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Long-term prospective evaluation of offspring of diabetic mothers
B L Silverman1, T Rizzo, O C Green
1Department of Pediatrics, Northwestern University Medical School, Chicago, Illinois.
Insights
Maternal diabetes during pregnancy can impact child development. Offspring of diabetic mothers (ODM) showed early high birth weight, later obesity, and neurodevelopmental differences linked to maternal metabolic control.
Area of Science:
- Endocrinology
- Developmental Pediatrics
- Metabolic Research
Background:
- Altered maternal metabolism during pregnancy may influence fetal development.
- Offspring of diabetic mothers (ODM) are a key group to study fuel-mediated teratogenesis.
Purpose of the Study:
- To investigate the long-term anthropometric and neuropsychological outcomes in ODM.
- To correlate maternal metabolic status with child development.
- To test Freinkel's hypothesis of fuel-mediated teratogenesis.
Main Methods:
- Longitudinal study of physical growth (birth to 8 years) and neurodevelopment (up to 4 years) in ODM.
- Assessment of neonatal behavior using the Brazelton Neonatal Behavioral Assessment Scale (BNBAS).
- Cognitive assessment using the Stanford-Binet Intelligence Scale at 4 years.
Main Results:
- ODM exhibited high birth weight, with normal growth until age 5, followed by rapid weight gain and obesity by age 8.
- Poorer maternal glycemic control in the second and third trimesters correlated with lower newborn behavioral scores.
- Inverse correlation found between childhood IQ and maternal lipid metabolism (free fatty acids, beta-hydroxybutyrate) during pregnancy.
Conclusions:
- Maternal metabolic disturbances in diabetes impact offspring's physical growth, leading to childhood obesity.
- Prenatal exposure to altered maternal metabolism affects newborn neurobehavioral development.
- Childhood cognitive development is inversely associated with maternal lipid metabolism during pregnancy, supporting fuel-mediated teratogenesis.
Abstract:
We have suggested that altered maternal metabolism may affect the subsequent anthropometric and neuropsychological development of children who were in utero during disturbances in maternal fuel economy. This study reports the physical growth through 8 yr of age and the neuropsychological development through 4 yr of age in offspring of diabetic mothers (ODM). At birth, 50% of infants had weights greater than 90th percentile for gestational age. By 12 mo, length and weight were similar to the general population. Height remained normal until 7 yr of age, when it became slightly greater than average. After 5 yr of age, relative weight increased dramatically, and by 8 yr of age, half of the ODM had weights greater than 90th percentile. This childhood obesity in ODM is correlated with maternal prepregnant weight and independently with amniotic fluid insulin at 32-38 wk gestation. The Brazelton Neonatal Behavioral Assessment Scale (BNBAS) was administered to 185 newborn ODM. Significant correlations were found between poorer second- and third-trimester glycemic regulation and lower scores in three of four newborn BNBAS dimensions. The Stanford-Binet Intelligence Scale was measured in 102 ODM at 4 yr of age. We found an inverse correlation between childhood IQ and second- and third-trimester maternal lipid metabolism (serum free fatty acids and beta-hydroxybutyrate). This correlation is not explained by adverse perinatal events, socioeconomic status, maternal IQ, ethnicity, or diabetes type. These long-range associations between altered maternal metabolism and childhood growth and development continue to support Freinkel's hypothesis of fuel-mediated teratogenesis.