Medical Management of Pregnancy Complicated by Diabetes 7th Edition

ERIKA F. WERNER, MD, MS, is Interim President, Tufts Medical Center Physicians Organization; Chair, Department of Obstetrics & Gynecology, Tufts Medical Center; and Louis E. Phaneuf Teaching and Research Professor of Gynecology at Tufts University School of Medicine. Dr. Werner is a national expert on diabetes in pregnancy, preeclampsia, and cost-e  ective practices in obstetrics. Dr. Werner has 100 peer-reviewed articles, is the associate editor of several obstetric journals, and has won numerous teaching awards.

Foreword vii
Acknowledgments ix
Contributors to the 7th Edition xi
1. Preparing for Pregnancy (Zork) 1
Highlights 2
Preexisting Diabetes 5
Prepregnancy Counseling 9
Prepregnancy Assessment 11
Prepregnancy Management 14
Previous Gestational Diabetes Mellitus 18
References 19
2. Lifestyle Management for Diabetes in Pregnancy (Hernandez) 25
Highlights 27
Weight Gain Recommendations 29
Controversy: Calorie Restriction for Patients with Obesity 30
Nutrition Management in Pregnancy 32
For Preexisting Diabetes 32
For Gestational Diabetes Mellitus 34
Individualized Meal Planning and Recordkeeping 35
Macronutrients 37
Energy 37
Carbohydrate 38
Dietary Fiber 40
Glycemic Index 42
Resistant Starch and High-Amylose Foods 42
Protein 42
Dietary Fat 42
Micronutrients 43
Sodium 43
Folate 44
Iron 44
Vitamin D and Calcium 44
Other Nutrients 45
Vitamin and Mineral Supplementation 45
Food Safety 45
Caffeine 45
Alcohol 46
Nonnutritive Sweeteners 46
Herbal Medicines and Supplements 46
Listeria 46
Mercury 47
Exercise as a Treatment Modality 47
Selected Readings 48
References 48
3. Glycemic Goals and Assessment During Pregnancy (Han) 53
Highlights 54
Normoglycemia during Pregnancy 55
Diagnosis of Diabetes 57
Self-Monitoring of Capillary Blood Glucose 59
Continuous Glucose Monitoring in Pregnancy 61
Ambulatory Glucose Profiles 62
Factors Affecting Glucose Levels 63
Other Measures of Metabolic Control 64
Ketonuria and Ketonemia 66
Selected Readings 67
References 67
4. Medications for Diabetes in Pregnancy (Zera) 73
Highlights 74
Metabolic Changes during Pregnancy 75
Insulin 77
Obstetric Considerations 81
Oral Antidiabetes Medications 83
References 85
5. Common Complications (Harper) 91
Highlights 92
Hyperemesis/Gastroparesis 93
Preterm Birth 97
Preeclampsia 98
Diabetic Ketoacidosis 98
Congenital Anomalies and Perinatal Deaths 99
References 100
6. Risk Assessment, Fetal Surveillance, and Delivery in Pregnancies
Complicated by Diabetes (Hamel) 105
Highlights 106
Screening, Diagnostic Testing, and Fetal Surveillance 107
Genetic Screening 109
Ultrasound 111
Antenatal Testing 113
Timing and Mode of Delivery 116
Selected Reading 118
References 118
7. Postpartum Concerns for Individuals with Diabetes (Ludgin) 121
Highlights 122
Postpartum Care 123
Chest-feeding 125
Nutrition Recommendations 126
Selected Readings 129
References 129
8. Contraception (Cleary) 133
Highlights 134
Hormonal Contraceptives: Background 137
History of Gestational Diabetes without Additional Medical
Complications 137
Long-Acting Reversible Contraception (LARC): Intrauterine Devices
and Implants 137
Non-LARC Hormonal Contraceptives 142
Permanent Sterilization 144
Timing of Contraceptive Counseling 145
Selected Readings 145
References 146
9. Neonatal Care (Sen, Tiwari) 149
Highlights 150
Overview 151
Newborn Outcomes 152
Nursery Care 161
Long-Term Follow-Up 162
Summary 164
References 164
Index 175