Complications in the offspring
DOI:
https://doi.org/10.47196/diab.v57i3Sup.672Keywords:
complications in the offspring, diabetesAbstract
The mechanisms of damage induced by diabetes mellitus (DM) in pregnancy are related to maternal and fetal hyperglycemia and increased oxidative stress. The underlying mechanisms are mainly focused on the microbiota, inflammation, reactive oxygen species, cell viability and epigenetics.
Maternal DM fosters an abnormal intrauterine environment for the fetus, which not only influences pregnancy outcomes, but also leads to fetal abnormalities and the development of diseases in the offspring later in life, such as metabolic and cardiovascular pathologies. Various motor and behavioral neurodevelopmental problems are also described, including an increased incidence of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).
Gestational DM (GDM) has a profound impact on placental mitochondrial metabolism and dynamics, with plausible implications for the short- and long-term health of the offspring. Circulating hyperglycemia is transported across the placenta, early stimulating the pancreas, and generating excess insulin, promoting overgrowth and adiposity in the fetus. These changes lead to short-term consequences in the offspring such as macrosomia, hypoglycemia, respiratory distress syndrome, and hypocalcemia. But it is also known that intrauterine exposure to a hyperglycemic environment increases the risk and programming of fetal metabolism, which leaves a long-term impact with increased risk in the offspring of developing DM and/or obesity later in adult life. Children of mothers with GDM may have higher body mass index (BMI), waist-hip ratio, and higher percentage of fat mass and lower lean mass, increased fasting glucose levels, insulin, C-peptide, blood pressure systolic and triglycerides, as well as reduced HDL cholesterol levels and precocious puberty in female offspring.
Offspring exposed to mothers with untreated GDM during pregnancy are at increased risk of insulin resistance with limited beta cell compensation compared with offspring of mothers without GDM.
GDM is significantly and independently associated with impaired infant glucose tolerance, high weight for gestational age, and prematurity.
References
I. Lowe WL, et al. Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study (HAPO FUS): maternal gestational diabetes mellitus and childhood glucose metabolism Diabetes Care 2019;42(3):372-380.
II. Grunnet LG, et al. Adiposity, dysmetabolic traits, and earlier onset of female puberty in adolescent offspring of women with gestational diabetes mellitus. A clinical study within the Danish National Birth Cohort. Diabetes Care 2017;40(12):1746-1755.
III. Damm P, et al. Gestational diabetes mellitus and long-term consequences for mother and offspring: a view from Denmark. Diabetologia 2016;59(7):1396-1399. doi: 10.1007/s00125-016-3985
IV. Yan YS. Long-term outcomes and potential mechanisms of ospring exposed to intrauterine hyperglycemia. Front Nutr 2023;10:1067282. doi: 10.3389/fnut.2023.1067282.
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Copyright (c) 2023 on behalf of the authors. Reproduction rights: Argentine Diabetes Society
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