Medical Management of Pregnancy Complicated by Diabetes / Edition 4

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Pregnancy complicated by diabetes is a medical challenge that can be minimized through a program of expert protocols and patient partnerships. This newly revised edition presents a complete package of these protocols that can help produce healthy infants in pregnancies complicated by type 1, type 2, and gestational diabetes.
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Product Details

  • ISBN-13: 9781580402323
  • Publisher: American Diabetes Association
  • Publication date: 5/14/2009
  • Edition description: Fourth Edition
  • Edition number: 4
  • Pages: 182
  • Product dimensions: 6.00 (w) x 8.90 (h) x 0.50 (d)

Meet the Author

American Diabetes Association/Lois Jovanovic, MD, Editor

Lois Jovanovic, MD (Santa Barbara, CA) is a respected endocrinologist specializing in diabetes in pregnancy. She is CEO & Chief Scientific Officer of the Sansum Medical Research Institute, Santa Barbara. She is also a Clinical Professor of Medicine at the University of Southern California-Los Angeles Medical Center; Faculty in Internal Medicine, Santa Barbara Cottage Hospital; Attending Physician, The Santa Barbara County Diabetes/Endocrine Clinic; and Adjunct Professor, Biomolecular Science and Engineering Program, University of California, Santa Barbara.

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Table of Contents

A Word About This Guide xi
Contributors xiii
Prepregnancy Counseling and Management of Women With Preexisiting Diabetes or Previous Gestational Diabetes 1
Highlights 2
Preexisting Diabetes 4
Prepregnancy Counseling 7
Prepregnancy Assessment 10
Prepregnancy Management 12
Previous Gestational Diabetes 16
Contraception 21
Highlights 22
Oral Contraceptives 25
Norplant System 25
Barrier Methods 26
Intrauterine Devices 26
Rhythm 27
Permanent Sterilization 27
Psychological Impact of Diabetes and Pregnancy 29
Highlights 30
Response to Pregnancy in Women With Preexisting Diabetes 33
Response to Diagnosis of Gestational Diabetes 33
Long-Term Adaptation 34
Personality Types and Individualizing Treatment 35
Dealing With Crises 36
Hospitalization 36
Fetal Demise 37
Birth Anomalies 37
Importance of Team Approach 38
Importance of Support System 38
Monitoring 45
Highlights 46
HbA1C Measurement in Pregnancy 47
Preexisting Diabetes 47
Gestational Diabetes 48
Self-Monitoring 48
Blood Glucose 48
Accuracy 49
Goals 51
Recording 52
Urine Ketone Testing 53
When to Test 53
Intervention for Ketonuria 53
Education 53
Medical Tests to Evaluate Maternal Status 54
Preexisting Diabetes 54
Gestational Diabetes 56
Management of Morning Sickness 59
Highlights 60
Dietary Remedies 61
Insulin Adjustments 62
Medical Management 64
Nutritional Management During Pregnancy in Preexisting Diabetes 67
Highlights 69
Patient Responsibility 70
Nutrient Needs of Pregnancy 70
Protein 71
Calories 71
Calcium 71
Iron 72
Folate 72
Assessing Diet and Eating Habits 72
Vitamin/Mineral Supplementation 73
Determining Calorie Level 73
Weight Gain 74
Meal Planning: Distributing Calories and Carbohydrates 75
Carbohydrate 75
Fine Tuning: Matching Carbohydrate to Insulin 76
Developing the Meal Plan 77
Fiber 78
Protein 78
Fat 78
Record Keeping and Follow-Up 80
Sodium, Caffeine, and Artificial Sweeteners 80
Management of Hypoglycemia 81
Postpartum Nutritional Management 82
Lactation 82
Fluid Requirements 83
Carbohydrates and Hypoglycemia 83
Maternal Supplementation 84
Use of Insulin During Pregnancy in Preexisting Diabetes 87
Highlights 88
Metabolic Alterations During Normal Gestation 89
Therapeutic Insulin Use 90
Insulin Regimens 90
Insulin Pumps 93
Dosage Adjustment 93
Preterm Delivery 95
Insulin During Labor and Delivery 96
Postpartum Insulin Requirements 97
Breastfeeding 97
Oral Hypoglycemic Agents 97
Diagnostic Testing and Fetal Surveillance 99
Highlights 100
Diagnostic Testing With Ultrasound 101
a-Fetoprotein Testing 103
Genetic Testing 104
Fetal Surveillance With Ultrasound 105
Fetal Activity Determinations 105
Antepartum Fetal Monitoring 105
Amniocentesis for Fetal Lung Maturity Determination 108
Timing and Mode of Delivery 108
Fetal Surveillance During Labor 109
Diabetic Ketoacidosis 109
Preterm Labor 109
Gestational Diabetes 111
Highlights 112
Epidemiology 114
Screening 115
Diagnosis 117
Nutritional Management 118
Goals 118
Factors Affecting Blood Glucose Levels 119
Dietary Guidelines 121
Individualized Meal Planning 123
Controversy: Calorie Restriction for Obese Patients 124
Record Keeping and Follow-Up 125
Postpartum 126
Insulin Therapy 126
Exercise as a Treatment Modality 128
Obstetric Management 129
Neonatal Care of Infants of Diabetic Mothers 133
Highlights 134
Perinatal Mortality and Morbidity 135
Resuscitation 136
Macrosomia, Birth Injury, and Asphyxia 136
Congenital Anomalies 138
Respiratory Distress 139
Hypoglycemia 140
Nursery Care 141
Glucose Homeostasis 141
Hypocalcemia and Hypomagnesemia 142
Hyperbilirubinemia and Erythremia 144
Long-Term Follow-Up 145
Postpartum Follow-Up of Women With Gestational Diabetes 151
Highlights 152
Postpartum Testing and Follow-Up 153
Yearly Follow-Up and Counseling 156
Index 159
Resources for Health Care Professionals 174
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