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Adaptation of the Fetal Pancreas to Maternal Diabetes

  • Piero P. Foà
Part of the Endocrinology and Metabolism book series (EAM, volume 2)

Abstract

Webster’s dictionary defines a parasite as “one living at another’s expense” or as “an organism living in or on another living organism obtaining from it part or all of its organic nutrients and commonly exhibiting some degree of adaptive structural modification” (1). Either definition well describes the mammalian embryo: Aristotle (2) and Leonardo da Vinci (3) knew it and so did Michele Medici, a professor at the Pontifical University of Bologna, who, about 150 years ago, wrote that “the material destined for the nutrition of the fetus is carried by the uterine blood vessels to the placenta and, after being absorbed by the latter, is transported to the fetus thanks to the umbilical vessels… probably without direct commerce of blood” (4). We now know that the composition of this nutritional material is the product of maternal metabolism, suitably modified by a balance of apparently opposite endocrine forces: hyperinsulinism in the fed state, albeit associated with a degree of insulin resistance, and an increased secretion of counterregulatory hormones in the fasted state (5–8). As a result of this shifting equilibrium, the mother stores nutrients during the fed state and mobilizes them during periods of fasting, thus guaranteeing an adequate and constant supply to the growing conceptus. No matter how abundant and well balanced the nutrients, to use them the embryo must develop suitable enzymes, a process regulated partly by the quality and quantity of the nutrients themselves, partly by the manner in which the nutrients are obtained, and partly by hormones that become available as gestation progresses.

Keywords

Gestational Diabetes Mellitus Diabetic Mother Maternal Diabetes Diabetic Pregnancy Fetal Macrosomia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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  • Piero P. Foà

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