Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-23T15:47:34.990Z Has data issue: false hasContentIssue false
  • English
  • Français

The impact of gestational diabetes and maternal obesity on the mother and her offspring

Published online by Cambridge University Press:  05 March 2010

P. M. Catalano
P. M. Catalano*
Affiliation:
Department of Reproductive Biology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA
*
Address for correspondence: Dr P. M. Catalano, Department of Reproductive Biology, Case Western Reserve University, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, Ohio 44109, USA. (Email pcatalano@metrohealth.org)
Get access Rights & Permissions [Opens in a new window]

Abstract

The in utero maternal metabolic environment is important relative to both short and long term development of the offspring. Although poor fetal growth remains a significant factor relative to long-term outcome, fetal overgrowth is assuming greater importance because of the increase in obesity in the world’s populations. Maternal obesity and gestational diabetes are the most common metabolic complications of pregnancy related to fetal overgrowth and more specifically adiposity.

Women with gestational diabetes have increased insulin resistance and inadequate insulin response compared with weight-matched controls. Gestational diabetes increases the risk of maternal hypertensive disease (preeclampsia) as well as cesarean delivery. At birth the neonate has increased adiposity and is at risk for birth injury. Multiple studies have reported that children of women with gestational diabetes have a greater prevalence childhood obesity and glucose intolerance; even at glucose concentrations less than currently used to define gestational diabetes, compared with normoglycemic women.

Obese women also have increased insulin resistance, insulin response and inflammatory cytokines compared with average weight women both before and during pregnancy. They too are at increased risk for the metabolic syndrome-like disorders during pregnancy that is hypertension, hyperlipidemia, glucose intolerance and coagulation disorders. Analogous to women with gestational diabetes, neonates of obese women are heavier at delivery because of increased fat and not lean body mass. Similarly, these children have an increased risk of childhood adiposity and metabolic dysregulation. Hence, the preconceptional and perinatal period offers a unique opportunity to modify both short and long term risks for both the woman and her offspring.

Keywords

gestational diabetesobesitypregnancy
Type
Reviews
Information
Journal of Developmental Origins of Health and Disease , Volume 1 , Issue 4 , August 2010 , pp. 208 - 215
Copyright
Copyright © Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.World Health Organization. Obesity: preventing and management of a global epidemic. World Health Organization Technical Report Ser. 2000; 894, 1–4.Google Scholar
2. Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Final report. Circulation, 2002; 106, 3143–3421.CrossRefGoogle Scholar
3.Alberti, KG, Zimmet, PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus: provisional report of a WHO consultation. Diabetes Med. 1998; 15, 539–553.3.0.CO;2-S>CrossRefGoogle ScholarPubMed
4.World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications: report of a WHO Consultation. Part 1: Diagnosis and Classification of Diabetes Mellitus. World Health Organization: Geneva, Switzerland. 1999. Retrieved December 12, 2003, from http://whqlibdoc.who.int/hq/1999/WHO_NCD-NCS_99.2.pdfGoogle Scholar
5.Einhorn, D, Reaven, GDM, Cobin, RH, et al. American College of Endocrinology position statement on the insulin resistance syndrome. Endocr Pract. 2003; 9, 237–252.CrossRefGoogle Scholar
6.Metzger, BE, Coustan, DR. Summary and recommendations of the fourth international workshop-conference on gestational diabetes mellitus. Diabetes Care. 1998; 21(Suppl 2), B161–B167.Google ScholarPubMed
7.American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010; 33(Suppl 1), 562–569.Google Scholar
8.Catalano, PM, Huston, L, Amini, SB, Kalhan, SC. Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes mellitus. Am J Obstet Gynecol. 1999; 180, 903–916.CrossRefGoogle ScholarPubMed
9.Buchanan, TA. Pancreatic β-cell defects in gestational diabetes: Implications for the pathogenesis and prevention of type 2 diabetes. JCEM. 2001; 86, 989–993.CrossRefGoogle Scholar
10.Catalano, PM, Buchanan, T. Metabolic changes during normal and diabetic pregnancies. In Diabetes Mellitus in Women (eds. Reece EA, Coustan D, Gabbe S), 2004; pp. 129–147. Lippincott Williams & Wilkins: Philadelphia.Google Scholar
11.Catalano, PM, Tyzbir, ED, Roman, NM, Amini, SE, Sims, EAH. Longitudinal changes in insulin release and insulin resistance in non-obese pregnant women. Am J Obstet Gynecol. 1991; 165, 1667–1672.CrossRefGoogle Scholar
12.Freinkel, N. Banting Lecture, 1980 of pregnancy and progeny. Diabetes. 1980; 29, 1003–1035.CrossRefGoogle ScholarPubMed
13.Kirwan, JP, Hauguel-de Mouzon, S, Lepercq, J, et al. TNFα is a predictor of insulin resistance in human pregnancy. Diabetes. 2002; 51, 2207–2213.CrossRefGoogle ScholarPubMed
14.Xiang, AH, Peters, RK, Trigo, E, et al. Multiple metabolic defects during late pregnancy in women at high risk for type 2 diabetes. Diabetes. 1991; 48, 848–854.CrossRefGoogle Scholar
15.Ryan, EA, O’Sullivan, MJ, Skyler, JS. Insulin action during pregnancy: studies with the euglycemic clamp technique. Diabetes. 1985; 34, 80–89.CrossRefGoogle ScholarPubMed
16.Joffe, GM, Esterlitz, J, Levine, RJ, et al. .; for the Calcium for Preeclampsia Prevention (CPEP) Study Group. The relationship between abnormal glucose tolerance and hypertensive disorders of pregnancy in healthy nulliparous women. Am J Obstet Gynecol. 1998; 179, 1032–1037.CrossRefGoogle ScholarPubMed
17.Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008; 358, 1991–2002.CrossRefGoogle Scholar
18.Center for Disease Control and Prevention, National Diabetes Fact Sheet, 2007.Google Scholar
19.American Diabetes Discussion: Clinical Practice Recommendations – 2007. Diagnosis and classification of diabetes. Diabetes Care. 1997; 30(Suppl 1), 542–547.Google Scholar
20.Kim, C, Newton, KM, Knopp, RH. Gestational diabetes and the incidence of type 2 diabetes. Diabetes Care. 2002; 25, 1862–1868.CrossRefGoogle ScholarPubMed
21.Athukorala, C, Crowther, CA, Willson, K. Women with gestational diabetes mellitus in the ACHOIS Trial: Risk factors for shoulder dystocia. Aust NZ J Obstet Gynaecol. 2007; 47, 37–41.CrossRefGoogle ScholarPubMed
22.Alam, M, Raza, SJ, Sherali, AR, Akhtor, AS. Neonatal complications in infants born to diabetic mothers. J Coll Physicians Surg Pak. 2006; 16, 212–215.Google ScholarPubMed
23.Cordero, L, Trener, SH, Landon, MB, et al. Management of infants of diabetic mothers. Arch Pediatr Adolesc Med. 1998; 152, 249–254.CrossRefGoogle ScholarPubMed
24.Catalano, PM, Thomas, A, Huston-Presley, L, Amini, SB. Increased fetal adiposity: a very sensitive marker of abnormal in-utero development. Am J Obstet Gynecol. 2003; 189, 1698–1704.CrossRefGoogle ScholarPubMed
25.The HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcome (HAPO) study. Associations with neonatal anthropometrics. Diabetes. 2009; 58, 453–459.CrossRefGoogle Scholar
26.Radaelli, T, Varastehpour, A, Catalano, PM, Hauguel-de Mouzon, S. Gestational diabetes induces placental genes for chronic stress and inflammatory pathways. Diabetes. 2003; 52, 2951–2958.CrossRefGoogle ScholarPubMed
27.Pettitt, DJ, Knowler, WC, Baird, HR, Bennett, PH. Gestational diabetes: infant and maternal complications of pregnancy in relation to third-trimester glucose tolerance in the Pima Indians. Diabetes Care. 1980; 3, 458–460.CrossRefGoogle ScholarPubMed
28.Pettitt, DJ, Aleck, KA, Baird, HR, et al. Congenital susceptibility to NIDDM: role of the intrauterine environment. Diabetes. 1988; 37, 622–628.CrossRefGoogle ScholarPubMed
29.Dabelea, D, Hanson, RL, Lindsay, RS, et al. Intrauterine exposure to obesity conveys risks for type 2 diabetes and obesity: a study of discordant sib ships. Diabetes. 2000; 49, 2208–2211.CrossRefGoogle Scholar
30.Dabelea, D, Pettitt, DJ. Intrauterine diabetic environment confers risks for type 2 diabetes mellitus and obesity in the offspring, in addition to genetic susceptibility. J Pediatr Endocrinol Metab. 2001; 14, 1085–1091.CrossRefGoogle ScholarPubMed
31.Pettitt, DJ, Baird, HR, Aleck, KA, et al. Excessive obesity in offspring of Pima Indian women with diabetes during pregnancy. N Engl J Med. 1983; 308, 242–245.CrossRefGoogle ScholarPubMed
32.Pettitt, DJ, Knowler, WDC, Bennett, PH, et al. Obesity in offspring of diabetic Pima Indian women despite normal birth weight. Diabetes Care. 1987; 10, 76–80.CrossRefGoogle ScholarPubMed
33.Boney, CM, Verner, A, Tucker, R, Vohr, BR. Metabolic syndrome in childhood: association with birth weight, maternal obesity and gestational diabetes mellitus. Pediatrics. 2005; 115, E290–E296.CrossRefGoogle ScholarPubMed
34.Hillier, TA, Pedula, KC, Schmidt, MM, et al. Childhood obesity and metabolic imprinting. Diabetes Care. 2007; 30, 2287–2292.CrossRefGoogle ScholarPubMed
35.Clausen, TD, Mathiesen, ER, Hansen, T, et al. Overweight and the metabolic syndrome in adult offspring of women with diet-treated gestational diabetes mellitus or type 1 diabetes. J Clin Endocrinol Metab. 2009; 94, 2464–2470.CrossRefGoogle ScholarPubMed
36.Crowther, CA, Hillier, JE, Moss, JR, et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005; 352, 2477–2486.CrossRefGoogle ScholarPubMed
37.Landon, MB, for the Eunice Kennedy Shriver National Institute of Child Health and Human Development MFMU Network. A prospective multicenter treatment trial of mild gestational diabetes (GDM). Society for maternal fetal medicine abstract 2. Am J Obstet Gynecol. 2008(Suppl) 52.CrossRefGoogle Scholar
38.Rasmussin, KM, Yaktine, AL (eds.). Weight Gain During Pregnancy: Reexamining the Guidelines. Institute of Medicine, 2009. National Academy Press: Washington, DC.Google Scholar
39.Sewell, MF, Huston-Presley, L, Amini, S, Catalano, PM. Body mass index, a true indicator of body fat in obese gravidas. J Reprod Med. 2007; 52, 907–911.Google ScholarPubMed
40.Kirwan, JP, Varastehpour, A, Jing, M, et al. Reversal of insulin resistance postpartum is linked to enhanced skeletal muscle insulin signaling. J Clin Endocrinal Metab. 2004; 89, 4678–4684.CrossRefGoogle ScholarPubMed
41.Friedman, JE, Kirwan, JP, Jing, M, Presley, L, Catalano, PM. Increased skeletal muscle tumor necrosis factor-alpha and impaired insulin signaling persist in obese women with gestational diabetes mellitus 1 year postpartum. Diabetes. 2008; 57, 606–613.CrossRefGoogle ScholarPubMed
42.Lashen, H, Fear, K, Sturdee, DW. Obesity is associated with increased first trimester miscarriage: Matched case-control study. Human Reprod. 2004; 19, 1644–1646.CrossRefGoogle ScholarPubMed
43.Strothard, KJ, Tennant, BWG, Bill, R, Ramin, J. Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA. 2009; 301, 636–650.CrossRefGoogle Scholar
44.Catalano, PM. Management of obesity in pregnancy. Obstet Gynecol. 2007; 109, 419–433.CrossRefGoogle ScholarPubMed
45.Buhimschi, CS, Buhimschi, IA, Malinow, AM, Weiner, CP. Intrauterine pressure during the second stage of labor in obese women. Obstet Gynecol. 2004; 103, 225–230.Google ScholarPubMed
46.Surkan, PJ, Hsieh, CC, Johansson, AL, Diceman, PW, Cnattingius, S. Reasons for increasing trends in large for gestational age births. Obstet Gynecol. 2004; 104, 720–726.CrossRefGoogle ScholarPubMed
47.Ananth, CV, Wen, SW. Trends in fetal growth among singleton gestations in the United States and Canada. Semin Perinatol. 2002; 26(4), 260–267.CrossRefGoogle Scholar
48.Sewell, MF, Huston-Presley, L, Super, DM, Catalano, PM. Increased neonatal fat mass, not lean body mass, is associated with maternal obesity. AJOG. 2006; 195, 1100–1103.CrossRefGoogle Scholar
49.Nohr, EA, Vaeth, M, Baker, JL, et al. Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy. Am J Clin Nutr. 2008; 87, 1750–1759.CrossRefGoogle ScholarPubMed
50.Chu, SY, Callaghan, WM, Bisch, CC, D’Angelo, D. Gestational weight gain by body mass index among US women delivering live births, 2004–2005: fueling future obesity. Am J Obstet Gynecol. 2009; 200, 271–277.CrossRefGoogle ScholarPubMed
51.Gottlieb, AG, Galan, HL. Shoulder dystocia: an update. Obstet Gynecol Clin North Am. 2007; 34, 501–531.CrossRefGoogle ScholarPubMed
52.Catalano, P, Presley, L, Minium, J, Hauguel-de Mouzon, S. Fetuses of obese mothers develop insulin resistance in utero. Diabetes Care. 2009; 32, 1076–1080.CrossRefGoogle ScholarPubMed
53.Whitaker, RC. Predicting preschooler obesity at birth: the role of maternal obesity in early pregnancy. Pediatrics. 2004; 114, e29–e36.CrossRefGoogle ScholarPubMed
54.Mingrone, G, Manco, M, Mora, MEU, et al. Influence of maternal obesity on insulin sensitivity and secretion of the offspring. Diabetes Care. 2008; 31, 1872–1876.CrossRefGoogle Scholar
55.Oken, E, Taveras, EM, Kleinman, KP, Rich-Edwards, JW, Gillman, MW. Gestational weight gain and child adiposity at age 3 years. Am J Obstet Gynecol. 2007; 196, 322e1–322e8.CrossRefGoogle ScholarPubMed
56.Catalano, PM, Farrell, K, Thomas, A, et al. Perinatal risk factors for childhood obesity and metabolic dysregulation. Am J Clin Nutr. 2009; 90, 1303–1313.CrossRefGoogle ScholarPubMed
57.Holemans, K, Caluwaerts, S, Poston, L, Van Assche, FA. Diet-induced obesity in the rat: a model for gestational diabetes mellitus. Am J Obstet Gynecol. 2004; 190, 858–865.CrossRefGoogle Scholar
58.Samuelsson, A-M, Matthews, PA, Argenton, M, et al. Diet-induced obesity in female mice leads to offspring hyperphagia, adiposity, hypertension, and insulin resistance: a novel murine model of developmental programming. Hypertension. 2008; 51, 383–392.CrossRefGoogle ScholarPubMed
59.Plagemann, A. Perinatal programming and functional teratogenesis: impact on body weight regulation and obesity. Physiol Behav. 2005; 86, 661–668.CrossRefGoogle ScholarPubMed