DIABETES AND THE GYNECOLOGIST

Abstract

The concept of a metabolic disorder of carbohydrate tolerance that progresses with age is examined. It is considered that acute exacerbations may occur at the time of puberty or during pregnancy or the menopause, leading to the development of manifest clinical diabetes.Pregnancy offers a unique opportunity for early diagnosis of potential diabetes in the mother. Existing screening tests are not satisfactory or reliable in uncovering this inborn error of metabolism that may lead to stillbirth or a grossly overweight baby, the onset of clinical diabetes in the mother occurring only many years later.Evidence is presented concerning four conditions that may cause maternal and fetal hyperinsulinism (the primary cause of fetal macrosomia). Also reported is the finding that approximately 50% of apparently normal women over the age of 50 show impaired glucose tolerance.