Medical University of Graz, Graz, Austria
UCL Great Ormond Street Institute of Child Health, London, U.K.
Diabetes. 2021 Apr;70(4):823-830. doi: 10.2337/db20-1111.
Excess nutritional supply to the growing fetus, resulting from maternal diabetes and obesity, is associated with increased risks of fetal maldevelopment and adverse metabolic conditions in postnatal life. The placenta, interposed between mother and fetus, serves as the gateway between the two circulations and is usually considered to mediate maternal exposures to the fetus through a direct supply line. In this Perspective, however, we argue that the placenta is not an innocent bystander and mounts responses to fetal "signals of distress" to sustain its own adequate function and protect the fetus. We describe several types of protection that the placenta can offer the fetus against maternal metabolic perturbations and offer a theoretical model of how the placenta responds to the intrauterine environment in maternal diabetes and obesity to stabilize the fetal environment. Our approach supports growing calls for early screening and control of pregnancy metabolism to minimize harmful fetal outcomes.
母体糖尿病和肥胖导致胎儿营养过剩，增加了胎儿发育异常和出生后代谢异常的风险。胎盘位于母体和胎儿之间，是两者循环之间的通道，通常被认为是通过直接供应线将母体暴露于胎儿。然而，在本观点中，我们认为胎盘不是无辜的旁观者，它会对胎儿的“窘迫信号”做出反应，以维持其自身的适当功能并保护胎儿。我们描述了胎盘可以为胎儿提供的几种保护措施，以防止母体代谢紊乱，并提供了一个理论模型，说明胎盘如何应对母体糖尿病和肥胖症中的宫内环境，以稳定胎儿环境。我们的方法支持了对妊娠代谢进行早期筛查和控制以最小化有害胎儿结局的呼声。
