Long-term health outcomes in offspring born to women with diabetes in pregnancy

Abstract

In this review, we critically assess recent evidence from human studies regarding the potential implications of exposure to maternal diabetes in-utero for long-term adiposity, cardiometabolic outcomes, and cognitive ability of the offspring. Evidence supports a direct causal role for exposure to maternal diabetes in utero in determining offspring long-term greater adiposity and adverse cardiometabolic health. Although a majority of observational studies report associations of exposure to maternal pregnancy diabetes with lower cognitive ability, there is also evidence supporting an opposite 'protective' intrauterine effect of exposure to maternal pregnancy diabetes on offspring cognitive ability. Epigenetic modification has been suggested as a mediator on the pathways from maternal pregnancy diabetes to long-term offspring outcomes and several recent studies that are reviewed here lend some support to this notion, but research in this area is still too novel to be conclusive.

Fig. 1

Schematic representation of potential pathways linking maternal diabetes in pregnancy with long- term offspring greater adiposity, adverse cardiometabolic health and lower cognitive ability. The figure is illustrative of the focus of this article and does not aim to show all possible relationships between the characteristics that are depicted. Pathways specific to offspring adiposity and cardiometabolic health are given in italics and pathways specific to cognitive ability in bold with common pathways in standard font. Adapted from Lawlor DA. The Society for Social Medicine John Pemberton lecture 2011. Developmental overnutrition—an old hypothesis with new importance? Int J Epidemiol. 2013;42:7–29 [•]; and Fraser A, Almqvist C, Larsson H, Långström N, Lawlor D. Maternal diabetes in pregnancy and offspring cognitive ability: sibling study with 723,775 men from 579,857 families. Diabetologia. 2013;1–8 [47], which is published under the CC-BY license.)