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Doctor Profile |
Polycystic ovary syndrome (PCOS) is seen in 6-10% of women of reproductive age.
Approximately 7% of all pregnancies are complicated by gestational diabetes mellitus (GDM).
U.S. prevalence rates of GDM are higher in African-American, Hispanic, Native American and Asian women.
Skin cancer rates have doubled in people under 40 in the U.S. in just the past 10 years.
During pregnancy, there is an approximate doubling in thyroid binding globulin (TBG) and a 30-40% increase in plasma volume.
The pregnant woman is the sole source of thyroid hormone to the fetus until approximately 13 weeks gestation.
Primary hypothyroidism occurs in 3-10% of women.
Excluding pregnancy, hyperprolactinemia accounts for approximately 10-20% of cases of amenorrhea.
Since PCOS is no longer considered just a reproductive disorder, it is important for physicians who treat this condition to understand the complex personal and health concerns these women are often faced with. High levels of testosterone, as noted earlier, can result in acne, hirsutism and alopecia to various degrees in these patients. The discussion is often very emotional for these women, because many of them have been wondering for years why they have struggled with these cosmetic issues when other female family members are unaffected. The options for intervention with anti-androgenic therapies like spironolactone, the regulation of menses, and the lowering of testosterone levels with oral contraceptive agents should be addressed in a sensitive fashion. These women often need frequent follow-up to address their various concerns and track their progress with lifestyle modifications, weight loss (if it is indicated), medication side effects, and symptom improvement.
Diabetes and Pregnancy
Approximately 7% of all pregnancies are complicated by gestational diabetes mellitus (GDM), resulting in more than 200,000 cases annually. The prevalence may range from 1 to 14% of all pregnancies, depending on the population studied and the diagnostic tests employed. In the U.S. prevalence rates are higher in African-American, Hispanic, Native American, and Asian women compared to Caucasian women. The frequency is increased in women who are obese or have a family history of diabetes.
The initial approach is medical nutrition therapy, usually under the supervision of a dietician or certified diabetes educator. The goal of therapy is not weight reduction, rather prevention of fasting and postprandial hyperglycemia. For this reason, women diagnosed with gestational diabetes are asked to check blood sugars at least four times per day: fasting (upon awakening) and again two hours after each meal. If fasting capillary blood glucose is greater than 90-100 mg/dL or if one-to-two-hour postprandial glucose values exceed 120 mg/dL then therapy with insulin is considered. The main purpose of drug intervention at these levels is to minimize the incidence of macrosomia, and its associated risks of shoulder dystocia and birth trauma. Approximately 15% of women with GDM require insulin therapy because target glucose levels are exceeded despite dietary interventions. Nearly all women (90%) with GDM are normoglycemic after delivery. However, they are at risk for recurrent GDM, impaired glucose tolerance, and overt diabetes. Between 5 and 50% of women diagnosed with gestational diabetes will ultimately progress to type 2 diabetes. This incidence is influenced by family history, body weight, glucose levels, need for insulin during pregnancy, and lifestyle after pregnancy. One-third to two-thirds of women with GDM will have GDM in a subsequent pregnancy. Women who have a recurrence tend to be older, more parous, and have a greater increase in weight between their pregnancies than women without a recurrence. Higher infant birth weight in the index pregnancy and higher maternal prepregnancy weight have also been associated with recurrent GDM.
Diabetes and Pregnancy
Approximately 7% of all pregnancies are complicated by gestational diabetes mellitus (GDM), resulting in more than 200,000 cases annually. The prevalence may range from 1 to 14% of all pregnancies, depending on the population studied and the diagnostic tests employed. In the U.S. prevalence rates are higher in African-American, Hispanic, Native American, and Asian women compared to Caucasian women. The frequency is increased in women who are obese or have a family history of diabetes.
The initial approach is medical nutrition therapy, usually under the supervision of a dietician or certified diabetes educator. The goal of therapy is not weight reduction, rather prevention of fasting and postprandial hyperglycemia. For this reason, women diagnosed with gestational diabetes are asked to check blood sugars at least four times per day: fasting (upon awakening) and again two hours after each meal. If fasting capillary blood glucose is greater than 90-100 mg/dL or if one-to-two-hour postprandial glucose values exceed 120 mg/dL then therapy with insulin is considered. The main purpose of drug intervention at these levels is to minimize the incidence of macrosomia, and its associated risks of shoulder dystocia and birth trauma. Approximately 15% of women with GDM require insulin therapy because target glucose levels are exceeded despite dietary interventions. Nearly all women (90%) with GDM are normoglycemic after delivery. However, they are at risk for recurrent GDM, impaired glucose tolerance, and overt diabetes. Between 5 and 50% of women diagnosed with gestational diabetes will ultimately progress to type 2 diabetes. This incidence is influenced by family history, body weight, glucose levels, need for insulin during pregnancy, and lifestyle after pregnancy. One-third to two-thirds of women with GDM will have GDM in a subsequent pregnancy. Women who have a recurrence tend to be older, more parous, and have a greater increase in weight between their pregnancies than women without a recurrence. Higher infant birth weight in the index pregnancy and higher maternal prepregnancy weight have also been associated with recurrent GDM.