Offspring of mothers with Type 1 diabetes - defining an abnormal early environment

Maternal diabetes is associated with adverse consequences to mother and baby. Offspring have a twofold increase in congenital anomalies with cardiac and neural tube defects predominating.1 Excessive fetal growth and fetal adiposity2 are higher, resulting in substantive increases in intrapartum complications, independent of their fourfold increased background risk of perinatal mortality.1 In the longer term, offspring have an increased risk of obesity and type 2 diabetes3,4—reflecting potential in utero programming of disease; however, the mechanisms underlying this association are not known. We established the Scottish Multicentre Study of Diabetes in Pregnancy and Fetal Insulin and Glycaemia Study (FIGS) cohort to begin to address the metabolic pathways that may contribute to this abnormal phenotype at birth and later life. This study involved eight centers across Scotland with 250 women participating in the study, cord blood was obtained in 200 women, and follow-up in childhood is ongoing. A convenience sample of control mothers, who had no history of obstetric or metabolic disease and in whom routine screening for gestational diabetes was negative, was recruited from routine obstetric follow-up clinics after the 34th week of pregnancy. In keeping with other studies, offspring of mothers with diabetes were delivered around 2 weeks earlier than controls and showed evidence of marked increase in growth with birth weight, almost two standard deviations above that expected in the general population