Book Review

The Diabetes in Pregnancy Dilemma: Leading Change with Proven Solutions

N Engl J Med 2007; 356:98-99January 4, 2007

Article

The Diabetes in Pregnancy Dilemma: Leading Change with Proven Solutions
Edited by Oded Langer. 720 pp., illustrated. Lanham, MD, University Press of America, 2006. $59.95. ISBN: 978-0-7618-3270-6

Pregnancy presents substantial challenges with complications, argue the authors of The Diabetes in Pregnancy Dilemma, a well-developed, comprehensive, and clearly written contribution to the literature and a “must have” reference for clinicians who care for women during pregnancy or who are challenged by the problem of diabetes in pregnancy. The book provides an excellent foundation regarding the history, causes, epidemiology, pharmacology, pathogenesis, and ethical implications of diabetes in pregnancy. It also offers evidence-based recommendations for the clinical care of women with diabetes in pregnancy, thereby providing a composite resource for the field.

The book addresses all the known forms of diabetes, their specific evidence-based treatments, and continued controversies related to each subcategory of the disease. It also presents a readable assessment of the nature of diabetes in pregnancy and recommendations on how to manage the disease so that pregnancy has a successful outcome. The format of the book and its clear presentation of complex knowledge are also likely to draw praise from clinicians interested in a guide to key factors in the management of this problem. The book draws attention to the need for a multidisciplinary approach to the care of a pregnant woman with diabetes, one that also addresses her fears.

The book's editor, Oded Langer, is internationally known in the field and has pioneered the use of oral hypoglycemic agents in pregnancy. Two useful features he has added to each chapter are an introductory list of key points and a closing summary. A noteworthy inclusion — and essential to the successful management of diabetes in pregnancy — is information on behavioral interventions; their strengths and limitations when used with patients with type 1 diabetes, gestational diabetes, and type 2 diabetes are effectively addressed. Langer stresses the need for an approach that includes nutritional therapy, regular physical exercise, and weight management (the problem of obesity is also discussed). Also recommended is an individualized approach that emphasizes the importance of the patient's social circumstances. These approaches are well documented in the medical literature. This book, unlike most references on the topic, advocates a mixed method of care.

The contributors make clear the complexities of caring for women with diabetes in pregnancy when the disease is accompanied by a hypertensive disorder or chronic hypertension. They also discuss the need for ongoing access to care and lifestyle modifications, as well as the importance of patient education and preconception counseling. The health disparities among subpopulations of women — an important consideration, given that black American women have an increased risk of both diabetes and hypertension during pregnancy — are also addressed.

Langer provides a comprehensive approach to the treatment of diabetes during pregnancy and evidence-based advice for the management of complications. Presented in a straightforward manner, the information is quite far-reaching; the book will serve well as a desk reference for practicing physicians, basic and translational scientists, and medical educators.

Martha A. Hargraves, Ph.D., M.P.H.
University of Texas Medical Branch, Galveston, TX 77555
mhargrav@utmb.edu