Recent studies have established that the neonate born to a pregnancy with maternal diabetes or obesity (‘diabesity’) is characterised by increased fat accumulation. The neonatal fat is the result of triglyceride synthesis and deposition stimulated by elevated foetal insulin levels combined with insulin’s mitogenic activity directly stimulating the growth of the white adipocytes. Foetal insulin levels are determined by foetal glucose and some amino acids such as arginine. Although the placenta plays a key role in providing maternally derived nutrients to the growing foetus, there is currently no evidence that it actively contributes to an excessive maternal-to-foetal glucose flux at the end of gestation. Early in gestation, the maternal environment in diabesity, and in particular the glucose-insulin axis, can modify placental growth and development, which may contribute to an enhanced glucose flux to the foetus already early in pregnancy. This may have long-lasting effects on the foetal pancreas and accelerate beta-cell maturation. The association of foetal and neonatal insulin levels and the proportion of body fat with obesity later in the offspring’s life calls for interventions during pregnancy to prevent or reduce foetal hyperinsulinaemia. Dietary and/or physical activity interventions initiated before or in early pregnancy would likely be most effective. Results from the very few studies with foetal insulin as the outcome are inconsistent. However, there is a major lack of randomised intervention trials on this topic.
Authors: Desoye G, van Poppel M. ;Full Source: Best Practice & Research Clinical Obstetrics & Gynaecology. 2014 Aug 19. pii: S1521-6934(14)00162-X. doi: 10.1016/j.bpobgyn.2014.05.012. [fusion_builder_container hundred_percent=”yes” overflow=”visible”][fusion_builder_row][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”][Epub ahead of print] ;[/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]