Step by Step Diabetes in Pregnancy
Step by Step Diabetes in Pregnancy
Guest Editors MC Gupta Retd Professor and Head of Medicine SN Medical College
Agra
Nidhi Gupta MBBS MS (Obs & Gyn) FICMCH Dip USG (Ian Donald), MICOG
Department of Obstetrics and Gynaecology SN Medical College
Agra
Series Editors Narendra Malhotra MD FICOG
Jaideep Malhotra MD FICOG
e.mail: mnmhagral0@dataone.in
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Step by Step Diabetes in Pregnancy
© 2006, MC Gupta, Nidhi Gupta
This book has been published in good faith that the material provided by authors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and authors will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters to be settled under Delhi jurisdiction only.
First Edition: 2006
9788180618123
Typeset at JPBMP typesetting unit
Printed at Gopsons
4Foreword
Prior to the advent of insulin, diabetes posed a formidable challenge to the clinician. Most of the diabetic women either did not become pregnant or were advised MTP as the obstetric outcome of such cases was very poor (maternal mortality of about 25% and perinatal loss of 50%).
This dismal picture has changed today. With better glycaemic controls more and more diabetic women are becoming pregnant and achieving a successful obstetrical outcome. Today, the obstetrician has to be prepared to manage diabetic pregnant women as he/she is an important part of the high risk team, consisting of an obstetrician, internist, endocronologist, perinatologist and nutritional counsellor.
Prof (Dr) MC Gupta, former Head and Professor of PG Department of Medicine, SN Medical College, Agra is a renowned academician with indepth knowledge of his subject. Dr (Mrs) Nidhi Gupta is an MS (Obst and Gyn) attached to the Department of Obstetrics and Gynecology, SN Medical College, Agra with a keen interest in academics. Both of them have teamed together to produce a book which is simple and easy to follow. It will help the clinicians 5to manage the diabetic pregnancy “Step by Step” to achieve success in the form of a healthy baby and a healthy mother.
A separate chapter has been devoted to various types of insulins, their pharmacokinetics, dosage schedules, delivery systems, side effects and drug interactions. This can act as a ready reckoner for the general practitioner.
I congratulate both the authors to bring out this book and I am sure that this will help medical practitioners to understand and manage diabetes during pregnancy successfully.
Late Prof Dr NL Patney
Former Professor and Head
PG Department of Medicine
SN Medical College
Agra
6Preface
Diabetes is a very common condition in the Indian population specially in our females. A clear understanding of Diabetes is needed by the antenatal service providers—the obstetricians to ensure proper screening to all our pregnant women and to detect, pick up and manage these pregnancies to the best for a favourable maternal and neonatal outcome.
We have attempted to bring out all the aspects of diabetes in pregnancy in this small booklet.
Prof MC Gupta, retired HOD of SN Medical College Medicine Department and Dr. Nidhi Gupta, Obstetrician and Gynaecologist have done a wonderful job to simplify this complex problem for the daily practitioner.
Narendra Malhotra
8Acknowledgements
We are thankful to Dr Nidhi Gupta for her efforts in compiling this booklet and to Prof MC Gupta for looking at the medical aspects of Diabetes.
We are thankful to our readers for giving us an overwhelming response to our Step by Step Series and to Jaypee Brothers Medical Publishers for bringing out this series.
Narendra Malhotra
10Acknowledgements
First of all, a heartfelt thanks to the series editors, Dr Narendra Malhotra and Dr Jaideep Malhotra who though are real tough task masters but always get the best out of me.
Modernization and industrialisation may be a boon to the whole mankind but its greatest rewards are diseases like diabetes. Its prevalence is increasing globally and more so in developing countries like India, women are not immune to this disease. The obstetricians of present times have to face a dual dilemma of treating this disease, its complications and at the same time trying to achieve a successful obstetric outcome. This book provides a step by step management of such women by the clinician.
In preparing this book, I have utilised the knowledge of stalwarts and organisations working in this field and consulted many books and publications. I wish to express my appreciation and gratitude to all of them.
I would like to acknowledge gratitude to all my teachers with a special mention of Prof (Dr) MC Gupta, Prof (Dr) Deoki Nandan and Prof (Dr) Arun Nagrath who have always encouraged me in my academic endeavours.
A very special and sincere thanks to my mothers—Mrs Savitri Gupta and Dr Satya Suri who have always 11stood by me in all my successes and failures. A special mention and heartful thanks to my brother Dr Vinit Suri and my friends who have always critically appraised me which have helped me to improve with each book.
The foreword of this book is written by a great man and a great teacher who we lost last month. Prof NL Patney will always remain in our hearts and minds as a role model for all of us to be a clinician and a human being like him.
A special thanks to my dear husband Mr Anurag Gupta and children Abhishek and Akrishti for their unending support and help in my efforts.
Nidhi Gupta