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Medical Disorders and Pregnancy

• Editor's Note
• List of Articles

List of Articles

• Gestational Diabetes: A Comprehensive Review
  The prevalence of gestational diabetes mellitus (GDM) continues to rise in the face of the obesity epidemic affecting up to 14% of the population. It is the most common clinical issues facing obstetricians and gynecologists and their patients. This document is to provide a comprehensive review of understanding of gestational diabetes mellitus (GDM) and provide management guidelines. Because the risk factors for GDM (particularly obesity) are independent risk factors for fetal macrosomia, the role of maternal hyperglycemia has been widely debated. Considerable controversy remains regarding the exact relationship of these complications to maternal hyperglycemia. Women with GDM are more likely to develop maternal and fetal complications. Whether the relationship with GDM is casual or not, clinicians should be aware of these risks. In addition, women with GDM have an increased risk of developing diabetes later in life.
  
  
• Diabetes In Pregnancy
  Diagnosis of gestational diabetes is typically made on the basis of an oral glucose tolerance test. A lack of consensus exists regarding the optimal testing protocol and threshold to identify women and infants with increased risk of complications. The majority of women with pregnancy complicated by diabetes have gestational diabetes (GDM). The American Diabetes Association defines GDM as any degree of glucose intolerance with onset or first recognition during pregnancy. Long-term risks of gestational diabetes include increased risk of recurrent GDM in subsequent pregnancies, risk of diabetes in the mother, and increased risk of childhood obesity, glucose intolerance and diabetes in the offspring.
  
  
• Medical Nutrition Management of Gestational Diabetes
  A cornerstone of blood glucose management of GDM is Medical Nutrition Therapy (MNT). The goal of MNT is to help the woman achieve normoglycemia without ketosis and optimal nutritional intake for maternal health and fetal growth. An estimated 50-75% of pregnancies complicated by GDM can be successfully managed with MNT alone. It is important to initiate such intervention as soon as possible after diagnosis. Referral to a Registered Dietitian (RD) should be made within 48 hours of diagnosis so that intervention can be initiated within one week after diagnosis.
  
  
• Chronic Hypertension in Pregnancy
  This review discusses the effects of chronic hypertension on pregnancy, to clarify the terminology and criteria used to define and diagnose it during pregnancy, and to review the available evidence for treatment options. Chronic hypertension complicates pregnancy and is associated with several adverse outcomes, including premature birth, intrauterine growth restriction (IUGR), fetal demise, placental abruption, and cesarean delivery. An additional diagnostic complication may arise in women with hypertension who begin prenatal care after 20 weeks of gestation.
  
  

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