Fetal programming in diabetes: an emphasis on prevention consequences of ketoacidosis

Abstract

The article is devoted to the analysis of scientific publications about the negative impact of ketoacidosis in pregnant women with diabetes on the development of the fetal nervous system from the standpoint of fetal programming and finding ways to prevent its negative effects on the fetus. It was found that the index of intellectual development of children 2 years old had a negative correlation with the level of β-hydroxybutyrate in maternal serum in the third trimester of pregnancy. Therefore, there is a need to avoid ketoacidosis and maternal starvation in order to prevent intellectual disabilities.It is known that the control of metabolic processes in mothers with diabetes can affect the autonomic nervous regulation and motor activity of the fetus. To date, there are no studies that have examined the possible relationship between maternal ketone bodies and fetal heart rate variability. Moreover, the routine monitoring of quantitative indicators of ketone bodies is not currently implemented during pregnancy. All existing treatment strategies for diabetes are performed to detect carbohydrate tolerance disorders and correct blood glucose levels with insulin or metformin.Among all the pharmacological methods of preventing the effects of ketosis, of course, the most reasonable and promising is the use of xylitol solutions. Numerous studies have presented that xylitol is an insulin-independent energy source which has a positive effect on carbohydrate and lipid metabolism, helps to correct oxidative stress. Therefore, the study of the state of the fetal autonomic nervous regulation and indicators of intellectual development of the child under the influence of preventing the synthesis of ketone bodies by xylitol infusion may be the basis for improving the management of pregnant women with diabetes.