Medical Management of Pregnancy Complicated by Diabetes, 4th Edition [Paperback] Review

While the book provided some good information, I was expecting more judging by the title. (I was also surprised at how small the book was given its cost.) Bottom line? There is much more specific and far more up-to-date information available for free on the internet. A quick search under "diabetes mellitus and pregnancy" will provide a wealth of it, including specific (and current) rates of birth defects at what blood sugar levels and which tests should be conducted during which trimester.

I think the problem may be that it's trying to do too much. The introduction states that the book is designed to "present to the clinician a complete package of protocols."Given some of the very basic information, I hope there are no clinicians who don't know some of this stuff.

The first chapter discusses the fact that it's a good idea to talk to women before conception about the importance of good blood sugar control (does anyone not know that?) and lists the doctors one should see and some of the tests that should be conducted. It basicaly suggests a thorough exam for all the diabetic trouble spots--eyes, kidneys, A1c levels, thyroid, etc. All good sense. However, the second chapter is on contraception, which seems unecessary and out of place.Worse, the first chapter boldly states that if the woman has "clinically proven" cardiac disease, she should not only be counseled against pregnancy, but "should be asked to consider permanent sterilization"(!). No discussion about risk factors or degrees of severity--just any cardiac disease equals sterilization.If the book is only geared toward "clinicians," perhaps that's acceptable. But a discussion of birth control, and a list of what kinds of insulin exist and their duration seems geared toward the completely uninitiated. I found it shocking.

A large problem I had was with the graph of birth defect rates, something I was very, very concerned with. It doesn't seem to be labeled accurately. It says it measures number of spontaneous abortions, major malformations and no major malformations in conjunction with HA1c levels in the first trimester. However, above the HA1c levels it says "Mean + SD (standard deviation)." You can't tell what the SD refers to, and it reports some pretty high numbers. I contacted the ADA (publisher) about this since it suggests that an A1c between 7.7 and 9.3 has fewer incidents of major malformation than an A1c below 7.7. The person I corresponded with was very nice, and told me a few times they would get back to me. They finally said I should check with my doctor if I'm pregnant, which did NOT answer the question. I checked the source material listed at the end of the chapter--this graph is based on information from "reference 13," which was an article published in 1979. I found much more current info on my own with a simple internet check.

There was information about the fact that insulin requirements will increase as the pregnancy progresses, but my doctor has a chart that shows you the typical increases. Further, the book Pumping Insulin has a good chapter on pregnancy and what to expect in dosage increases, diet breakdowns and blood sugar goals pre- and post-meal.

Much of the rest of the book seems like common sense,things you could find in almost any book on pregnancy or in some other book designed for the lay person written from the diabetic's point of view rather than the clinician's.

Overall, I wish someone had steered me toward better information. Given the title, I was expecting it to be sort of a "one-stop shop" where I could get all the factual information I would need. Perhaps I expected too much.

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Product Description:

The most trusted reference on treatingpregnancy with diabetes is back in a newedition


Pregnancy complicated by diabetes is a medical challengethat can be minimized through a program ofexpert protocols and patient partnerships. This bookpresents a complete package of these protocols thatwhen followed, can help produce healthy infants inpregnancies complicated by type 1, type 2, and gestationaldiabetes.
Based on an ADA Technical Review, this fourth editionprovides up-to-date information that includes: newguidelines for treatment using the new insulinanalogues; a discussion on the use of oral hypoglycemicagents in pregnancy; and the latest in obstetrical surveillanceof pregnant women with diabetes.

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