Prediabetes and the big baby

Diabetic Medicine : a Journal of the British Diabetic Association
D R Hadden

Abstract

The concept of prediabetes has come to the fore again with the worldwide epidemic of Type 2 diabetes. The careful observations of W. P. U. Jackson and his colleagues in Cape Town, South Africa 50 years ago still deserve attention. Maternal hyperglycaemia cannot be the only cause of fetal macrosomia, and the pathophysiological reason for the unexplained stillbirth in late diabetic pregnancy still eludes us. The biochemical concepts of 'facilitated anabolism' and 'accelerated starvation' were developed by Freinkel as explanations of the protective mechanisms for the baby during the stresses of pregnancy. Some of these nutritional stresses may also occur in the particular form of early childhood malnutrition known in Africa as kwashiorkor, where subcutaneous fat deposition, carbohydrate intolerance, islet hyperplasia and sudden death may follow a period of excess carbohydrate and deficient protein intake. Different feeding practices in different parts of the world make comparisons uncertain, but there is evidence for insulin resistance in both the macrosomic fetus of the hyperglycaemic mother and in the child with established kwashiorkor. These adaptive changes in early development may play both a physiological and a pathological ...Continue Reading

References

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Citations

Mar 8, 2011·American Journal of Perinatology·S Katherine LaughonJanet Catov
Nov 7, 2008·Seminars in Fetal & Neonatal Medicine·David R Hadden, Ciara McLaughlin
May 18, 2018·The British Journal of Nutrition·Adrianne R BischoffLaurette Dube
Jul 4, 2013·Clinical Obstetrics and Gynecology·Ronald C W MaPeter D Gluckman
Jul 13, 2019·Nature Reviews. Disease Primers·H David McIntyrePeter Damm
Mar 21, 2009·Current Opinion in Endocrinology, Diabetes, and Obesity

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