Gestational Diabetes. From Diagnosis to Treatment

Preface

Chapter 1. Maternal Metabolism and Nutrient Delivery to Fetus
(Gagan Priya, MD, DM, and Sanjay Kalra, MD, DM, Consultant Endocrinologist, Fortis Hospital and Ivy Hospital, Mohali, Punjab, India, and others)

Chapter 2. The Impairments of Glucose Metabolism ın Pathophysıology of Gestatıonal Dıabetes Mellıtus
(Mehtap Kacar, MD, Burcin Tuvana Us, MD, and Nuray Yazihan, MD, Department of Physiology, Yeditepe University, Faculty of Medicine, Istanbul, Turkey, and others)

Chapter 3. The Role of the Human Placenta in Pathophysiology of Gestational Diabetes Mellitus
(Melin Uygur, MD, Department of Endocrinology and Metabolism, Yeniyüzyıl University Medical Faculty, Istanbul, Turkey)

Chapter 4. The Fetal Metabolism and the Pathophysiological Mechanisms of Fetal Complications
(Mehtap Kacar, Burcin Tuvana Us and Nuray Yazihan, Department of Physiology, Yeditepe University, Faculty of Medicine, Istanbul, Turkey, and others)

Chapter 5. Insulin Resistance in Pregnancy and Etıopathogenesıs of Gestational Diabetes Mellitus
(Mamta Gupta, MD, and Sonia Kataria2 DGO, DNB, Ex Head of Obstetric and Gynaecology Deptartment, Hindu Rao Hospital and Associated NDMC Medical College, New Delhi, India, and others)

Chapter 6. The Effect of Obesity on the Development of Gestational Diabetes Mellitus
(İnan Anaforoğlu, Department of Endocrinology and Metabolism, Bahçeşehir University, Faculty of Medicine, Istanbul, Turkey)

Chapter 7. Adıpokınes: Role ın Pathogenesıs of Gestational Diabetes Mellitus
(Mamta Gupta, MD and Sonia Kataria, DGO, DNB, Ex Head of Obstetric and Gynaecology Department, Hindu Rao Hospital and Associated NDMC Medical College, New Delhi, India, and others)

Chapter 8. Lipid Metabolism in Pathophysiology of Gestational Diabetes Mellitus
(Mehmet Sargın, MD, Department of Family Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey)

Chapter 9. Gestational Diabetes Mellitus and Inflammation
(Çiğdem Özkan, MD, and Alev Eroğlu Altınova, MD, Department of Endocrinology and Metabolism, Gazi University Medical Faculty, Ankara, Turkey)

Chapter 10. The Roles of Oxidative Stress and Heavy Metal Toxicity in the Pathogenesis of Gestational Diabetes Mellitus
(Mehtap Kacar, MD, Burcin Tuvana Us, MD, and Nuray Yazihan, MD, Department of Physiology, Faculty of Medicine, Yeditepe University, Istanbul, Turkey, and others)

Chapter 11. Gut Microbiata and Etıopathogenesıs of Gestatıonal Dıabetes Mellıtus
(Mamta Gupta, MD and Sonia Kataria, DGO, DNB, Ex Head of Obstetric and Gynaecology Department, Hindu Rao Hospital and Associated NDMC Medical College, New Delhi, India, and others)

Chapter 12. Autoimmunity: Role in Etiopathogenesis of Gestational Diabetes Mellitus
(Mamta Gupta, MD and Sonia Kataria, DGO, DNB, Ex Head of Obstetric and Gynaecology Department, Hindu Rao Hospital and Associated NDMC Medical College, New Delhi, India, and others)

Chapter 13. Environmental and Dietary Factors: Role ın Etıopathogenesıs of Gestatıonal Dıabetes Mellıtus
(Mamta Gupta, MD and Sonia Kataria, DGO, DNB, Ex Head of Obstetric and Gynaecology Department, Hindu Rao Hospital and Associated NDMC Medical College, New Delhi, India, and others)

Chapter 14. Metabolomics: Role ın Etıopathogenesis of Gestatıonal Dıabetes Mellıtus
(Mamta Gupta, MD and Sonia Kataria, DGO, DNB, Ex Head of Obstetric and Gynaecology Department, Hindu Rao Hospital and Associated NDMC Medical College, New Delhi, India, and others)

Chapter 15. Genetic and Epigenetic Factors: Role ın Etıopathogenesis of Gestatıonal Dıabetes Mellıtus
(Mamta Gupta, MD and Sonia Kataria, DGO, DNB, Ex Head of Obstetric and Gynaecology Department, Hindu Rao Hospital and Associated NDMC Medical College, New Delhi, India, and others)

Chapter 16. Vitamin D and Gestational Diabetes Mellitus
(Güzin Fidan Yaylalı, MD, Department of Endocrinology and Metabolism, Pamukkale University, Denizli, Turkey)

Chapter 17. Epidemiology and Prevalence of Gestational Diabetes Mellitus
(Ersen Karakılıç, MD, Department of Endocrinology and Metabolism, Canakkale 18 March University Medical Faculty, Canakkale, Turkey)

Chapter 18. Epidemiology and Approach to Gestational Diabetes Mellitus in India
(Samreen Siddiqui, Sujeet Jha and Shweta Dubey, Institute of Endocrinology, Diabetes and Metabolism, Max Healthcare, New Delhi, India, and others)

Chapter 19. Geographic and Ethnic Variations in the Incidence of Gestational Diabetes Mellitus
(Alev Selek, MD, Department of Endocrinology and Metabolism, Kocaeli University School of Medicine, İzmit, Turkey)

Chapter 20. Risk Factors for Gestational Diabetes Mellitus
(Hamide Piskinpasa, MD, and Meral Mert, MD, Department of Endocrinology and Metabolism, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey)

Chapter 21. Risk Scores for Selective Screening for Gestational Diabetes in Sub Saharan Africa
(Akwilina Wendelin Mwanri and Safiness Simon Msollo, Department of Food Technology, Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro, Tanzania, and others)

Chapter 22. Definition, History, Diagnosis and General Features of Gestational Diabetes Mellitus
(Imran Ali Khan, MD, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences,
King Saud University, Riyadh, Saudi Arabia)

Chapter 23. Diagnosis and Screening Methods in Gestational Diabetes Mellitus
(Mine Adaş, MD, and Aylia Yeşilova, MD, Department of Endocrinology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey, and others)

Chapter 24. Comparison of Screening Methods in Gestational Diabetes Mellitus
(Shahjada Selim, MD, Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh)

Chapter 25. Hyperglycemia in Pregnancy among South Asian Women: Experience from Universal Screening and Multi-Disciplinary Management
(Malitha Patabendige, MD, and Asanka Jayawardane, MD, Senior Registrar in Obstetrics and Gynaecology, Castle Street Hospital for Women, Colombo, Sri Lanka, and others)

Chapter 26. Biomarkers in the Early Diagnosis of Gestational Diabetes Mellitus
(Mehtap Kacar, Burcin Tuvana Us and Nuray Yazihan, Department of Physiology, Yeditepe University, Faculty of Medicine, Istanbul, Turkey, and others)

Chapter 27. Glycemic Targets ın Gestatıonal Diabetes Mellitus
(Dilek Yazıcı, MD, Department of Endocrinology and Metabolism, Koç University Medical School, Istanbul, Turkey)

Chapter 28. Which Is More Important in Gestational Diabetes Mellitus: Fasting or Postprandial Blood Glucose?
(Elif Kilic Kan, MD, and Aysegul Atmaca, MD, Department of Internal Medicine, Division of Endocrinology and Metabolism, Ondokuz Mayis University School of Medicine, Samsun, Turkey)

Chapter 29. Glucose Monitoring in Management of Gestational Diabetes Mellitus
(Sevim Şen, PhD, Department of Nursing, Faculty of Health Sciences, Yeditepe University, Istanbul, Turkey)

Chapter 30. Medical Nutrition Therapy ın Gestatıonal Dıabetes Mellıtus
(Binnur Okan Bakır, PhD, Department of Nutrition and Dietetics, Yeditepe University, Istanbul, Turkey)

Chapter 31. Physical Activity and Excercise in Gestational Diabetes Mellitus
(Dilek Şahinoğlu, Physiotherapist, Department of Physical Therapy and Rehabilitation, Yeditepe University Hospital, Istanbul, Turkey)

Chapter 32. Insulın Therapy in Gestational Diabetes Mellitus
(Filiz Haydardedeoglu, MD, and Okan Sefa Bakiner, MD, Department of Endocrinology and Metabolism, Baskent University, Dr. Turgut Noyan Research and Training Center, Yuregir, Adana, Turkey)

Chapter 33. Insulin Pump Therapy and Continuous Glucose Monitoring Systems in Pregnancy with Pregestational and Gestational Diabetes
(Havva Sezer, MD, and Oğuzhan Deyneli, MD, Section of Endocrinology, Koç University Hospital, Istanbul, Turkey, and others)

Chapter 34. Oral Antihyperglycemic Agents in the Treatment of Gestational Diabetes Mellitus
(Şule Temizkan, MD, Department of Endocrinology and Metabolism, Başkent University Faculty of Medicine, Istanbul, Turkey)

Chapter 35. Role of Myoinositols in Gestational Diabetes Mellitus
(Vidushi Kulshrestha, MD, Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India)

Chapter 36. Management of Obesity in Pregnancies with Gestational Diabetes Mellitus
(Arundhati Dasgupta MD, DM, Consultant Endocrinologist, Rudraksh Superspeciality Care, Siliguri, West Bengal, India)

Chapter 37. The Effect of Treatment on Outcomes in Gestational Diabetes Mellitus
(Özlem Haliloğlu, MD, Endocrinology and Metabolism Unit, Turkish Republic Ministry of Health, Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey)

Chapter 38. Role of Diabetes Nurse in the Management of Gestational Diabetes Mellitus
(Sevim Şen, PhD, Department of Nursing, Faculty of Health Sciences, Yeditepe University, Istanbul, Turkey)

Chapter 39. Health 4.0 to Facilitate Effective Self-Care for Patients with Gestational Diabetes Mellitus
(Nilmini Wickramasinghe, PhD, Professor Digital Health and Deputy Director Iverson Health Innovation Research Institute, Swinburne University of Technology and Epworth HealthCare, Australia)

Chapter 40. Integrating Gestational Diabetes Mellitus Management in Primary Health Care
(Qudsia Anjum, Specialist Family Medicine, Burjeel Medical Center, Abu Dhabi, UAE)

Chapter 41. Maternal Complications of Gestatıonal Dıabetes Mellıtus
(Başak Karbek, MD, Department of Endocrinology and Metabolism, Baskent University Istanbul Health Application and Research Center, Istanbul, Turkey)

Chapter 42. Fetal and Neonatal Complications of Gestational Diabetes Mellitus
(Petek Feriha Arioglu, MD, Department of Obstetrics and Gynecology, Maternal Fetal Medicine/Perinatology, Baskent University Medical Faculty, Istanbul, Turkey)

Chapter 43. Congenital Malformations in Gestational Diabetes Mellitus
(Arzu Güntürk, MD, Department of Internal Medicine, Yeditepe University School of Medicine,
Istanbul, Turkey)

Chapter 44. Maternal Hypoglycemia
(Evin Bozkur, MD, and Ilkay Cakir, MD, Endocrinology and Metabolism Clinic, University of Health Sciences, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey)

Chapter 45. Management of Macrosomic Baby
(Gülay Ciler Erdag, MD, Department of Pediatrics, Yeditepe University School of Medicine, Istanbul, Turkey)

Chapter 46. Hypertension in Gestational Diabetes Mellitus: Diagnosis and Treatment
(Pınar Şişman, MD, and Özen Öz Gül, MD, Department of Endocrinology and Metabolism, Medicana Bursa Hospital, Bursa, Turkey, and others)

Chapter 47. Thyroid Dysfunction in Women with Gestational Diabetes Mellitus
(Seda Sancak, MD, Department of Internal Medicine, Endocrinology and Metabolism Disorders, Fatih Sultan Mehmet Education and Research Hospital, University of Health Sciences, Istanbul, Turkey)

Chapter 48. The Cardiovascular Disease as a Complication of Gestational Diabetes Mellitus
(Seda Sancak, MD, Department of Internal Medicine, Endocrinology and Metabolism Disorders, Fatih Sultan Mehmet Education and Research Hospital, University of Health Sciences, Istanbul, Turkey)

Chapter 49. Psychosocial Stress in Gestational Diabetes Mellitus and Its Management

Chapter 50. Fetal Monitorization ın Gestatıonal Dıabetes Mellıtus

Chapter 51. Oprimal Time and Mode of Delivery in Gestational Diabetes Mellitus

Chapter 52. Management of Glycemia during and after Labor

Chapter 53. Postpartum Management of Mother and Infant in Gestational Diabetes Mellitus

Chapter 54. The Protective Effect of Breastfeeding and Postpartum Weight Loss against the Development of Diabetes in Japanese Women with a History of Gestational Diabetes

Chapter 55. Nutritional Problems in Children of Mothers with Gestational Diabetes Mellitus

Chapter 56. Increasing Cumulative Incidence of Diabetes after Gestational Diabetes: A Double Cohort, Long-Term Follow-Up in a Danish Population

Chapter 57. Predictors of Postpartum Diabetes Mellitus

Chapter 58. Determinants of Recurrence in Gestational Diabetes Mellitus

Index

Gestational diabetes, because of its not only high prevalence but also resulting complications in both mother and fetus makes it one of the most important problem of a pregnant woman.

The exact cause of gestational diabetes is unknown. Obviously, there is no one reason for the development of the disease. Placental hormones likely play a role. Insulin resistance is in the center and some factors like adipokines, lipids, inflammation, oxidative stress, heavy metals, gut microbiota, autoimmunity, metabolomics, genetic factors and vitamin D are the determinants for the development of insulin resistance and disease itself.

Worldwide distribution of the disease changes according to geography. Ethnic factors also play role. Although some well-known risk factors have role in the development of the disease, 1 in 20 women without any risk factors also develop GDM.

There is no universal screening and diagnostic methods. Some countries use universal screening some others prefer selective screening of women with risk factors. In addition, some suggest use of one-step diagnosis, while others two-step. The most challenging issue is use of some biomarkers in early (first trimester) diagnosis of pregnancy to prevent development of GDM.

Many modalities are used in treatment. Medical nutrition therapy is still the basis of management. Exercise has some roles, too. Besides pharmacotherapies like insulin and oral antidiabetics, some modern modalities like insulin pump therapy together with continuous glucose monitoring, telemedicine, dietary supplements like myoinositols are also covered in this book. Monitorization is important in diabetes and role of nurses in follow-up is incontrovertible.

If not treated well, both fetus and mother are open to complications. From congenital malformations to macrosomia, if inevitable, proper management of these problems has to be considered. Some comorbidities like hypertension, thyroid problems and psychosocial stress complicate the problem further.

Fetal monitorization, time and type of delivery and management of glycaemia during peripartum period are the issues to be considered towards to end of pregnancy.
The problem does not finish with the birth of baby. Both mother and newborn has to be followed for the development of future problems like postpartum diabetes and obesity. Nutrition and benefits of breastfeeding are important points for the health of the baby. In addition, every efforts has to be spent to prevent recurrence of the disease in subsequent pregnancies.

The most important instrument against fighting a disease is information i.e. how much we know about it. Understanding the problem thoroughly strengthens our hands to cope and overcome it more easily. The main target of this book is to handle every aspect of the disease from diagnosis to treatment as evident from the title. It is a candidate for a reference guide in this subject. It includes most recent and update data on gestational diabetes.