The influence of maternal glucose metabolism on fetal growth, development and morbidity in 917 singleton pregnancies in nondiabetic women

Farmer, George; Russell, George; Hamilton-Nicol, D. R.; Ogenbede, H. O.; Ross, I.S.; Pearson, David; Thom, H.; Kerridge, D. F.; Sutherland, H. W.

doi:10.1007/bf00276845

Cited by 63 publications

(36 citation statements)

References 24 publications

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“…We, like others [5][6][7][8], found that maternal blood glucose levels are directly related to neonatal weight independently of the other physiological factors. Thus, the known association between maternal diabetes and high birthweight extends into the physiological range of glucose tolerance.…”

Section: Discussionsupporting

confidence: 76%

“…Thus, it is possible that even subtle hyperglycaemia during pregnancy may lead to fetal hyperinsulinaemia and macrosomia, perhaps in conjunction with other factors (fetal beta-cell hypersensitivity, maternal amino adds, paternal glucose intolerance). In general, maternal glucose levels during normal pregnancy have been found to be positively associated with birthweight [5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

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Relation of birthweight to maternal plasma glucose and insulin concentrations during normal pregnancy

et al. 1993

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Summary.Maternal diabetes mellitus is complicated by fetal macrosomia and predisposes the offspring to diabetes, but recent evidence indicates that a low, not high, birthweight is associated with a higher incidence of Type 2 (non-insulin dependent) diabetes in adult life. To clarify the relationships between maternal glucose and insulin levels and birthweight, we measured oral glucose tolerance and neonatal weight in a large group (n = 529) of women during the 26th week of pregnancy. Women with gestational diabetes (n = 17) had more familial diabetes, higher pre-pregnancy body weight, and tended to have large-for-gestational-age babies. In contrast, women with essential hypertension (n = 10) gave birth to significantly (p < 0.01) smaller babies. In the normal group (without gestational diabetes or hypertension, n --503), maternal body weight before pregnancy and at term, maternal height, week of delivery, gender of the newborn, and parity were all significant, independent predictors of birthweight, together explaining 23 % of the variability of neonatal weight. In addition, both fasting (p < 0.006) and 2-h post-glucose (p = 0.03) maternal plasma glucose concentrations were positively associated with birthweight independent of the other physiological determinants, accounting, however, for only 10% of the explained variability. In a subgroup of 134 normal mothers with prepregnancy body mass index of less than 25 kg. m 2, in whom plasma insulin measurements were available, the insulin area-under-curve was inversely related to birthweight (p < 0.02) after simultaneously adjusting for physiological factors and glucose area. When glucose and insulin measurements were combined in the I/G ratio (ratio of insulin to glucose area), this was still inversely related to birthweight. Furthermore, maternal insulinaemia was directly related to blood pressure levels (p <0.001) independently of body weight. We conclude that in normal pregnancy, whereas physiological factors account for most of the explainable variability of infant weight, the influence of the maternal metabolic milieu is dual, positive for glucose levels but negative for insulin concentrations. Maternal hyperinsulinaemia during pregnancy may be one trait linking low birthweight with predisposition to diabetes in adult life.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Relation of birthweight to maternal plasma glucose and insulin concentrations during normal pregnancy

et al. 1993

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“…The risk is increased compared with offspring of diabetic fathers and siblings born before the onset of maternal diabetes (3,5), suggesting that it results from the fetal environment in gestational diabetes mellitus (GDM) rather than from genes. Even in nondiabetic pregnancies, variations within the normal range of maternal fasting glucose concentrations are associated with altered neonatal adiposity (6). It is not known whether this is associated with changes in later body size and glucose/insulin concentrations in the offspring.…”

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confidence: 99%

Anthropometry, Glucose Tolerance, and Insulin Concentrations in Indian Children

et al. 2005

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OBJECTIVE -The purpose of this study was to test the hypothesis that the environment experienced by fetuses of mothers with gestational diabetes mellitus (GDM) and mothers with higher glucose concentrations that are in the normal range causes increased adiposity and altered glucose/insulin metabolism in childhood.RESEARCH DESIGN AND METHODS -Children (n ϭ 630) whose mothers were tested for glucose tolerance during pregnancy had detailed anthropometry performed at birth and annually thereafter. At 5 years, plasma glucose and insulin concentrations were measured in the children (2-h oral glucose tolerance test) and their fathers (fasting samples only).RESULTS -Newborns of diabetic mothers (n ϭ 41) were larger in all body measurements than control newborns (babies with nondiabetic parents). At 1 year, these differences had diminished and were not statistically significant. At 5 years, female offspring of diabetic mothers had larger subscapular and triceps skinfold thicknesses (P ϭ 0.01) and higher 30-and 120-min insulin concentrations (P Ͻ 0.05) than control children. Offspring of diabetic fathers (n ϭ 41) were lighter at birth than control children (P Ͻ 0.001); they showed no differences in anthropometry at 5 years. In control children, skinfold thickness and 30-min insulin concentrations were positively related to maternal insulin area under the curve, and skinfold thicknesses were related to paternal fasting insulin concentrations independently of the parents' skinfold thickness and socioeconomic status.CONCLUSIONS -Maternal GDM is associated with adiposity and higher glucose and insulin concentrations in female offspring at 5 years. The absence of similar associations in offspring of diabetic fathers suggests a programming effect in the diabetic intrauterine environment. More research is needed to determine whether higher maternal glucose concentrations in the nondiabetic range have similar effects. Diabetes Care 28:2919 -2925, 2005T he prevalence of type 2 diabetes is escalating in developing countries undergoing the "epidemiologic transition." India is predicted to have 79 million people with type 2 diabetes by the year 2030 (32 million in 2000) (1). Studies in western populations, predominantly among the Pima Indian communities of North America, have shown that individuals whose mothers were diabetic when they were in utero have an increased risk of early obesity and impaired glucose tolerance (IGT) and type 2 diabetes in adult life (2-4). The risk is increased compared with offspring of diabetic fathers and siblings born before the onset of maternal diabetes (3,5), suggesting that it results from the fetal environment in gestational diabetes mellitus (GDM) rather than from genes. Even in nondiabetic pregnancies, variations within the normal range of maternal fasting glucose concentrations are associated with altered neonatal adiposity (6). It is not known whether this is associated with changes in later body size and glucose/insulin concentrations in the offspring.There are few data from India on the preval...

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“…Some studies have shown that variations within the normal range of maternal glucose alter foetal growth and increase the subsequent risk of obesity. Farmer et al 28 had observed that fasting glucose concentrations of nondiabetic mothers increased all the neonatal measurements, particularly skinfolds. A continuous exposure even to a small excess of maternal glucose has been thought to induce chronic insulin stimulation and increase growth of insulin-sensitive adipose tissue and islet cells in the foetus.…”

Section: Long-term Effects Of Maternal Diabetesepidemiological Evidencementioning

confidence: 99%

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

Krishnaveni

Yajnik

2017

Current Science

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Maternal diabetes predisposes the growing foetus to non-communicable disease risk later in life. Studies show an increased risk of adiposity/obesity, type-2 diabetes and higher blood pressure in offspring of diabetic mothers. Altered metabolic and neuroendocrine functions, and epigenetic modification of genes involved in these functions are some of the mechanisms proposed for the offspring disease risk. Though optimal management of diabetes during pregnancy prevents its immediate complications, there is limited evidence on the influence of glycaemic control on longterm effects in the offspring. Future focus should be on prevention of pregnancy diabetes through appropriate maternal and child health policies in vulnerable populations.

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The influence of maternal glucose metabolism on fetal growth, development and morbidity in 917 singleton pregnancies in nondiabetic women

Cited by 63 publications

References 24 publications

Relation of birthweight to maternal plasma glucose and insulin concentrations during normal pregnancy

Relation of birthweight to maternal plasma glucose and insulin concentrations during normal pregnancy

Anthropometry, Glucose Tolerance, and Insulin Concentrations in Indian Children

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

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