Abstract
The gestational period represent a critical time for influencing birth weight, infant adiposity and growth rate, all of which are important factors in the development of obesity and diabetes in adolescence and adulthood. Prior to pregnancy, the nutritional status and weight of a mother also has significant influence on these factors. During gestation, numerous maternal factors can have a negative influence on programming of the long-term health of the offspring. Rate of maternal weight gain, glucose intolerance, gestational diabetes and pre-pregnancy BMI all have significant influence on infant size and adiposity at birth. Additionally, these factors are related to the development obesity and its co-morbidities in adolescence and adulthood. Given the rates of obesity and associated health care costs, it is very timely to understand possible fetal origins of obesity and diabetes to help shape interventions.
Highlights
The fetal origins of adult diseases are based upon the hypothesis of “programming”, the process wherein a stimulus occurring at a critical period of development exerts a lasting effect [1]
This study demonstrated that increased gestational weight gain (GWG) in the range of 12.9 - 29.1 kg, which is significantly over the Institute of Medicine (IOM) recommendation depending on the women’s pre-pregnancy BMI, had 2.5-fold increased risk of developing impaired glucose tolerance (IGT) in pregnancy compared to women who gained less weight (p < 0.05)
Based on the evidence presented it can be concluded that there is a continuum of overweight/obesity which contributes to dysregulated insulin and glucose metabolism, culminating in Gestational diabetes mellitus (GDM)
Summary
The fetal origins of adult diseases are based upon the hypothesis of “programming”, the process wherein a stimulus occurring at a critical period of development exerts a lasting effect [1]. Maternal under-nutrition causes small body size at birth and these smaller infants are at increased risk of developing coronary heart disease in adult life [5] This period in history was a unique time indicating that maternal nutrition may affect the intrauterine environment for fetal growth and that malnutrition occurring during the “critical window” for fetal development may program long-term conesquences for adult health. One of the most common fetal outcomes of GDM/IGT is increased fetal growth, including macrosomia and large for gestational age (LGA) infants Both of these populations are at risk for numerous complications during birth as well as later in life. The data presented show that does frank diabetes during pregnancy, whether preexisting or brought on by pregnancy, lead to long-term programming effects, but other sub-clinical manifestations of dysregulated glucose and insulin metabolism have a long lasting impact as well
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