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Babies and Diabetes

Posted on July 28, 2021 | No Comments on Babies and Diabetes

Birthweight reflects maternal and fetal well-being during pregnancy and many of the adult-onset illnesses can be traced back to metabolic disturbances early in life. The relationship between birthweight and the risk for diabetes in adult life can be described as a U-shaped curve.

Low birthweight babies and big babies at birth predict future diabetes (the upper arms of the U-shaped curve). The bottom line of the U-shaped curve corresponds to the birthweight that predicts the lowest risk for future diabetes. This target birthweight would be above 2,500 grams to below 4,000 grams in Filipinos.
There are many causes of low birthweights (Please see table). The end-effect is a fetus whose cells have been programmed abnormally resulting in modification of the structure and function of several organ systems. In the pancreas, the underweight fetus does not have adequate nutrition for beta cell* growth and development. The reduction in beta cell number translates to less insulin production and secretion. Insulin is the hormone that controls blood sugar levels, therefore insulin deficiency can manifest as sugar (glucose) intolerance.

Thin babies at birth who in later life become obese are at risk for both diabetes and heart disease. The thrifty gene concept introduced by Hales and Barker in the early 90s explains that in times of famine or scarcity of food, the thrifty genes helped our bodies hang onto every calorie for survival. As man moved from being food hunters to an era where food is plenty, lifestyle diseases such as diabetes have become the problem of the present century.

Big babies on the other hand are “over-nourished” because of maternal hyperglycemia (high blood sugar). High sugar from the mother enters the fetus via the cord blood and swallowed amniotic fluid. The high sugar content of the amniotic fluid is also a strong stimulus for insulin production and secretion by the fetal beta cell. Insulin on the fetal side is a growth factor and body fat is deposited especially around the belly, giving the baby a “chubby” snapshot at birth. These fat babies are insulin resistant, meaning they have enough insulin in their bodies but insulin action is impaired. Childhood obesity and inactivity if not addressed early will eventually lead to the development of Type 2 Diabetes Mellitus.

There are some babies who are exposed to maternal hyperglycemia in the womb but have normal weight at birth. Genetics play a strong influence here. A recent explanation is the so called “fidgety fetus” hypothesis which states that there is an intrinsic genetic trait (or fidget gene) that keeps the fetus active inside the mother’s womb. This could also be likened to fetal exercise in utero. Prevention of diabetes starts in the womb. Efforts should be made to prevent the factors that would lead to low birthweights.

On the other extreme, the pregnant woman should be screened for riskfactors for gestational diabetes (diabetes that occurs during pregnancy). These include a family history of diabetes (especially in a first-degree relative), history of miscarriages and big babies in previous pregnancies, hypertension, overweight and lack of exercise. The mother eventually undergoes a blood glucose test. Once the diagnosis is confirmed, education on proper nutrition, exercise and strict sugar control is initiated and reinforced with each visit with a physician.

The delivery of a healthy baby that is appropriate for the age of conception is the primary goal of each pregnancy. A healthy baby will grow up to be a healthy adult who (hopefully!) will practice healthy lifestyle habits. Know your birthweight. It is an excellent guide to a long and- healthy life.’

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