Nutrition PETRY GESTATIONAL DIABETES Origins, Complications, and Treatment DIABETES GESTATIONAL Edited by CLIVE J. PETRY Given the rapid increase in the worldwide incidence of gestational diabetes, the need for defining the risks and effects associated with raised glucose con- centrations in pregnancy is great. Recent large studies are helping to define the risks, as well as identify the benefits of reducing glucose intolerance. Written by an esteemed list of international authors, Gestational Diabetes: Origins, Com- plications, and Treatment presents timely reviews relating to some of the most important aspects of gestational diabetes, specifically its causes, consequences, and treatments. Divided into five sections, the book begins with a section on metabolism in pregnancy and gestational diabetes, dealing with maternal and foetal glucose metabolism and the controversial area of what actually constitutes gestational diabetes. The next section examines risk factors and causes of gestational dia- betes, including the obvious but often overlooked factors—being female and pregnant. The text also outlines environmental and genetic risk factors. The third section deals with the potential complications of gestational diabetes for both mother and offspring, considering short-term and long-term effects. The largest section in the book addresses treatments in an effort to improve the outcome for the mother and the baby. Chapters describe the nutritional approach, considered the cornerstone of treating gestational diabetes, as well as evidence for the role of exercise in its treatment and a useful strategy for treating gestational diabetes pharmacologically. The final section discusses fu- ture prospects in diagnosing and screening, prevention, pathophysiology, and treatment of gestational diabetes. K13753 6000 Broken Sound Parkway, NW Suite 300, Boca Raton, FL 33487 711 Third Avenue an informa business New York, NY 10017 2 Park Square, Milton Park www.taylorandfrancisgroup.com Abingdon, Oxon OX14 4RN, UK CAT#K13753 cover.indd 1 12/13/13 9:38 AM GESTATIONAL DIABETES Origins, Complications, and Treatment Edited by CLIVE J. PETRY GESTATIONAL DIABETES Origins, Complications, and Treatment Boca Raton London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2014 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 20131203 International Standard Book Number-13: 978-1-4398-7997-9 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. 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Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com Contents Preface......................................................................................................................vii About the Editor ........................................................................................................ix Contributors ..............................................................................................................xi SECTION I Gestational Diabetes Chapter 1 Glucose, Foetal Growth, and Pregnancy ..............................................3 Xinhua Chen and Theresa O. Scholl Chapter 2 What Is Gestational Diabetes? ........................................................... 33 Robert Lindsay SECTION II Origins Chapter 3 Environmental Risk Factors for Gestational Diabetes ....................... 51 Eran Hadar and Moshe Hod Chapter 4 Genetic Risk Factors for Gestational Diabetes ..................................69 Clive J. Petry SECTION III Complications Chapter 5 Complications of Gestational Diabetes ..............................................95 Liat Salzer and Yariv Yogev SECTION IV Treatments Chapter 6 Dietary Therapy for Gestational Diabetes ....................................... 119 Colin A. Walsh and Fionnuala M. McAuliffe v © 2010 Taylor & Francis Group, LLC vi Contents Chapter 7 Exercise and Gestational Diabetes ................................................... 147 Michel Boulvain Chapter 8 Pharmacological Treatment of Gestational Diabetes ....................... 157 David Simmons SECTION V Future Prospects Chapter 9 Future Prospects for Gestational Diabetes ....................................... 195 Clive J. Petry © 2010 Taylor & Francis Group, LLC Preface Gestational diabetes, defined as diabetes that first develops in a pregnant woman, is coming of age. Although this has been recognised as a distinct form of diabe- tes since the 1960s, recent large studies such as the Hyperglycemia and Adverse Pregnancy Outcome Study and the Australian Carbohydrate Intolerance Study in Pregnant Women are only now helping to precisely define the risks associated with having raised glucose concentrations in pregnancy, as well as the benefits that may be gained by reducing such glucose intolerance. As such, they may end up making the contribution to gestational diabetes that the Diabetes Control and Complications Trial and the UK Prospective Diabetes Study have made to type 1 and 2 diabetes, respectively. The need for this is great given that the worldwide incidence of gesta- tional diabetes is increasing rapidly in line with the increased prevalence of obesity, and the risks associated with a gestational diabetes pregnancy stretch beyond those to the mother (such as a massively increased risk of developing type 2 diabetes) and the newborn (e.g., macrosomia) to long-term, transgenerational risks in the offspring (such as for obesity and type 2 diabetes, and in females for gestational diabetes). The complications of these transmitted conditions could lead to potentially catastrophic effects, such as the offspring’s generation being the first in modern times to die at younger ages than their parents (Zimmet et al., 2007).* This book therefore sets out to provide timely reviews relating to what may be considered some of the most important aspects of gestational diabetes, in particular its causes, consequences, and ways of treating it. The book is split into five main sec- tions to encompass this. The initial section is based around metabolism in pregnancy and gestational diabetes. The first chapter, by Dr. Chen and Professor Scholl, deals with the important area of maternal and foetal glucose metabolism in pregnancy, particularly in relation to insulin resistance. The second chapter, by Dr. Lindsay, deals with the controversial topic of what actually constitutes gestational diabetes, an area that is currently receiving much attention in the literature. Section II contains chapters about risk factors and causes of gestational diabetes. The most obvious risk factors for gestational diabetes, almost by definition but often overlooked, are the subject being female and pregnant! However, whilst these factors are sensitive for the development of gestational diabetes, they carry no specificity, as only a fraction of pregnant women develop gestational diabetes. Environmental risk factors with greater specificity for gestational diabetes are outlined in Chapter 3 by Dr. Hadar and Professor Hod. In Chapter 4 I then outline the rapidly expanding field of genetic risk factors for gestational diabetes and how these are closely linked to genetic risk factors for other forms of diabetes. Having outlined the causes of gestational diabetes, the succeeding section then deals with the consequences of having this condition, namely, the potential * Zimmet, P. et al. 2007. The International Diabetes Federation Consensus Definition of the Metabolic Syndrome in Children and Adolescents. Brussels, Belgium: IDF Communications. Available at http:// www.idf.org/webdata/docs/Mets_definition_children.pdf. vii © 2010 Taylor & Francis Group, LLC viii Preface complications for both the mother and her offspring. In Chapter 5 Dr. Salzer and Professor Yogev outline