Getting Back Into Shape After The Pregnancy

Pregnancy Diet Plan

Pregnancy Diet Plan

The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.

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Pregnancy Without Pounds

This proven program will get you through your pregnancy in better shape than most other women in as little as 27 minutes a day and with minimal effort. It contains all the information that I believe will Help you to look and feel like I did barefoot and beautiful! Inside you will learn Exactly how to avoid unwanted pounds, overcome your food cravings, care for your skin, dress to kill and look like one Hot Mama. Ive also put together Fifty simple, yet extremely effective pregnancy-friendly exercises and stretches to keep you and your body looking and feeling Great (includes 3 different fitness programs depending on Your fitness level)!

Pregnancy Without Pounds Summary

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The author presents a well detailed summery of the major headings. As a professional in this field, I must say that the points shared in this manual are precise.

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Recommended Maternal Weight Gains In Nondiabetic Pregnancies

Optimal weight gain for pregnancy needs to reflect the woman's pre-pregnancy weight (22). The guidelines on recommended maternal weight gains are based on large obstetric surveys in non-diabetic women in the United States (23). The maternal weight gain required to minimise the frequency of small-for-gestational-age (SGA) infants is higher for underweight (BMI< 19.8 kg m2) than overweight or obese women, see Table 7.2. As the majority of women with pre-existing Type 2 and GDM are already obese it is important that the dietary advice given does not result in higher post-partum than pre-pregnancy weights. When the pre-pregnancy BMI is > 35 kg m2, the risk of a SGA infant is low and even when little or no maternal weight gain occurs the risk of a SGA infant does not appear to increase (11). Overweight (BMI 26.1-29 kg m2) and obese (BMI > 29 kg m2) women are more likely to give birth to a LGA infant than normal weight women and this risk increases with increasing maternal weight...

Abnormal Glucose Tolerance Insulin Sensitivity and Insulin Secretion

The Pima Indian Study investigated whether insulin secretion and insulin action were associated with maternal diabetes diagnosed before vs. after pregnancy among adult offspring with normal glucose tolerance. While insulin action as measured by hyperinsulinemic euglycemic clamp did not differ, insulin secretion was reduced by 40 as measured by the acute insulin response among adult offspring exposed to diabetes in utero compared with those whose mothers developed diabetes after pregnancy (29). Since 1965, Pima Indian women have had oral glucose tolerance tests during pregnancy, as well as outside pregnancy approximately every 2 years (18, 30). As a result, extensive maternal diabetes information is available for the offspring of women who had diabetes before or during pregnancy (mothers with diabetes during pregnancy), for those mothers who developed diabetes only after pregnancy (prediabetic mothers), as well as for those who remained nondiabetic.

Diet And Insulin Therapy For

Once diet alone can no longer consistently ensure fasting glucose values below 5.5mmol l and a 1h post-prandial value below 7mmol l, the introduction of insulin should be considered (63). It is important to recognise that a small proportion of women will require insulin early in pregnancy and not to assume dietary non-compliance (92). Those requiring insulin are the most metaboli-cally compromised and tend to have both the highest perinatal complications and the fastest deterioration to diabetes after pregnancy (93). Insulin is also occasionally introduced in later pregnancy for obstetric rather than glycaemic reasons this might occur for accelerated foetal growth or unexplained polyhydramnios (94).

Gestational Diabetes Mellitus

Gestational diabetes is carbohydrate intolerance resulting in hyperglycemia of variable severity with onset or first recognition during pregnancy. The definition applies irrespective of whether or not insulin is used for treatment or the condition persists after pregnancy. It does not exclude the possibility that the glucose intolerance may antedate pregnancy but has been previously unrecognized (2,3).

Performance of Postpartum Screening

Reasons why women forego screening are speculative but include women's low perception of diabetes risk (83), lack of healthcare provider perception of risk (84, 85), and lack of other steps necessary for screening such as lab slip distribution or test ordering (84, 86). The reasons why women forego screening may also differ between study populations. Russell et al. found that screened and unscreened women had similar glucose levels during pregnancy (80), but screened women were more likely to attend the postpartum visit, suggesting that barriers to the postpartum visit also presented barriers to screening. In contrast, Smirnakis et al. found that screened women had more favorable fasting and 1-h glucose values from the index GDM diagnosis (79). Even though many women were not screened, greater than 90 attended a postpartum visit, suggesting that lower risk during pregnancy influenced rates of return after pregnancy rather than postpartum visit barriers in that health system.

Pregnancy After Renal Transplantation

Combined kidney-pancreas transplants prior to pregnancy have been reported several times 315-318 , and the NTPR also reported 23 pregnancies after combined transplants 319 . In this group 25 had PET while 91 were hypertensive 70 of deliveries were premature. Two-thirds of these gravidas were treated for some type of infections. Barrou et al reviewed 19 cases of pregnancy after simultaneous pancreas-kidney transplants reported to the International Pancreas Transplant Registry in the CsA era 320 . There were 19 live births with average birth weight 2150 + 680 gm and two major congenital malformations. Only one pancreas graft and one kidney graft were lost after pregnancy in two different recipients. Pancreas-kidney transplantation may reduce risk factors for the development of macroangiopathy but fails to halt progression of macrovascular diseases 321 . Beyond these studies, there has been hypothetical concern that pregnancy may adversely affect renal graft survival 294,297 . The NTPR...

Diabetic Retinopathy in Pregnancy

A retrospective study by Lovestam-Adrian in 1997 addressed the issue whether the short-term risk of progression of DR in pregnant women with DM1 is increased than in nonpregnant women with DM1 and similar diabetes characteristics matched for age and duration of diabetes (78). The patients had been followed for 12 months before, during, and 6 months after pregnancy. The results indicated that progression of retinopathy to potential loss of sight was similar between the pregnancy group and the control group, and pregestational elevated A1C and a rapid decrease in A1C were each significant risk factors for progression of preexisting retinopathy in the groups (78).

Genetic Factors vs Environment

It is possible to disentangle the effects of genetic susceptibility vs. exposure to diabetes in utero in several ways. First, offspring of mothers who had early onset diabetes either before (diabetic mothers) or after pregnancy (prediabetic mothers) can be compared, as both groups of women will share similar genetic predisposition to type 2 diabetes and so differences in the offspring can be attributed to the diabetic intrauterine environment. Among the Pima Indians, offspring of mothers who were diagnosed with diabetes before the index pregnancy exhibited reduced insulin secretion than offspring born to mothers who developed diabetes at a similar age, but after the index pregnancy (29). In this same high-risk population, children who were exposed to diabetes during pregnancy were more likely to be obese than children born to prediabetic or nondiabetic mothers, and there was no difference in weight relative to height between the offspring of prediabetic vs. nondiabetic mothers (19)....

Will a woman with gestational diabetes need antidiabetic treatment after delivery

(50-70 percent of obese women after delivery develop Type 2 DM within five years, compared to 25 percent of women with normal weight after delivery). The risk of future development of diabetes is also definitely higher when impaired glucose tolerance is detected after delivery (12 percent of pregnant women with normal glucose tolerance develop diabetes 6-8 weeks after birth, compared to 84 percent of those with impaired glucose tolerance). Also, 30-60 percent of women with gestational diabetes will manifest gestational diabetes again in a next pregnancy. The risk is higher following multiparous births by older women as well as for those who gained lots of weight between pregnancies. Around 20 percent of pregnant women with gestational diabetes will develop impaired glucose tolerance after delivery. These women should be regularly followed for possible development of Type 2 DM in the future and receive proper dietary advice for avoidance of obesity and 'diabetogenic' medicines. For...

Genetic Models of RAGE Modification and Diabetic Nephropathy

In order to definitively address the role of RAGE in the pathogenesis of DN, genetic models have been employed in experimental systems. In the first studies, Yamamoto and colleagues (52) generated transgenic mice that overexpress RAGE in vascular cells (and to some degree on mononuclear phagocytes) and cross-bred these mice with animals that develop insulin-dependent diabetes shortly after birth. The double-transgenic diabetic mice displayed increased enlargement of the kidney, glomerular hypertrophy, increased albuminuria, mesangial expansion, advanced glomerulosclerosis, and increased serum creatinine compared with the diabetic litter-mates that lacked the RAGE transgene. In those studies, consistent with roles for advanced glycation in amplifying RAGE-mediated perturbation in this setting, these authors found that administration of OPB-9195, an inhibitor of AGEs, prevented the nephropathy phenotype in the double-transgenic mice (52).

Apart from macrosomia how can other conditions harm the foetus of a pregnant woman with DM

Hypocalcaemia (total serum calcium level < 7 mg dl 1.75 mmol L or ionized calcium < 4 mg dl 1.0 mmol L ) is a common complication, especially in low birth weight infants of diabetic pregnancies. The extent of hypocalcaemia is related to the severity and duration of maternal diabetes. It is thought to be caused by the lower parathyroid hormone (PTH) concentrations after birth in infants of diabetic mothers compared to normal infants. It is combined with hyperphosphataemia and is usually asymptomatic, as is hypomagnesaemia.

Role of metabolic programming in etiology of obesity epidemic

It is well established that critical periods of development that coincide with periods of rapid cell division are important for the abilities of specific tissues and organs to differentiate and mature in preparation for survival after birth.22,23 Therefore, poor fetal nutrition results in selective protection of the brain at the expense of other organs such as the pancreas and liver, and results in altered growth and permanent changes in organ structure and function (Figure 4.1).22,24 Metabolic programming is meant to confer an adaptive advantage to an infant exposed to a post-natal deficiency similar to the one encountered in utero. This is also related to the idea of thrifty genes that are involved in the adaptive response to environments with scarce availability of food and function to increase survival in such environments. However, when these genes are introduced to situations where resources are abundant, they begin to lose their adaptive advantages and become detrimental due to...

Is Disease Prevention Possible

Against the background of this information, intervention can be considered at three levels before detectable abnormalities are present (primary intervention) after development of immune markers of progression but before the onset of hyperglycaemia (secondary prevention) and after presentation with overt hyperglycaemia (tertiary prevention). Primary prevention should be offered as early in life as possible in practice from soon after birth. For the reasons given above, children born to a family affected by diabetes, especially those who carry high-risk HLA genotypes, are most appropriate for trial interventions. Safety is the major criterion for any form of primary prevention, since this will inevitably have to be offered to many who would not in any case have developed the disease.

Type Diabetesa Matter of Cell Life and Death

These technical difficulties notwithstanding, a model of postnatal pancreatic p-cell growth in humans is emerging from studies of both humans (7-9) and rodents (21, 22) (Figs. 1 and 2). Under normal circumstances, there is a transient burst of p-cell replication just after birth, followed by a transitory rise in p-cell neogenesis (21) (Fig. 2). In the later phase of this neonatal burst of p-cell replication and neogenesis, there is also a modest amount of apoptosis that parallels pancreatic islet rearrangement. Because this rate of apoptosis is low, the net effect is a marked increase in p-cell growth early in life. It should be noted that the early burst of p-cell growth has been observed primarily in rodent models. This is obviously difficult to substantiate in newborn humans, although it is generally thought that a similar spurt of human postnatal p-cell growth occurs (21). Thereafter, through childhood and adolescence the rates of p-cell replication, neogenesis, and apoptosis drop...

The Impact of Maternal Obesity on the Energy Cost of Pregnancy

The total energy cost of pregnancy is positively associated with prepregnancy fat mass, body fat, and pregnancy weight gain (6), but maintenance costs are only associated with prepregnancy fatness. This might be explained by the fact that prepregnancy fatness is a marker of overall nutritional status or that prepregnancy fatness may indicate a positive energy balance before conception, and this energy balance might be maintained throughout pregnancy. Either mechanism would explain the wide variability in metabolic response to pregnancy and serve to match energy requirements to energy availability, hence optimizing fetal growth. Leptin has been suggested to be the signal that may link prepregnancy fatness with the maternal metabolic response to pregnancy (5).

Medical Nutritional Therapy and Exercise

Obesity is a risk factor for GDM, and in 1990 the Institute of Medicine issued the first weight-gain recommendations for pregnancy (42). In addition to blood glucose levels, women with GDM need to be aware of optimal weight gain, as there is a strong correlation between infant birth weight and pregravid BMI, even after adjustment for insulin levels (43). In addition, pregnancy weight gain, after adjustment for glucose levels, is also associated with neonatal hypoglycemia and hyper-bilirubinemia (43). Women with normal BMI (19.8-26.0 kg m2) are recommended to gain a total of 25-35 lb or 11.4-15.9 kg. Women with BMIs between 26.1 and 29.0 kg m2 should gain between 15 and 25 lb or 6.8 and 11.4 kg. Obese women with BMI greater than 29 k m2 are supposed to gain 15 lb (42).

Energy Requirements In Pregnancy

Table 7.2 The 1990 guidelines of the United States Institute of Medicine on maternal weight gain targets according to pre-pregnancy BMI Table 7.2 The 1990 guidelines of the United States Institute of Medicine on maternal weight gain targets according to pre-pregnancy BMI

Genetic Factors in Type Diabetes The End of the Beginning

In the case of diabetes, however, the situation is rather different. Thus, when considering the group of human autosomal dominant disorders of insulin secretion, termed maturity-onset diabetes of the young (MODY), it is notable that in no case has the homologous heterozygous murine knockout exhibited hyperglycemia (6). Even with something as fundamental as the insulin receptor, there are significant differences between the human and mouse phenotypes. Thus, mice lacking both copies of the insulin receptor are born of normal weight but die rapidly after birth of ketoacidosis (12), whereas humans with analogous null mutations are small at birth and rarely if ever develop ketoacidosis (3). We have demonstrated (4) that humans with the PPARg Pro467Leu allele develop extreme insulin resistance, diabetes mellitus, and hypertension. Surprisingly, mice with the identical mutation, although they are hypertensive, show completely normal insulin sensitivity and glucose homeostasis (13) Thus, when...

JoAnne M Rizzotto Judy Giusti and Laurie Higgins

And Preexisting Diabetes Calories for Pregnancy Weight Gain Pregnancy complicated by diabetes presents unique challenges for women with preexisting diabetes and those with gestational diabetes. All women with preexisting diabetes, who are of childbearing years, should receive preconception counseling to prepare for pregnancy. Prenatal counseling and care should include a team consisting of healthcare providers who are well versed in the care of diabetes and pregnancy. Women with diabetes should receive Medical Nutrition Therapy (MNT) counseling prior to and throughout pregnancy. The goals of MNT and meal planning are (1) to provide adequate calories and nutrients to achieve target pregnancy weight gain and glycemic control and (2) to promote lifelong healthy lifestyle behaviors. These goals will optimize maternal, fetal, and perinatal outcomes and minimize pregnancy complications. They require balancing food and activity with insulin to meet glucose goals.

Prenatal Androgenization and PCOS

The developmental origins hypothesis of PCOS emerged following astute clinical observations in women with congenital virilizing disorders and was further substantiated by experimental animal research. Examples of prenatally androgenized humans are women with classical congenital adrenal hyperplasia from 21-hydroxylase deficiency and rare cases of women with congenital adrenal virilizing tumors(25, 26). These women are exposed to excess adrenal androgens during intrauterine life and, despite the normalization of androgen excess with treatment, manifest a PCOS-like syndrome in adult life, including functional ovarian hyperandrogenism, LH hypersecretion, anovulatory cycles, and polycystic ovarian morphology as well as central adiposity and insulin resistance (25, 26). Similar PCOS traits have also been reported recently for girls with congenital P450 oxidoreductase deficiency who are exposed to excess adrenal androgens in prenatal life but not after birth (27). Collectively, these...

Effect Of Pregnancy On The Subsequent Progression Of Diabetic Nephropathy

For years, there has been concern that the hyperfiltration, hypertension, or heavy proteinuria of pregnancy might damage glomeruli, tubules, and interstitium and accelerate the postpartum progression of DN to end-stage renal disease. In a pooled series of 195 women experiencing pregnancies with DN and having renal function assessed 1-10 years afterwards, 23 were in renal failure and 5.6 had died (table 4). Not surprisingly, the frequency of progression to renal failure after pregnancy was 49 in the group of women Table 5. Course of diabetic nephropathy during and after pregnancy comparing patients with preserved vs impaired renal function in early pregnancy. Data pooled from references 95,96,190, 192,192 . Note the limited number of cases with severe azotemia in early pregnancy. Table 5. Course of diabetic nephropathy during and after pregnancy comparing patients with preserved vs impaired renal function in early pregnancy. Data pooled from references 95,96,190, 192,192 . Note the...

Agathocles Tsatsoulis

Thus, female primates, exposed to androgen excess during fetal life, exhibit the reproductive and metabolic features of PCOS in adulthood. Women with congenital 21-hydroxylase deficiency and congenital adrenal virilizing tumors develop features characteristic of PCOS during adult life, despite the normalization of androgen excess after birth. Rare cases of women with congenital sex hormone-binding globulin (SHBG) and P450 aromatase deficiency may also develop some of the features of PCOS in adulthood.

Oxidative stress in premature infants

Hypoxia Premature Infants

NO is a free radical that may be oxidized or reduced, depending on its concentration and the presence of other oxidants such as oxygen. Hyperoxic exposure of rat pups up-regulated both inducible and endothelial NO synthase and therefore increased the concentrations of NO and subsequently peroxynitrite as well.103 NO is highly toxic for preterm infants. However, a clinical trial with inhaled NO did not report higher occurrences of BPD in NO-treated premature infants compared with controls.104 Hamon et al. recently reported that low doses (5 ppm) of inhaled NO administered soon after birth in hypoxemic premature infants were associated with significant decreases in their oxidative stress after 24 hr as assessed by plasma MDA.105

Bmp Signaling In Kidney Development

Day 11 postcoitum, and is maintained throughout development in the collecting tubule derivatives of the ureteric duct. BMP-7 is also expressed transiently in the induced mesenchyme, but not the uninduced mesenchyme, and its derivatives. BMP-7 is essential for kidney development as homozygous-null mice have arrested kidney development, possess dysplastic kidneys, and die soon after birth (35,36). Kidney development is normal in the BMP-7-null mice until embryonic day 14.5. Then branching of the ureteric duct, condensation of the metanephric mesenchyme around the ureteric duct, and differentiation of epithelial structures all cease and uninduced mutant mesenchymal cells suffer apoptosis. BMP-7 appears to act as a survival factor for undifferentiated mesenchyme, opposing apoptotic signals. Thus, with additional factors, such as basic fibroblast growth factor 2, BMP-7 expands the stromal progenitor cell population adjacent to the nephrogenic mesenchyme and ensures that the cells are...

Pregnancy Induced Hypertension

Hyperinsulinemia may increase renal reabsorption of sodium and stimulate the sympathetic nervous system, both of which can increase the risk of developing hypertension (115). Furthermore, insulin resistance and or its associated factors have been shown to be associated with PIH even years after pregnancy (175-180). Insulin resistance or associated hyperglycemia may impair endothelial function, which may decrease prostacyclin production (39). The hyperinsulinemic insulin resistance intrinsic to PCOS may therefore increase the risk of PIH.

Counseling and Preconception Care Recommendations to Reduce Maternal and Fetal Risks of Preexisting Diabetes What Are

It usually returns to baseline after pregnancy, even in patients with diabetes (37). The EURODIAB trial showed that pregnancy was not a factor in the development of microalbuminuria (38), and the DCCT found no important long-term effects of pregnancy on the development of renal disease or nephropathy (39). A 2002 study found that in women with microalbuminuria and normal baseline renal function, pregnancy had no prolonged impact on renal function (40). Studies in women with other forms of mild renal impairment have shown similar results (41). A universal question among women with diabetes who are planning pregnancies is What should I eat Nutrition counseling is an integral part of any diabetes PCC program as it is necessary to ensure both glycemic control and nutritional adequacy before, during and after pregnancy. Individual recommendations will vary depending on insulin-dosing plan and patient characteristics and preferences. This requires a team approach with the dietitian working...

Longterm Dietary Advice For The Mother And Her Child

Ideally all women with GDM should receive lifestyle advice and education in pregnancy that is relevant to after pregnancy. It will be an important challenge to find methods of delivering dietetic education and advice both effectively and cheaply to enable all women with GDM to receive the necessary ongoing support and care they require after pregnancy in the community.

Course Of Nephropathy During Pregnancy

Course of renal parameters during and after pregnancy in women with diabetic nephropathy. Data pooled from references 95,96,100,101,148,190,191,192 Table 4. Course of renal parameters during and after pregnancy in women with diabetic nephropathy. Data pooled from references 95,96,100,101,148,190,191,192 Diabetic nephropathy can progress to end-stage renal disease (ESRD) during pregnancy, although this is unusual. Of 195 women followed after pregnancy and summarized in table 4, none progressed to end-stage disease during pregnancy. There is experience with both hemodialysis and continuous ambulatory peritoneal dialysis in pregnancy, but analyzed cases include few diabetic women 210-216 . In about one-fourth of reported cases of dialysis in pregnancy the patients conceived prior to starting dialysis - they either were close to needing dialysis prior to the unplanned gestation or had a rapid decline in renal function during pregnancy 213 . In this group termination of pregnancy...

Conclusions

In summary, pregnancy in the woman with type 1 DM remains challenging. Surprisingly, despite an increase in the tools available for diabetes management and monitoring, the outcomes during and after pregnancy have not dramatically improved. Much of this may still be connected to the fact that there is not enough prepregnancy planning in those women with type 1 DM. Clearly this needs to be addressed by endocrinologists and care providers in communities where those with type 1 DM receive their day-to-day care. Until this reality changes, clearly the risks will remain greater in this population, requiring more aggressive monitoring and greater potential for poor outcomes for both mother and child.

Types of Diabetes

About half of the time, type 1 diabetes starts during childhood or the early teenage years. For this reason, it used to be called juvenile-onset diabetes. If your symptoms first appeared during your early teenage years, your health care provider probably suspected diabetes right away. If you were a young child when the disease developed, it might have occurred so fast that you went into a coma, before anyone suspected diabetes. Type 2 diabetes most often develops in adulthood and used to be called adult-onset diabetes. Usually, it does not appear suddenly. Instead, you may have no noticeable symptoms or only mild symptoms for years before diabetes is detected, perhaps during a routine exam or blood test. Gestational diabetes only appears during pregnancy in women with no previous history of type 1 or type 2 diabetes and usually goes away after pregnancy. Pregnant women are tested for gestational diabetes, usually during the 24th week of gestation. After pregnancy, 5 to 10 percent of...

Gestational Diabetes

Gestational diabetes most often develops between the 24th and 28th week of pregnancy, occurs in 2-5 of pregnancies, and usually disappears after birth. Gestational diabetes is more common in older, obese, or diabetes-prone ethnic groups, and in those with a positive family history. Most (80-94 ) women with gestational diabetes will return to normal after delivery. Hispanic females and Native Americans are especially prone to developing diabetes after an episode of gestational hyperglycemia, with the occurrence rate being as high as 50 within 5 years of pregnancy termination. The other gestational diabetics will have a 30-40 chance of developing diabetes in 10-20 years.

Nephropathy

Hyperfiltration is also thought to be a key determinant in early renal injury in diabetes. This is supported by studies showing accelerated nephropathy following subtotal nephrectomy in experimental models.115 Glomerular volumes are significantly higher in patients with nephropathy than in those who remain normoalbuminuric.116 Glomerular pressure and volume may also be influenced by genetic factors though a variety of mechanisms. One that has received recent attention has been the strong association between nephron endowment and mean glomerular volume. In humans, no further nephronogenesis occurs after birth. At the time of birth, infants possess all the glomeruli that they will ever develop. Nephronogenesis is linked to a number of factors, including intrauterine nutrition as well as genetic influences such as maternal body mass. There is a strong correlation between glomerular size and nephron number, so that fewer glomeruli result in an increase in mean glomerular volume.117 This...

Weight gain

Women should be weighed at each prenatal visit. Weight gain goals should be made for each trimester to optimize maternal and fetal outcomes. During the first trimester, a weight gain of 2-5 pounds occurs as a result of maternal blood volume expansion and hypertrophy of breast and uterine tissue. Excessive weight gain during the first 20 weeks increases the risk of weight retention postpartum (5). See Table 1 for recommendations for total pregnancy weight gain and weight gain recommendations for the second and third trimester. Weight gain recommendations for women with normal BMI pregnant with twins is 37-54 pounds overweight women, 31-50 pounds and obese women, 25-42 pounds (4). Gradual weight gain over the entire pregnancy is expected. Excessive weight gain increases the risk of fetal macrosomia, cesarean section, birth trauma, and postpartum weight retention. Any weight loss during pregnancy calls for immediate evaluation and intervention. Underweight women who fail to gain adequate...

Insulin Therapy

Table 2 demonstrates the usual insulin requirements during pregnancy, although a greater increase in insulin will be required with significant maternal weight gain. We recommend calculating the daily insulin dosage referred to as Big I, which is equal to the units multiplied by kilogram of weight based on trimester of pregnancy in which Big I is the total daily units of insulin required. For women who are using multiple injections, one-half of the total requirement consists of NPH divided into three daily doses approximately 8 h apart (breakfast, 4 p.m., and midnight) and one-half consists of insulin lispro or insulin aspart divided into three premeal doses (breakfast, lunch, and dinner).

Medical Aspects

GDM substantially increases the risk of future DM2. Risk estimates of type 2 diabetes after GDM vary from 17 to 63 within 5-16 years after pregnancy, depending upon the ethnic background of the study population and the detection method for GDM and glucose intolerance (78). Catalano et al. (81) quoted the original studies by O'Sullivan that reported that the 15-year prevalence of type 2 diabetes in women with a history of gestational diabetes was approximately 60 in obese women during pregnancy and 30 in lean women at the time of diagnosis. The greatest risk factor for early-onset type 2 diabetes after pregnancy was early gestational age at the time of diagnosis and elevated fasting glucose. The greatest long-term risk factor was maternal obesity.