The intrauterine environment: Implications for the offspring of diabetic mothers

The proposition that maternal fuel metabolism may exert long-range effects on development - that is, the hypothesis of fuel-mediated teratogenesis - is corroborated by the many retrospective and prospective reports summarized in this review. The findings that have emerged from both animal and human studies indicate that the intrauterine environment of diabetes has a profound influence on later development of obesity, glucoregulation, and possibly hypertension. This suggests that diabetes can predispose to more diabetes, which may contribute to the overall increasing burden of diabetes in the population. However, this process is potentially preventable by more effective normalization of metabolism throughout gestation in women with known diabetes and by early diagnosis and correction of metabolic disturbances of gestational diabetes. Appropriate management of the pregnant diabetic patient may thereby constitute a meaningful strategy for modifying some of the self-perpetuating, and apparently congenitally 'acquired,' contributions to such public health problems as adult obesity, diabetes, and even hypertension.