In developed countries the incidence of gestational diabetes lies between 1 and 8%. With the general decrease of perinatal mortality and morbidity, the complications arising from gestational diabetes have become more striking and significant. Moreover, impaired maternal carbohydrate metabolism may lead to non genetic fuel mediated disposition to diabetes in the offspring. The renewed topicality has greatly stimulated research in this field. This book provides both a general survey and the current thinking on special questions of gestational diabetes. It also deals with related topics such as epidemiology, prognosis, follow-up, contraception, etc. The book is addressed to obstetricians and other physicians engaged in prenatal care as well as to internists and neonatologists.

InhaltsangabeGestational Diabetes - Survey.- 1 Gestational Diabetes: A Survey and the Graz Approach to Diagnosis and Therapy.- Nomenclature and classification.- Physiology and pathophysiology.- Metabolic changes in pregnancy.- Endocrine effects of pregnancy on carbohydrate metabolism.- Insulin homeostasis in the fetoplacental unit.- Insulin homeostasis in the fetoplacental unit of normal pregnancy.- Insulin homeostasis in the fetoplacental unit of the diabetic woman.- Screening for disorders of carbohydrate metabolism.- Target groups.- Period of screening.- Methods of glucose tolerance testing.- Further diagnostic procedures.- Monitoring blood glucose.- Amniotic fluid insulin determination.- Methods of determining amniotic fluid insulin.- The determination of glucose in the amniotic fluid.- Treatment.- Dietary treatment.- Insulin treatment.- Metabolic control during insulin treatment.- Quality of metabolic control.- Monitoring blood glucose.- Glycosylated hemoglobin.- Patient education.- Monitoring pregnancy, labor and the puerperium.- Arrest of preterm labor with ?-mimetic tocolytic agents.- Induction of fetal lung maturation.- Birth weight.- Sonographic estimation of fetal weight and ultrasound diagnosis of diabetogenic fetopathy.- Postpartal screening for diabetes.- Newborns of diabetic mothers.- Assessment of the quality of metabolic management during pregnancy by the condition of the newborn.- Selected Topics on Gestational Diabetes.- A. The Significance of Gestational Diabetes.- 2 The World Scope of Gestational Diabetes.- Determinant biological factors of pathologic childbearing.- Determinants of diabetes.- Diabetic patterns during pregnancy.- Diabetes health care in pregnancy in tropical and subtropical zones.- B. On Physiologic and Pathophysiologic Features of Gestational Diabetes.- 3 Pathophysiological Background for Gestational Diabetes.- Plasma insulin in pregnancy.- Serum proinsulin in pregnancy.- Insulin degradation in pregnancy.- Glucagon secretion in pregnancy.- Insulin resistence in pregnancy.- Concluding remarks.- Summary.- 4 The Human Placenta in Gestational Diabetes.- Histopathology.- Histomorphometry.- Immunpathology.- Carbohydrate metabolism.- Lipid metabolism.- Nucleic acids, amino acids and proteins.- The placenta as affector of fetal growth.- Miscellaneous.- 5 Prevention of Placental Insufficiency Syndrom in Diabetic Pregnancies.- Materials and methods.- Results.- Discussion.- C. On Screening and Diagnostics in Gestational Diabetes.- 6 Gestational Diabetes, Significance of Risk Factors and Results of a Follow-up Study 8 Years After Delivery.- Methods.- Result and discussion.- Screening using random blood glucose values.- Conclusions.- 7 The Oral 100 g-Glucose-Tolerance Test-Special Criteria for Evaluation in Late Pregnancy.- Methods.- Results.- Discussion.- Summary.- 8 Glucosylated Proteins in Normal and Diabetic Pregnancy.- Biochemistry of glucosylation and Browning reactions.- Studies on methods of measurement.- Studies on the role of glucosylation in the problems of pregnancy complicated by diabetes mellitus.- Studies on the clinical utility of glucosylated protein.- Measurements during pregnancy.- Conclusions.- 9 Glycosylated Haemoglobins and Neonatal Macrosomia.- Glycosylated haemoglobins (GHb).- GHb and pregnancy.- Problem formulation.- Methods.- Results.- Discussion.- Summary.- 10 Recurrence of Gestational Diabetes in Subsequent Pregnancies.- Materials and methods.- Results.- Discussion.- Summary.- D. On Prophylaxis and Therapy in Gestational Diabetes.- 11 Preconceptional Diabetes Counseling in Gestational Diabetes.- Material and methods.- Results.- Discussion.- 12 The Use of Prophylactic Insulin in Women with Gestational Diabetes.- Diagnosis of gestational diabetes.- Indications for therapeutic insulin.- Theoretical causes of fetal macrosomia despite relative maternal euglycemia.- Prophylactic insulin-results of randomized trials.- Retrospective data.- Clinical strategy.- Risks.- Conclusions.- 13 Insulin Tre