Pregnancy as a Tissue Culture Experience: the Critical Implications of Maternal Metabolism for Fetal Development

Freinkel, Norbert; Metzger, Boyd E.

doi:10.1002/9780470720462.ch2

Cited by 59 publications

(16 citation statements)

References 61 publications

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“…Thus, there appears to be additional metabolic factors related to maternal overweight that influence fetal growth [40][41][42] . Insulin resistance increases with maternal weight and this may cause metabolic disturbances that result in an increased flux of nutrients across the placenta, causing fetal hyperinsulinemia and accelerated fetal growth [43][44][45][46] . Diabetes in pregnancy is associated with a significant risk of fetal macrosomia, even when good metabolic control is achieved [35] .…”

Section: Discussionmentioning

confidence: 99%

First-Trimester Prediction of Macrosomia

Poon¹,

Karagiannis²,

Stratieva³

et al. 2010

Fetal Diagn Ther

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Objective: To determine if combinations of maternal characteristics and measurements of parameters used in screening for aneuploidies at 11–13 weeks provide significant prediction of macrosomia. Method: Maternal characteristics, fetal nuchal translucency (NT), free β-human chorionic gonadotrophin (β-hCG) and pregnancy-associated plasma protein-A (PAPP-A) were recorded at 11⁺⁰–13⁺⁶ weeks in 36,743 singleton pregnancies. Regression analysis was used to determine if in predicting macrosomia significant contributions are provided by maternal factors, fetal NT, free β-hCG and PAPP-A. Results: The risk for macrosomia increased with maternal weight and height and was higher in parous women with previous delivery of a macrosomic baby and in those with diabetes mellitus; the risk was lower in women of African and South Asian racial origins, in cigarette smokers and in those with chronic hypertension. In the macrosomic group compared to the unaffected group there were higher Δ-NT (0.167 vs. 0.116 mm), free β-hCG (1.010 vs. 0.964 MoM) and PAPP-A (1.103 vs. 1.003 MoM). Prediction of macrosomia provided by maternal factors was significantly improved by fetal NT, free β-hCG and PAPP-A (34.4 vs. 33.1% at a false-positive rate of 10%). Conclusion: Prediction of macrosomia is provided in the first trimester of pregnancy by a combination of maternal characteristics and measurements of parameters used in screening for aneuploidies.

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Section: Discussionmentioning

confidence: 99%

First-Trimester Prediction of Macrosomia

Poon¹,

Karagiannis²,

Stratieva³

et al. 2010

Fetal Diagn Ther

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“…A growing body of evidence suggests that intrauterine exposure to diabetes may 'programme' long-term effects in offspring, as first described in 1979 by Freinkel and Metzger as fuel-mediated teratogenesis [3,4]. Follow-up studies of offspring of diabetic pregnancies have demonstrated an increased rate of diabetes or pre-diabetes in the offspring [5] and features of the 'metabolic syndrome' [6] (obesity, glucose intolerance, hypertension and dyslipidaemia).…”

Section: Introductionmentioning

confidence: 99%

The diabetic pregnancy and offspring BMI in childhood: a systematic review and meta-analysis

et al. 2011

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Aims/hypothesis Offspring of mothers with diabetes are at increased risk of metabolic disorders in later life. Increased offspring BMI is a plausible mediator. We performed a systematic review and meta-analysis of studies examining offspring BMI z score in childhood in relation to maternal diabetes. Methods Papers reporting BMI z scores for offspring of diabetic (all types, and pre-and during-pregnancy onset) and non-diabetic mothers were included. Citations were identified in PubMed; bibliographies of relevant articles were hand-searched and authors contacted for additional data where necessary. We compared offspring BMI z score with and without adjustment for maternal pre-pregnancy BMI. We performed fixed effect meta-analysis except where significant heterogeneity called for use of a random effects analysis. Results Data were available from nine studies. In the diabetic group unadjusted mean offspring BMI z score was 0.28 higher (all diabetic mothers vs controls (95% CI 0.09, 0.47; p=0.004; nine studies; offspring of diabetic mothers n=927, controls n=26,384) and with adjustment for maternal prepregnancy BMI, 0.07 higher (95% CI −0.15, 0.28; p=0.54; three studies; offspring of diabetic mothers n=244, controls n=11,206). There was no evidence of a difference in offspring BMI z score in relation to type of diabetes (gestational vs type 1, p=0.95).Conclusions/interpretation Maternal diabetes is associated with increased offspring BMI z score, although this is no longer apparent after adjustment for maternal prepregnancy BMI in the limited number of studies in which this is reported. Causal mediators of the effect of maternal diabetes on offspring outcomes remain to be established; we recommend that future research includes adjustment for maternal pre-pregnancy BMI.

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“…The concept that intrauterine exposure to diabetes 'programmes' long-term offspring health was postulated by Freinkel and Metzger as 'fuel-mediated teratogenesis' in 1980 [7,8]. Offspring of diabetic mothers (ODM) have a higher rate of Electronic supplementary material The online version of this article (doi:10.1007/s00125-012-2689-8) contains peer-reviewed but unedited supplementary material, which is available to authorised users.…”

Section: Introductionmentioning

confidence: 99%

The diabetic pregnancy and offspring blood pressure in childhood: a systematic review and meta-analysis

Aceti¹,

Santhakumaran²,

Logan³

et al. 2012

Diabetologia

110

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Aims/hypothesis Offspring of diabetic mothers have increased risk of the metabolic syndrome in adulthood. Studies examining BP in offspring of diabetic mothers have conflicting conclusions. We performed a systematic review and metaanalysis of studies reporting offspring BP in children born to diabetic mothers. Methods Citations were identified in PubMed. Authors were contacted for additional data. Systolic and diastolic BP in offspring of diabetic mothers and controls were compared. Subgroup analysis of type of maternal diabetes and offspring sex were performed. Fixed-effects models were used, and random-effects models where significant heterogeneity was present. Meta-regression was used to test the relationship between offspring systolic BP and prepregnancy BMI. Results Fifteen studies were included in the review and 13 in the meta-analysis. Systolic BP was higher in offspring of diabetic mothers (mean difference 1.88 mmHg [95% CI 0.47, 3.28]; p00.009). Offspring of mothers with gestational diabetes had similar diastolic BP to controls, but higher systolic BP (1.39 mmHg [95% CI 0.00, 2.77]; p00.05); results for type 1 diabetes were inconclusive and there were no separate data available on offspring of type 2 diabetic mothers. Male offspring of diabetic mothers had higher systolic BP (2.01 mmHg [95% CI 0.93, 3.10]; p00.0003) and diastolic BP (1.12 mmHg [95% CI 0.36, 1.88]; p00.004) than controls; in female offspring there was no difference (systolic: 0.54 mmHg [95% CI −1.83, 2.90], p00.66; diastolic: 0.51 mmHg [95% CI −1.07, 2.09], p00.52). The correlation between offspring systolic BP and maternal prepregnancy BMI was not significant (p00.37). Conclusions/interpretation Offspring of diabetic mothers have higher systolic BP than controls. Differences related to sex and type of maternal diabetes require further investigation.

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Pregnancy as a Tissue Culture Experience: the Critical Implications of Maternal Metabolism for Fetal Development

Cited by 59 publications

References 61 publications

First-Trimester Prediction of Macrosomia

First-Trimester Prediction of Macrosomia

The diabetic pregnancy and offspring BMI in childhood: a systematic review and meta-analysis

The diabetic pregnancy and offspring blood pressure in childhood: a systematic review and meta-analysis

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