Fetal development in women with diabetes: imprinting for a life-time?

Abstract

Objective: To test the hypothesis that fetal exposure to a hyperglycemic intrauterine environment in women with type 1 diabetes is associated with asymmetrically distributed excessive fetal growth and imprinting consistent with adverse health issues later in life. Methods: We report findings from a feasibility study on 19 young adults, born to mothers with type 1 diabetes. Long-term follow-up of the offspring in young adulthood included: oral glucose tolerance test, body mass index (BMI), dual X-ray absorptiometry, and blood pressure (BP). We report z-BMI and z-BP to account for varying gender and age. Results: The young adults born to women with diabetes averaged 19.9 years at follow-up; 37% were female, and 21% African American. Maternal glycohemoglobin A₁ concentration in the 2nd trimester was 9.2% for offspring born with asymmetric LGA and 7.5% for those born with symmetric LGA or AGA. There was significant correlation between maternal glucose control during pregnancy and fasting glucose, z-BMI and z-systolic BP in the young adults. Conclusion: The hyperglycemic intrauterine environment is associated with short-term morbidity, manifested as asymmetric LGA (the “fat” baby). In addition, increasing level of maternal hyperglycemia during pregnancy is associated with increased adiposity and elevated fasting glucose in the young adult offspring.

Keywords::

• Fetal programming
• asymmetric LGA
• offspring
• long-term follow-up
• maternal glycemic control
• type 1 diabetes

Acknowledgements

Supported in part by Diabetes in Pregnancy Program Project Grant (PPG), HD11725, funded from 1978 to 1995 by the National Institutes of Health, U.S.P.H.S. Grant Number MO1 RR 08084, General Clinical Research Centers Program, National Center for Research Resources and by an Institutional Clinical and Translational Science Award, NIH/NCRR Grant Number 5UL1RR026314. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Declaration of interest: The authors report no declaration of interest.