Nutrient-mediated teratogenesis and fuel-mediated teratogenesis: two pathways of intrauterine programming of diabetes

Abstract

The epidemic of diabetes is spreading quickly to the poor and the deprived. Nutrition during fetal life influences the future risk for diabetes; and both under- and overnutrition contribute and coexist in rapid-transition countries. Nutrient imbalance seems particularly important; for example, low maternal vitamin B(12) status coupled with high folate predicted higher adiposity and insulin resistance in Indian children, suggesting a role for 1-C (methyl) group donors in fetal programming. Maternal hyperglycemia worsens the situation. Improving the early-life environment may be more cost-effective for preventing diabetes than controlling lifestyle factors alone in later life.