Diabetes CareIs the Biphasic Effect of Diabetes and Obesity on Fetal Growth a Risk Factor for Childhood Obesity?

In this context, early growth restriction is followed by in utero catch-up development, potentially leading to overgrowth by the end of pregnancy – a common phenotype in infants born to obese and/or diabetic mothers.

The authors of this paper, drawing on research from the past four decades, propose to shift focus to what they perceive as a biphasic pattern of development in fetuses of women with type 1 and type 2 diabetes. This pattern is characterized by growth reduction in early pregnancy and in utero catch-up growth in the last trimester. Given the alarming 30% increase in gestational diabetes rates from 2016 to 2020, this issue warrants special attention.

Key Points:

• The pattern of fetal growth deviation in pregnancies complicated by maternal diabetes or obesity is biphasic.
• Because infants born to women with obesity and diabetes often exhibit overgrowth, the pregnancy period presents an opportunity to mitigate childhood obesity by preventing neonatal overgrowth.
• Until now, prevention efforts have primarily focused on growth in late pregnancy.
• The deviations in growth observed earlier in pregnancy potentially contribute to neonatal overgrowth.

Additional Points:

• The authors observed a biphasic pattern in growth deviation in fetuses of women with obesity, type 1 diabetes, or gestational diabetes, in comparison to lean women and those with normal glucose tolerance.
  • A reduction in growth occurs in early pregnancy.
  • Overgrowth takes place in late pregnancy, from around 30 gestational weeks onward.
• Like postnatal catch-up growth, in utero catch-up growth may increase the risk of obesity later in life.
• Children born to women with type 1 diabetes who were small in early gestation demonstrated poorer fetal functional development and cognitive development at 4 years of age.
• The authors advocate for the improvement of maternal metabolism as early as possible. (The proposed shift in focus of perinatal care to the early pregnancy period is not new, as it was suggested a decade ago.)

Conclusion:

• Most current research centers on size and weight at birth as predictors of future health. However, based on the four-decade research presented here, the authors suggest that greater emphasis should be placed on understanding and preventing the impact of growth reduction in early pregnancy and in utero catch-up growth in fetuses of women with type 1 diabetes, gestational diabetes, or obesity.

Data Sources:

• Six large-scale, longitudinal studies that included approximately 14,400 pregnant women with at least three measurements of fetal growth.