Whitfield Williams was Professor of Obstetrics at the Johns Hopkins University and wrote the first major American textbook on obstetrics, which still survives today in the eighteenth edition. He was concerned that the demonstration of sugar in the urine in pregnancy would be overinterpreted. 'I know of no complication of pregnancy the significance of which is more variously interpreted than the presence of sugar in the urine of pregnant women.' Williams blamed Matthews Duncan for concluding that the detection of sugar in the urine constituted one of the most serious complications of pregnancy, as Duncan's views were accepted without question, although they were based on a small series of 22 pregnancies in 16 women collected from the then medical literature over 60 years, and his own small experience in Aberdeen. Williams presented six case reports to illustrate the various conditions in which sugar may be observed in the urine of pregnant women: simple lactosuria, transient glycosuria (two cases), alimentary glycosuria, recurrent glycosuria and mild diabetes. All resulted in a normal pregnancy outcome (although all the recorded birthweights were > 8 lb). He then analyzed the urinary records of 3000 consecutive patients in the obstetrical department of the Johns Hopkins Hospital, in 167 of whom sugar had been demonstrated by Fehling's solution. He concluded that 137 of these represented definite postpartum lac-tosuria, being recognized only during lactation, and that almost all the others who had been recognized in late pregnancy were similar. He was able accurately to distinguish glucose from lactose in a few cases and found only two of the 167 cases had definite glycosuria, and could thus be considered to have mild diabetes complicating pregnancy. This may be the first evidence of screening for gestational diabetes, suggesting a rather low prevalence in hospital practice in Baltimore, USA, nearly 100 years ago.
The major difficulty in the bedside measurement of reducing sugars by Fehling's test is no longer apparent, as all test strips now use a glucose oxidase system and recognize only glucosuria (lactosuria will still occur but no longer causes medical concern). Whitfield Williams then tabulated all reported cases (81) of diabetes complicating pregnancy from 1826 to 1907: he considered 15 cases to be doubtful, as glycosuria disappeared after delivery (including the famous patient first reported by Bennewitz in 1826, although he had not read the full case report in the original Latin). He calculated an overall immediate maternal mortality of 27%, with an additional 23% of mothers dying within the following 2 years. He concluded:
Pregnancy may occur in diabetic women, or diabetes may become manifest during pregnancy; either is a serious complication, although the prognosis is not so alarming as is frequently stated.
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Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...