Maternal diabetes and perinatal programming

Alterations of the intrauterine and neonatal environment may predispose for disorders and diseases throughout later life (perinatal programming). Especially, hormones and nutrients are dose-dependent organizers of the developing organism. Studies in offspring of diabetic mothers (ODM) have paradigmatically contributed to the perception of this developmental principle and our understanding of causal mechanisms. Fetal and neonatal hyperinsulinism in consequence of materno-fetal hyperglycaemia is the pathognomic feature in ODM. Epidemiological, clinical, as well as experimental data indicate that both insulin and glucose, when occurring in elevated concentrations during perinatal life, may epigenetically program a predisposition for obesity and diabetes later on. Similar may occur due to pre- and neonatal overfeeding. From a clinical point of view, avoidance of materno-fetal overnutrition, universal diabetes screening in all pregnant women and adequate therapy of all forms of diabetes during pregnancy, as well as avoidance of neonatal overfeeding are therefore recommended. These measures might serve as causal approaches of a genuine prevention to the benefit of long-term offspring health.