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Kongreß pp 266–274Cite as

Implications of Diabetes in Pregnancy for Developmental Biology

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Part of the book series: Verhandlungen der Deutschen Gesellschaft für Innere Medizin ((VDGINNERE,volume 93))

Abstract

Normal pregnancy modifies every aspect of maternal intermediary metabolism. The realignments of the fasted State may be characterized as “accelerated starvation” and the changes in the fed State may “facilitate anabolism”. These alterations in fuel economy contribute to the post-receptor insulin resistance of normal pregnancy and must be appreciated in any approaches to the management of pregnancies complicated by diabetes. Recent attention has focused on the implications of maternal fuel metabolism for intrauterine development in so far as maternal fuels delimit the “tissue culture medium” in which the new cells of the conceptus are formed and undergo Organization, differentiation and functional maturation. Neonatal characteristics of the off spring have been clearly linked to the antepartum metabolism of the mother and the exquisitely sensitive relationships to maternal insulinization have now been documented. Mounting evidence is also identifying the potentiality for more long-range effects of maternal metabolism. These appear to be mediated via fuel-related modifications of genetic expression during organogenesis in the embryo and during the development of terminally-differentiated cells in the fetus (i.e. “fuel-mediated teratogenesis”). As a consequence, permanent alterations may occur in behavioral, intellectual, metabolic, anthropometric and other phenotypic characteristics of the offspring. The long-range possibilities provide even more compelling reasons for attempts to normalize maternal metabolism during pregnancies complicated by diabetes or other perturbations of fuel homeostasis. They also underscore that diabetes in pregnancy may serve as a paradigm of the relationships that obtain between maternal fuel economy and developmental biology in all pregnancies.

The changes in metabolism that occur during normal pregnancy may be viewed in terms of their meaning for the mother as well as their relevance for the intrauterine development of the conceptus [1,2]. The considerations of development need not be confined to the immediate outcome of the pregnancy or the peripartum characteristics of the offspring. There has been growing recent awareness that maternal metabolism during pregnancy may also serve as a meaningful determinant of many of the life-long features of the offspring. The discussion to follow attempts to review pregnancy complicated by diabetes along the lines of the overall developmental implications. Due to constraints of space and time, the presentation will draw heavily upon the experiences of the author and his colleagues at the Diabetes in Pregnancy Center of Northwestern University Medical School.

Supported in part by research grants DK10699, MRP-HD11021, DK21843, and RR-48 and Training Grant DK07169 from the National Institutes of Health, USPHS, Bethesda, Maryland.

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Authors and Affiliations

  1. Center for Endocrinology, Northwestern University Medical School, Chicago, USA

    N. Freinkel

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  1. Humboldtstr. 14, D-6200, Wiesbaden, Deutschland

    Klaus Miehlke (ständigen Schriftführer) (ständigen Schriftführer)

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© 1987 J. F. Bergmann Verlag, München

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Freinkel, N. (1987). Implications of Diabetes in Pregnancy for Developmental Biology. In: Miehlke, K. (eds) Kongreß. Verhandlungen der Deutschen Gesellschaft für Innere Medizin, vol 93. J.F. Bergmann-Verlag. https://doi.org/10.1007/978-3-642-85460-6_60

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  • DOI: https://doi.org/10.1007/978-3-642-85460-6_60

  • Publisher Name: J.F. Bergmann-Verlag

  • Print ISBN: 978-3-8070-0364-1

  • Online ISBN: 978-3-642-85460-6

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