[Long term outcome in children of mothers with gestational diabetes]

Maternal Weight and Gestational Diabetes Impacts on Child Health: A Narrative Review

Maternal weight and gestational diabetes mellitus (GDM) have significant implications for both maternal and child health. This narrative review explores the intricate relationship between maternal pre-pregnancy weight, gestational weight gain, and GDM, focusing on their short- and long-term effects on child health outcomes. The review highlights evidence linking maternal obesity and GDM to increased risks of adverse outcomes in infants and children, such as macrosomia, neonatal hypoglycemia, childhood obesity, and metabolic disorders. It also discusses the intergenerational transmission of metabolic risk, underscoring the importance of early intervention and prevention strategies in maternal healthcare. Furthermore, the review emphasizes the need for tailored approaches to managing maternal weight and GDM to mitigate potential risks and improve health outcomes for future generations. Key recommendations include promoting healthy preconception weight, monitoring gestational weight gain, and enhancing postnatal follow-up for both mothers and children. This review underscores the critical role of maternal health in shaping the developmental trajectory of offspring and highlights opportunities for healthcare professionals to reduce the long-term impact of GDM on child health.

Fetoplacental vascular endothelial dysfunction as an early phenomenon in the programming of human adult diseases in subjects born from gestational diabetes mellitus or obesity in pregnancy

Gestational diabetes mellitus (GDM) and obesity in pregnancy (OP) are pathological conditions associated with placenta vascular dysfunction coursing with metabolic changes at the fetoplacental microvascular and macrovascular endothelium. These alterations are seen as abnormal expression and activity of the cationic amino acid transporters and endothelial nitric oxide synthase isoform, that is, the "endothelial L-arginine/nitric oxide signalling pathway." Several studies suggest that the endogenous nucleoside adenosine along with insulin, and potentially arginases, are factors involved in GDM-, but much less information regards their role in OP-associated placental vascular alterations. There is convincing evidence that GDM and OP prone placental endothelium to an "altered metabolic state" leading to fetal programming evidenced at birth, a phenomenon associated with future development of chronic diseases. In this paper it is suggested that this pathological state could be considered as a metabolic marker that could predict occurrence of diseases in adulthood, such as cardiovascular disease, obesity, diabetes mellitus (including gestational diabetes), and metabolic syndrome.