Gestational Diabetes and the Offspring: Implications in the Development of the Cardiorenal Metabolic Syndrome in Offspring

Abstract

The risk of developing type 2 diabetes and cardiovascular disease in women who had previously been diagnosed with gestational diabetes (GDM) is well established. There is increasing evidence that the offspring of women with GDM are at increased risk for the development of all components of the cardiorenal metabolic syndrome. Overall, it appears that these offspring have an increased risk for overweight/obesity, insulin resistance, higher blood pressure, renal disease, and type 2 diabetes. However, distinct differences in regional populations, lack of routine screening and treatment of GDM worldwide, and long follow-up periods for offspring represent a challenge in assessing the risk for development of these abnormalities in the offspring of women who have had GDM.

Fig. 1

Maternal GDM and associated CRS in offspring. The imbalance in the levels of leptin/adiponectin in the neonate of a mother with GDM affects the neurodevelopment of appetite centers in the hypothalamus causing hyperphagia. Diabetes during gestation causes an inflammatory response at the level of the placenta. The ROS generated in the maternal-fetal placenta microenvironment can induce inhibitory or permissive gene expression resulting in chromatin epigenetic remodeling of genes in multiple organs including the pancreas, kidney, heart, and muscle. The future development of the CRS is mediated by these modifications in the transcriptome and the presence of persistent stressors in the future life of the offspring. ROS = Radicals of oxygen species; NO = nitric oxide.