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Diabetes in Pregnancy

  • Agustin BustaEmail author
  • Alberto Franco-Akel
  • Yuriy Gurevich
  • Adina Schneider
  • Elliot Rayfield
Reference work entry

Abstract

Maternal diabetes is a significant cause of short-term and long-term morbidity for the infant and the mother. Infants born from mothers with gestational diabetes have a high prevalence of overweight, obesity, and risk to develop type 2 diabetes later in life. Gestational diabetes affects 18% of pregnancies. Its increasing incidence and prevalence worldwide are mostly attributed to the progressively increasing rates of obesity and a changing lifestyle in the general population. Gestational diabetes is an independent risk factor for the future development of overt postpartum diabetes.

Maternal and fetal complications are more frequent in patients with pre-existing diabetes than those with gestational diabetes. Nondiabetic women should receive universal screening for gestational diabetes, and women at risk for diabetes should be screened on the first prenatal visit. At present, there is general agreement on the strategy for diagnosis as well as the management of labor and delivery and postpartum follow-up in women withpre-existing diabetes and gestational diabetes.

The first-line treatment for gestational diabetes consists of dietary modification and increased physical activity. Subsequent pharmacologic therapy is warranted if this strategy fails. Early diagnosis of pre-existing diabetes, as well as proper diagnosis of gestational diabetes, warrants early treatment and a strict clinical follow-up since early intervention has been shown to improve fetal and maternal outcomes in randomized controlled trials.

Keywords

Gestational diabetes mellitus Perinatal Insulin resistance Macrosomic Large-for-gestational-age infants Preeclampsia Target glucose levels Maternal ketonemia Low-glycemic-index diet Diabetic retinopathy Teratogenic effects Pre-existing diabetes Pre-gestational 

Notes

Acknowledgments

We would like to thank Amanda Busta, undergraduate student at NYU, for her invaluable assistance in the preparation and editing of this manuscript, and to Jill Gregory, CMI, FAMI for the designing an illustration of figure 1.

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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Agustin Busta
    • 1
    Email author
  • Alberto Franco-Akel
    • 2
  • Yuriy Gurevich
    • 3
  • Adina Schneider
    • 4
  • Elliot Rayfield
    • 4
  1. 1.Division of Endocrinology, Diabetes and Bone Disease, Department of MedicineMount Sinai Beth Israel, Icahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Division of Endocrinology, Diabetes and Bone DiseaseMount Sinai Beth Israel, Icahn School of Medicine at Mount SinaiNew YorkUSA
  3. 3.Division of Endocrinology and MetabolismBeth Israel Medical Center, Albert Einstein College of MedicineNew YorkUSA
  4. 4.Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkUSA

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