Foetal Programming in a Diabetic Pregnancy: Long-Term Implications for the Offspring

Krishnaveni, Ghattu V.; Yajnik, C.S.

doi:10.18520/cs/v113/i07/1321-1326

Cited by 4 publications

(3 citation statements)

References 49 publications

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“…Poorly managed or untreated GDM leads to accelerated fetal growth [3] and therefore increases the risk of macrosomic and large-for-gestational-age neonates [4,5]. Pregnancies affected by GDM that are not adequately managed are consequently at risk of adverse neonatal outcomes, both immediately; e.g., shoulder dystocia, birth trauma, including birth hypoxic injuries, and neonatal hypoglycaemia [6][7][8], and in the longer term; e.g., metabolic dysregulation in later childhood [9,10]. Hence, it is essential to implement effective clinical interventions to maintain maternal glycaemic control, with the dual aim of maintaining fetal growth within normal parameters, thereby protecting both mother and baby from adverse outcomes.…”

Section: Introductionmentioning

confidence: 99%

Comparative impact of pharmacological treatments for gestational diabetes on neonatal anthropometry independent of maternal glycaemic control: A systematic review and meta-analysis

2020

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Background Fetal growth in gestational diabetes mellitus (GDM) is directly linked to maternal glycaemic control; however, this relationship may be altered by oral anti-hyperglycaemic agents. Unlike insulin, such drugs cross the placenta and may thus have independent effects on fetal or placental tissues. We investigated the association between GDM treatment and fetal, neonatal, and childhood growth. Methods and findings PubMed, Ovid Embase, Medline, Web of Science, ClinicalTrials.gov, and Cochrane databases were systematically searched (inception to 12 February 2020). Outcomes of GDMaffected pregnancies randomised to treatment with metformin, glyburide, or insulin were included. Studies including preexisting diabetes or nondiabetic women were excluded. Two reviewers independently assessed eligibility and risk of bias, with conflicts resolved by a third reviewer. Maternal outcome measures were glycaemic control, weight gain, and treatment failure. Offspring anthropometric parameters included fetal, neonatal, and childhood weight and body composition data. Thirty-three studies (n = 4,944), from geographical locations including Europe, North Africa, the Middle East, Asia, Australia/New Zealand, and the United States/Latin America, met eligibility criteria. Twenty-two studies (n = 2,801) randomised women to metformin versus insulin, 8 studies (n = 1,722) to glyburide versus insulin, and 3 studies (n = 421) to metformin versus glyburide. Eleven studies (n = 2,204) reported maternal outcomes. No differences in fasting blood glucose (FBS), random blood glucose (RBS), or glycated haemoglobin (HbA1c) were reported. No studies reported fetal growth parameters. Thirty-three studies (n = 4,733) reported birth weight. Glyburide-exposed

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Section: Introductionmentioning

confidence: 99%

Comparative impact of pharmacological treatments for gestational diabetes on neonatal anthropometry independent of maternal glycaemic control: A systematic review and meta-analysis

2020

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“…Of these, 10%-20% had pre-gestational diabetes (Type 1 and Type 2, other) while the majority (80%) had gestational diabetes (1). Maternal diabetes during pregnancy is associated with adverse short-and long-term outcomes for the offspring (2). The main short-term effect is excessive fetal growth and its sequelae in the peripartum period (difficult labour, need for interventional delivery, post-natal complications etc.).…”

Section: Article Highlightsmentioning

confidence: 99%

Maternal diabetes influences neonatal obesity-adiposity but not in later life Offspring obesity in diabetic pregnancy

Wagle

Deshpande-Joshi

Deshmukh

et al. 2023

Preprint

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Background: Based on studies in overweight-obese populations, it is tacitly assumed that maternal hyperglycemia is responsible for obesity-adiposity at birth and in later life. Study design: Two hospital based case control studies: 1) Neonatal outcomes, 2) Later life outcomes. Methods: We studied associations of neonatal and later life obesity-adiposity [age and sex-adjusted BMI, waist circumference, skinfolds, and body fat percent by Dual energy X-ray Absorptiometry (DXA)] in offspring of mothers with diabetes (ODM) and those of mothers without diabetes (ONDM). Exposures were parental hyperglycemia and overweight-obesity. Results: Neonatal study included 372 non-diabetic and 816 diabetic pregnancies [74 type 1 diabetes, 102 type 2 diabetes, 640 gestational diabetes (GDM)]. Mothers with type 1 diabetes were the youngest, thinnest, and with highest HbA1c. Maternal glycemia but not BMI was associated with neonatal obesity-adiposity. Thus, neonates of mothers with type 1 diabetes had highest ponderal index, abdominal circumference, and skinfolds. Later life study included 200 ODM (25 type 1 diabetes, 22 type 2 diabetes, 153 GDM) and 177 age, sex and socio-economic matched ONDM (2 to 26 y). Their obesity-adiposity was associated with bi-parental overweight-obesity in an additive manner, but not with parental diabetes. Offspring birth weight was also positively associated. Offspring of mothers with type 1 diabetes had the lowest and offspring of mothers with type 2 diabetes the highest obesity-adiposity. Conclusion: Neonatal obesity-adiposity is driven by maternal glycemia while later life obesity-adiposity by bi-parental obesity. Our results provide a clear insight into pathogenesis of obesity-adiposity in the offspring.

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“…Of these, 10-20% had pre-gestational diabetes (type 1, type 2, and other) while the majority (80%) had gestational diabetes (1). Maternal diabetes during pregnancy is associated with adverse short- and long-term outcomes for the offspring (2). The main short-term effect is excessive fetal growth and its sequelae in the peripartum period (difficult labour, neonatal injuries, need for interventional delivery, post-natal complications etc.).…”

Section: Introductionmentioning

confidence: 99%

Neonatal Adiposity is Largely Driven by Maternal Hyperglycemiain utero: Analysis of Routine Clinical Data from a Diabetes Clinic in India

Deshpande-Joshi,

Wagle-Patki,

Deshmukh

et al. 2024

Preprint

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Background: Segregation of the effect of maternal size and glycemia on fetal growth is difficult to understand in overweight-obese women with diabetes. Aim: To examine the effect of maternal size and degree of hyperglycemia on neonatal obesity-adiposity in the relatively thin Indian population. Study design: Analysis of real-life data collected in one diabetes clinic. Methods: We examined the association of maternal size (BMI) and degree of hyperglycemia (type of diabetes, type 1 being the thinnest and most hyperglycemic, type 2 and Gestational diabetes being overweight and obese but less hyperglycemic) with neonatal obesity-adiposity measurements (weight, ponderal index, abdominal circumference, and skinfold thickness) using multiple linear regression. Results: We included data on 772 pregnancies with diabetes (61 with type 1, 79 with type 2, and 632 with gestational) and 349 with normal glucose tolerance (NGT). Mothers with type 1 diabetes had the lowest BMI and highest HbA1c, however, their neonates were the most obese, centrally obese, and adipose. Compared to neonates of NGT mothers, those of mothers with type 1 diabetes were 370 g heavier, those of mothers with type 2 diabetes 265 g, and those of mothers with GDM by 200 g. Prediction models adjusted for gestational age at birth, neonatal sex, maternal age, parity, and year of birth confirmed that neonates of mothers with type 1 diabetes were the most obese-adipose, followed serially by those of mothers with type 2 diabetes, GDM, and NGT. Other obesity adiposity measurements showed a similar gradient. Compared to maternal type of diabetes, pre-pregnancy BMI and gestational weight gain (GWG) made a much smaller contribution to neonatal obesity-adiposity. Conclusion: Our findings provide a clear answer that maternal hyperglycemia rather than size is the primary driver of neonatal obesity-adiposity. Adequate control of maternal hyperglycemia will help control neonatal obesity-adiposity.

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Foetal Programming in a Diabetic Pregnancy: Long-Term Implications for the Offspring

Cited by 4 publications

References 49 publications

Comparative impact of pharmacological treatments for gestational diabetes on neonatal anthropometry independent of maternal glycaemic control: A systematic review and meta-analysis

Comparative impact of pharmacological treatments for gestational diabetes on neonatal anthropometry independent of maternal glycaemic control: A systematic review and meta-analysis

Maternal diabetes influences neonatal obesity-adiposity but not in later life Offspring obesity in diabetic pregnancy

Neonatal Adiposity is Largely Driven by Maternal Hyperglycemiain utero: Analysis of Routine Clinical Data from a Diabetes Clinic in India

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