Clinic of Obstetrics, Research Group ‘Experimental Obstetrics’, Charité-University Medicine Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, Germany.
Early Hum Dev. 2011 Nov;87(11):743-7. doi: 10.1016/j.earlhumdev.2011.08.018. Epub 2011 Sep 23.
Alterations of the intrauterine and neonatal environment may predispose for disorders and diseases throughout later life (perinatal programming). Especially, hormones and nutrients are dose-dependent organizers of the developing organism. Studies in offspring of diabetic mothers (ODM) have paradigmatically contributed to the perception of this developmental principle and our understanding of causal mechanisms. Fetal and neonatal hyperinsulinism in consequence of materno-fetal hyperglycaemia is the pathognomic feature in ODM. Epidemiological, clinical, as well as experimental data indicate that both insulin and glucose, when occurring in elevated concentrations during perinatal life, may epigenetically program a predisposition for obesity and diabetes later on. Similar may occur due to pre- and neonatal overfeeding. From a clinical point of view, avoidance of materno-fetal overnutrition, universal diabetes screening in all pregnant women and adequate therapy of all forms of diabetes during pregnancy, as well as avoidance of neonatal overfeeding are therefore recommended. These measures might serve as causal approaches of a genuine prevention to the benefit of long-term offspring health.
子宫内和新生儿环境的改变可能会导致生命后期出现各种障碍和疾病（围产期编程）。特别是，激素和营养物质是发育中生物体的剂量依赖性调节物。糖尿病母亲所生孩子（ODM）的研究对这一发展原则的认识和对因果机制的理解做出了典范性贡献。由于母体-胎儿高血糖，胎儿和新生儿的高胰岛素血症是 ODM 的特征性表现。流行病学、临床和实验数据表明，在围产期生命中，当胰岛素和葡萄糖浓度升高时，可能会通过表观遗传机制为以后肥胖和糖尿病埋下易感性的伏笔。由于产前和新生儿过度喂养也可能发生类似情况。因此，从临床角度来看，建议避免母体-胎儿营养过剩，对所有孕妇进行普遍的糖尿病筛查，并在怀孕期间对所有类型的糖尿病进行充分治疗，同时避免新生儿过度喂养。这些措施可能成为真正预防的因果方法，有利于长期后代健康。
