Open Access Medical Books



Edited by Luis Sobrevia .

172 pages .
Open Access .

Gestational diabetes (GD) is a syndrome characterized by glucose intolerance with onset or first recognition during pregnancy. This definition is widely and properly used in clinical terms. Something that at present is not well defined is the potential consequence of GD in the fetal development and increased postnatal risks. The, by now, clearer concept regarding health alterations in adulthood due to an abnormal intrauterine environment is something that indeed requires considering in order to better understand the consequences of human diseases of pregnancy. GD is one of the syndromes associated with altered phenotype at birth. Certainly, a proper management of these patients must be considered in order to diminish the health risk for the mother and the fetus.
In this book the contributors have compiled several aspects that should be considered in pregnancies with GD. The book is divided into two sections: (a) GD Patient Care and Considerations, and (b) Cell and Molecular Mechanisms Behind this Syndrome. In the first section (Chapter 1), Professor M.R. Begum (AKM Medical College, Dhaka, Bangladesh) proposes several management recommendations for a better comprehension of the diseases in pregnancy and its consequences. In this review, it is proposed that pregnancy progresses with changes in maternal carbohydrate occur and the placental hormones act as contrainsulin factor leading to insulin resistance with a final increase in insulin secretion. When this physiological compensation is inadequate, then GD develops. Unfortunately, we do not have tools for an early diagnosis of GD, or, even more importantly, a protocol that allows prevention of GD, but as soon as this syndrome is diagnosed or recognized management is required. GD ends in a sort of associated alterations in the mother (eg., preeclampsia, type 2 diabetes mellitus (DMT2) and others) and the fetus (eg., congenital anomaly, macrosomia and others). Thus, management of this syndrome aims mainly at maintaining euglycemia, preventing obstetrical complications and reaching optimal timing and appropriate mode of delivery. This chapter presents discussion which addresses suggestions for the management of patients including counselling, the role of nutrition and/or insulin therapy, or pharmacological treatment including oral antiadiabetic agents such as glybenclamide and metformin. In Chapter 2, Professor E.C.
Dantas Moisés (University of São Paulo, Brazil) proposes a multidisciplinary care of pregnant women with the diagnosis of GD. Complementing the previous chapter, this chapter includes non-pharmacological strategies to improve maternal and perinatal outcomes. Several aspects are touched in this concept, including nutrition. The chapter highlights the need for healthy eating habits according to the nutritional needs, physical activity as a strategy for prevention, and professional support from psychologists, nurses, social workers, and multidisciplinary groups. It is proposed that prenatal care of wom en is certainly required and that it is essential to provide information about the pathophysiology and prognosis of diabetes mellitus, either pregestational or gestational at this stage. Indeed, the United Nations (UN) Secretary General of World Health Organization (WHO) organized a special session of the UN General Assembly (2011) to address the control and prevention of non-communicable chronic diseases, presently the main cause of death and loss of health, which highlighted the importance of the health status of future mothers (i.e., pre-pregnancy) and its consequences on the health of fetus and the newborn. There is certainly a need for this and more research centres formed by multi and interdisciplinary groups should consider this concept......

Professor Luis Sobrevia
Cellular and Molecular Physiology Laboratory (CMPL)
Division of Obstetrics and Gynaecology
School of Medicine, Faculty of Medicine
Pontificia Universidad Católica de Chile
Santiago, Chile.
Honorary Professor
The University of Queensland Centre for Clinical Research
Herston, QLD, Australia.



Section 1 GD Patient Care and Considerations .

 1 GDM: Management Recommendations During Pregnancy 3 Mosammat Rashida Begum

 2 Multidisciplinary Care of Pregnant Women with Gestational Diabetes Mellitus: Non Pharmacological Strategies to Improve Maternal and Perinatal Outcomes 17 Elaine Christine Dantas Moisés

Section 2 Cell and Molecular Mechanisms .  

 3 The Role of Placental Exosomes in Gestational Diabetes Mellitus 29 Carlos Salomon, Luis Sobrevia, Keith Ashman, Sebastian E. Illanes, Murray D. Mitchell and Gregory E. Rice

 4 The Adenosine–Insulin Signaling Axis in the Fetoplacental Endothelial Dysfunction in Gestational Diabetes 49 Enrique Guzmán-Gutiérrez, Pablo Arroyo, Fabián Pardo, Andrea Leiva and Luis Sobrevia

 5 Pro-Inflammatory Cytokines, Lipid Metabolism and Inflammation in Gestational Diabetes Mellitus as Cause of Insulin Resistance 79 Alexander E. Omu

 6 Maternal Hypercholesterolemia in Gestational Diabetes and the Association with Placental Endothelial Dysfunction 103 A. Leiva, C Diez de Medina, E. Guzmán-Gutierrez, F. Pardo and L.

 7 The Role of Placenta in the Fetal Programming Associated to Gestational Diabetes 135 Carlos Escudero, Marcelo González, Jesenia Acurio, Francisco Valenzuela and Luis Sobrevia

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Published by: younes younes - Monday, April 29, 2013


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