These pages are best viewed with Netscape version 3.0 or higher or Internet Explorer version 3.0 or higher. When viewed with other browsers, some characters or attributes may not be rendered correctly.Long-Term Effects of the Intrauterine Environment The Northwestern University Diabetes in Pregnancy Center Bernard L. Silverman, MD We sought to test the hypothesis that long-term postnatal development
may be modified by metabolic experiences in utero. We enrolled offspring of women with
pregestational diabetes (this included type 1 and type 2 diabetes) and gestational
diabetes in a prospective study from 1977 to 1983. Fetal Copyright © 1998 American Diabetes Association For Technical Issues contact webmaster@diabetes.org |
-cell function was assessed by measurement of
amniotic fluid insulin (AFI) concentration at 32–38 weeks' gestation. Postnatally,
offspring were seen yearly for neuropsychological testing, measurement of anthropometrics,
and modified glucose tolerance testing. Neuropsychological control subjects were followed
longitudinally. Additional control subjects had anthropometrics measured once, and a
random subset of these had a single oral glucose challenge at 10–16 years. The rates
of major neuropsychological disturbances in our cohort did not differ significantly from
national estimates. However, aberrant maternal metabolism was associated with poorer
intellectual performance and psychomotor development. The macrosomia observed at birth in
offspring of diabetic mothers (ODM) resolves by 1 year of age. Obesity recurs in
childhood; and by 14–17 years, the mean BMI is 24.6 ± 5.8 kg/m2 in ODM
versus 20.9 ± 3.4 kg/m2 in control subjects. Obesity in adolescence is
associated with sex, mother's weight, and AFI concentration. Impaired glucose tolerance
(IGT) is found in 36% of ODM and is also associated with elevated amniotic fluid insulin
in utero. In confirmation of our original hypothesis, aberrant maternal metabolism is
associated with poorer intellectual and psychomotor development, obesity, and IGT in
offspring. Excessive insulin secretion in utero, as assessed by AFI concentration, is a
predictor of both obesity and IGT in adolescence.