What is it about?
Because of the complications of diabetes affecting the mothers and their fetus/newborns are less known, this review examined the epidemiologic and mechanistic issues involved in the developmental programming of diabetic mothers. This overview showed that sperm, egg, zygote or blastocyst derived from diabetic parents may develop into offspring with high risk of any type of diabetes, even if placed in a normal uterus, producing developmental delay, embryopathy, geno- and cyto-toxicity, teratogenic changes, free radicals and apoptosis. These early insults may then lead to an increased rate of miscarriage and congenital anomalies depending on free radicals signaling and cell-death pathways involved by the diabetogenic agents. Furthermore, sperm, egg, zygote or blastocyst from normal parents will have an increased risk of diabetes if placed in a diabetic uterus. Interestingly, diabetes has deleterious effect on male/female reproductive functions and on the development of the blastocysts/embryos. Indeed, this review hypothesized that the long-term effects of diabetes during the pregnancy (gestational diabetes) may influence, generally, on the health of the embryos, newborns (perinatal life) and adulthood. However, there are obvious species differences between pregnant women and animal models. Thus, maintaining normoglycaemia during pregnancy may play an important role in a healthy life for the newborns
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Why is it important?
the disturbance in the pro/antioxidant system due to the insulin dysfunction may retard the growth. From these findings, this review suggests that oxidative stress occurs in the diabetic pregnant state, which might promote maternal homeostasis alterations. Furthermore, the above results presumed that, the insulin-antioxidant system interactions could protect the cells and tissues, in general, during the development from the harmful effect of ROS due to GDM. Further studies are required to determine if these beneficial effects result in changes of diabetes complications only or not (inherited program modulate them).
Perspectives
It is goal to encourage the early referral of both pregestational and gestational diabetic women so that tight glycemic control will be instituted at the proper time in order to prevent maternal hyperglycaemia complications. At the same time, a better understanding of the physiological, cellular and molecular mechanisms of the developmental programming of hypertension, diabetes type 2 and eventually obesity by in utero exposure to diabetes in pregnancy may unveil pharmacological and nutritional targets for early prevention. The abnormal uterine environment may have deleterious effects on fetal/child metabolic programming and lead to metabolic syndrome in adulthood. A balanced/restricted diet and/or physical exercise often improve metabolic abnormalities in individuals with obesity and type 2 DM. This suggests that an appropriate dietary fatty acid profile and intake during the periconceptual/gestation/lactation period helps the female offspring to cope with deleterious intrauterine conditions. The hypothesis may change the focus from treatment of children and adults to prevention during early development. It also changes the focus from classical genetics to epigenetics and to nutrition and environmental chemical exposures during development; most importantly, it changes the focus from intervention to prevention. Also, antioxidant treatment of women with diabetes may be important in future attempts to prevent congenital malformations.
Full Professor Ahmed R. G.
Division of Anatomy and Embryology, Zoology department, Faculty of Science, Beni-Suef University, Egypt.
Read the Original
This page is a summary of: Evolutionary interactions between diabetes and development, Diabetes Research and Clinical Practice, May 2011, Elsevier,
DOI: 10.1016/j.diabres.2010.10.014.
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