Fetale Programmierung bei diabetischer Schwangerschaft

Zusammenfassung

Studien an Nachkommen diabetischer Mütter haben entscheidend zu der Erkenntnis beigetragen, dass Alterationen der perinatalen Umweltbedingungen für Krankheiten im späteren Leben prädisponieren. Hormone fungieren dabei als umweltabhängige Organisatoren des sich entwickelnden “Neuro-Endokrino-Immun-Netzwerks”, welches alle fundamentalen Lebensprozesse reguliert. Wenn sie aufgrund alterierter intrauteriner und/oder neonataler Umgebung in unphysiologischen Konzentrationen während “kritischer Entwicklungsphasen” vorkommen, können sie als “endogene funktionelle Teratogene” wirken. Fetaler und neonataler Hyperinsulinismus ist pathognomonisch für Nachkommen diabetischer Mütter. Daten unserer Arbeitsgruppe zeigen, dass ein perinataler Hyperinsulinismus die Entwicklung von Adipositas und Diabetes “programmieren” kann und dass mütterliches Übergewicht und damit einhergehende fetale/neonatale Überernährung ähnliches bewirken können. Ein generelles Glukoseintoleranzscreening und eine entsprechende Therapie sind daher ebenso empfehlenswert wie die Vermeidung einer frühpostnatalen Überernährung, als Maßnahmen einer genuinen Primärprävention.

Summary

It is meanwhile accepted that alterations of the perinatal environment predispose for diseases throughout life. Studies in offspring of diabetic mothers (ODM) have decisively contributed to this perception and our understanding of causal mechanisms. Hormones are environment-dependent organizers of the developing neuro-endocrine-immune network, which regulates all fundamental processes of life. When present in non-physiological concentrations during critical periods of development, induced by altered intrauterine and/or neonatal environment, hormones can therefore also act as endogenous functional teratogens. Fetal and neonatal hyperinsulinism is the pathognomic feature in ODM. Data obtained by our group indicate that increased insulin during perinatal life may program the development of obesity and diabetes. Similar may occur due to maternal overweight accompanied by increased fetal food supply, and neonatal overfeeding. From a clinical point of view, general screening and therapy of diabetes during pregnancy as well as avoidance of early postnatal overfeeding are therefore recommended, as causal approaches to a genuine primary prevention.

Schlüsselwörter

Perinatale nutritive Programmierung - Makrosomie - Gestationsdiabetes - Adipositas

Keywords

perinatal nutritional programming - macrosomia - gestational diabetes - obesity

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