancy-associated hypertension may be closely related to insulin resistance. A number of concepts and hypotheses are based on the central role of insulin in fetal development. Publication Types: Review