Medical Management of Pregnancy Complicated by Diabetes

242 Pages·2013·1.83 MB·English

by  Donald R. Coustan

Director, Book Publishing, Abe Ogden; Managing Editor, Greg Guthrie;
Acquisitions Editor, Victor Van Beuren; Editorial Services, Cenveo Publisher
Services; Production Manager, Melissa Sprott; Composition, ADA; Cover
Design, Jody Billert; Printer, United Graphics.
©2013 by the American Diabetes Association, Inc.® All Rights Reserved. No
part of this publication may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including duplication, recording, or any
information storage and retrieval system, without the prior written permission
of the American Diabetes Association.
Printed in the United States of America
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The suggestions and information contained in this publication are generally
consistent with the Clinical Practice Recommendations and other policies of
the American Diabetes Association, but they do not represent the policy or
position of the Association or any of its boards or committees. Reasonable
steps have been taken to ensure the accuracy of the information presented.
However, the American Diabetes Association cannot ensure the safety or
efficacy of any product or service described in this publication. Individuals are
advised to consult a physician or other appropriate health-care professional
before undertaking any diet or exercise program or taking any medication
referred to in this publication. Professionals must use and apply their own
professional judgment, experience, and training and should not rely solely on
the information contained in this publication before prescribing any diet,
exercise, or medication. The American Diabetes Association—its officers,
directors, employees, volunteers, and members—assumes no responsibility or
liability for personal or other injury, loss, or damage that may result from the
suggestions or information in this publication.
The paper in this publication meets the requirements of the ANSI Standard
Z39.48-1992 (permanence of paper).
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editions of this book with your logo, contact the American Diabetes
Association at the address below, at [email protected], or by calling 703-
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American Diabetes Association
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Alexandria, Virginia 22311
DOI: 10.2337/9781580405102
Library of Congress Cataloging-in-Publication Data
Medical management of pregnancy complicated by diabetes / Donald R.
Coustan, editor. -- 5th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-58040510-2 (alk. paper)
I. Coustan, Donald R. II. American Diabetes Association.
[DNLM: 1. Pregnancy in Diabetics--therapy. 2. Diabetes Mellitus. 3. Diabetes,
Gestational--therapy. 4. Pregnancy Outcome. WQ 248]
618.3--dc23
2012049594
eISBN: 978-1-58040-536-2
THIS BOOK IS DEDICATED TO THE MANY MOTHERS WITH
DIABETES
WHO HAVE ALLOWED US TO PARTICIPATE IN THEIR CARE
OVER THE YEARS,
BEING INVOLVED IN THE MOST IMPORTANT EVENTS IN
THEIR FAMILIES’ LIVES.
WE CONTINUE TO LEARN FROM EACH OF YOU,
AND APPLYING THOSE LESSONS HAS ADVANCED OUR
ABILITY
TO CARE FOR WOMEN WITH DIABETES DURING THEIR
PREGNANCIES.
Contents
Foreword
Acknowledgments
List of Contributors
Prepregnancy Counseling, Assessment, and Management of Women with
Preexisting Diabetes or Previous Gestational Diabetes
Highlights
Preexisting Diabetes
Prepregnancy Counseling
Prepregnancy Assessment
Prepregnancy Management
Previous GDM
Contraception in Women with Diabetes and Prediabetes: Options and Assessing
Risk and Benefits
Highlights
Intrauterine Devices
Hormonal Contraceptives
Permanent Sterilization
Selected Readings
Psychological Impact of Diabetes and Pregnancy
Highlights
Response to Pregnancy in Women with Preexisting Diabetes
Response to the Diagnosis of Gestational Diabetes
LongTerm Adaptation
Personality Types and Individualizing Treatment
Dealing with Crises
The Importance of a Team Approach
The Importance of a Support System
Selected Readings
Assessment of Glycemic Control
Highlights
Normoglycemia During Pregnancy
Self-Monitoring of Capillary Blood Glucose
Other Measures of Metabolic Control
Recommendations
Selected Readings
Management of Morning Sickness
Highlights
Nonpharmacologic Treatment
Insulin Adjustments
Medical Management
Selected Reading
Nutrition Management of Preexisting Diabetes During Pregnancy
Highlights
Medical Nutrition Therapy
Weight Gain Recommendations
Macronutrients
Micronutrients
Meal Planning
Other Substances
Food Safety
Postpartum Nutrition Management
Lactation Nutrition Management
Selected Readings
Use of Insulin During Pregnancy in Preexisting Diabetes
Highlights
Metabolic Alterations during Normal Gestation
Therapeutic Insulin Use
Dosage Adjustment
Insulin During Labor and Delivery
Postpartum Insulin Requirements
Oral Antidiabetes Agents
Diagnostic Testing and Fetal Surveillance
Highlights
Diagnostic Testing with Ultrasound
α-Fetoprotein Testing
Genetic Testing
Fetal Surveillance with Ultrasound
Fetal Activity Determinations
Antepartum Fetal Monitoring
Amniocentesis for Fetal Lung Maturity Determination
Timing and Mode of Delivery
Fetal Surveillance During Labor
Diabetic Ketoacidosis
Preterm Labor
Selected Readings
Gestational Diabetes Mellitus
Highlights
Diagnosis
Epidemiology
Nutritional Management
Exercise as a Treatment Modality
Metabolic Management During Pregnancy
Obstetric Management
Selected Readings
Neonatal Care of Infants of Mothers with Diabetes
Highlights
Perinatal Mortality and Morbidity
Resuscitation
Nursery Care
LongTerm Follow-Up
Selected Readings
Foreword
This fifth edition is intended to provide up-to-date guidance on all aspects of
the care of pregnant women with preexisting diabetes, whether she has type
1 or type 2 diabetes, and with gestational diabetes. The care of pregnant
women with diabetes and gestational diabetes requires a committed health-care
team and considerable resources. It is our hope that the information in this book
will be helpful in enabling the various health-care professionals who make up
that team to have access to practical advice and carry out their mission. Each of
the contributors is engaged actively in providing care to pregnant women with
preexisting diabetes and gestational diabetes. Although there are many
reasonable approaches to providing that care, we have outlined herein those that
we find to be effective.
Acknowledgments
The editor is indebted to Dr. Lois Jovanovic, who lovingly edited the first
four editions of this book. She has set a high standard for this fifth edition.
Her contributions to our understanding of diabetes in pregnancy and its
treatment have been seminal.
In addition to the contributors to this current fifth edition, the editor would
like to acknowledge the important contributions of the many health professionals
who have contributed to previous editions of this book; the current edition is
built on a very strong foundation: Richard M. Cowett, MD
Stephanie Dunbar, MPH, RD
Donna Jornsay, RN, BSN, CPNP, MSS, ACSW
Sue Kirkman, MD
John L. Kitzmiller, MD
Lisa Marasco, MA, IBCLC, FILCA
Noreen Hall Papatheodorou, MSS, ACSW
Anne M. Patterson, RD, MPH