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Doody's Review ServiceReviewer: Gilad A. Gross, MD (Washington University School of Medicine)
Description: This entry in the Series in Maternal Fetal Medicine is devoted to diabetes and pregnancy and explores both types of diabetes, pregestational and gestational. It seeks to answer both the question of how diabetes affects a pregnancy and what impact pregnancy has on the diabetic. The first edition was published five years ago and this update is needed, given the prevalence of this medical condition, the advancing technology, and the ever expanding body of literature on this topic.
Purpose: The purpose is not only to discuss the history of diabetes in pregnancy but to provide specialists in maternal fetal medicine and endocrinology with a basic understanding of the importance of and controversies that surround diabetes and pregnancy. It arms readers with not only the knowledge in understanding the techniques used worldwide for detection of diabetes but the controversies surrounding tightly controlled treatment of both gestational and pregestational diabetics. In addition, it covers the complications of the disease during pregnancy to both the mother and the fetus beginning during the time of embryogenesis. Overall the authors achieve their goals of providing a comprehensive, thorough book devoted to one of the most common medical conditions to complicate pregnancy.
Audience: It is most appropriate for high risk obstetricians and diabetologists who care for pregnant women with pregestational or gestational diabetes, but it has a broader appeal. For example, researchers will benefit from the numerous chapters devoted to the pathophysiology of diabetic embryopathy, genetics, and placental histopathology. General obstetricians/gynecologists do not require such an in-depth book on their personal library shelves, but it should be in a teaching service's library. The authors represent worldwide expertise.
Features: No aspect of diabetes in pregnancy is left unexplored. The organization of chapters has been carefully thought through. The book illustrates the current techniques used for both diagnosis and treatment of diabetic pregnant women. It does a great job of helping to clarify the uses of insulin and other hypoglycemic agents which are becoming more prevalent. It tackles difficult and controversial topics such as delivery timing and delivery mode with an evidence-based approach that can greatly assist practitioners confronted with difficult clinical decisions. Of significant importance to the target audience are the chapters the address both maternal and fetal complications and possible interventions to decrease morbidity. However, the book is so comprehensive that the importance or relevance of some of the chapters can be called into question. For example, while the history of this topic is quite fascinating, readers would be better served if those chapters were combined and more concise. Also, chapters on hormonal replacement in postmenopausal women and general ethics are somewhat of a distraction and are out of place in a focused book such as this. The chapters advance from detection of disease in advanced nations to third world countries and, albeit interesting, this may not be necessary for the general reader. Regarding diagnosis, the values the book uses are more relevant to the European reader as the United States uses milligrams per deciliter and not millimoles.
Assessment: This is a great review of the current understanding of the diagnosis and treatment of diabetes in pregnancy and can be used by both maternal fetal medicine specialists and endocrinologists caring for pregnant patients. For anyone looking for a complete book on diabetes in pregnancy, this is a very worthy purchase.