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Fetal growth and impaired glucose tolerance in men and women
K Phipps1, D J Barker, C N Hales
1Medical Research Council Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, UK.
Insights
Reduced fetal growth is linked to impaired glucose tolerance in middle-aged adults. Lower birth weight and smaller size at birth predict higher risks of glucose intolerance and diabetes later in life.
Area of Science:
- Endocrinology
- Public Health
- Developmental Biology
Background:
- Reduced fetal growth has been anecdotally linked to chronic diseases in adulthood.
- Previous studies suggested an association between low birth weight and impaired glucose tolerance in men.
- The long-term impact of fetal growth on glucose metabolism in both sexes requires further investigation.
Purpose of the Study:
- To investigate the association between reduced fetal growth and impaired glucose tolerance in men and women at age 50.
- To determine if birth size parameters predict the development of glucose intolerance in later life.
Main Methods:
- A follow-up study involving 140 men and 126 women born between 1935-1943 in Preston, UK.
- Detailed measurement of birth size parameters, including birth weight, head circumference, and placental weight.
- Standard oral glucose tolerance tests (OGTT) performed at age 50 to assess glucose tolerance and insulin response.
Main Results:
- Subjects with impaired glucose tolerance or non-insulin-dependent diabetes mellitus had significantly lower birth weight, smaller head circumference, and lower ponderal index.
- The prevalence of impaired glucose tolerance/diabetes decreased from 27% in the lowest birth weight group (<2.50 kg) to 6% in the highest group (>3.41 kg) (p < 0.002).
- Both 2-h plasma glucose and insulin concentrations during OGTT decreased progressively with increasing birth weight (p < 0.004 and p < 0.001, respectively), independent of gestational duration.
Conclusions:
- Confirms a strong association between impaired glucose tolerance in adult life and low birth weight in both men and women.
- Suggests that reduced fetal growth, potentially due to maternal undernutrition, has long-term consequences on glucose regulation.
- Highlights the potential impact of early-life growth on endocrine pancreas development and function.
Abstract:
A follow-up study was carried out to determine whether reduced fetal growth is associated with the development of impaired glucose tolerance in men and women aged 50 years. Standard oral glucose tolerance tests were carried out on 140 men and 126 women born in Preston (Lancashire, UK) between 1935 and 1943, whose size at birth had been measured in detail. Those subjects found to have impaired glucose tolerance or non-insulin-dependent diabetes mellitus had lower birthweight, a smaller head circumference and were thinner at birth. They also had a higher ratio of placental weight to birthweight. The prevalence of impaired glucose tolerance or diabetes fell from 27% in subjects who weighed 2.50 kg (5.5 pounds) or less at birth to 6% in those who weighed more than 3.41 kg (7.5 pounds) (p < 0.002 after adjusting for body mass index). Plasma glucose concentrations taken at 2-h in the glucose tolerance test fell progressively as birthweight increased (p < 0.004), as did 2-h plasma insulin concentrations (p < 0.001). The trends with birthweight were independent of duration of gestation and must therefore be related to reduced rates of fetal growth. These findings confirm the association between impaired glucose tolerance in adult life and low birthweight previously reported in Hertfordshire (UK), and demonstrate it in women as well as men. It is suggested that the association reflects the long-term effects of reduced growth of the endocrine pancreas and other tissues in utero. This may be a consequence of maternal undernutrition.