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Garg D, Sharma S. Neurodevelopmental Outcomes in Infants of Mothers with Gestational Diabetes: Are We Missing the Boat? Indian J Pediatr 2023; 90:1067-1068. [PMID: 37556032 DOI: 10.1007/s12098-023-04804-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/10/2023]
Affiliation(s)
- Divyani Garg
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Suvasini Sharma
- Division of Neurology, Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, 110001, India.
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2
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Cinquina V, Keimpema E, Pollak DD, Harkany T. Adverse effects of gestational ω-3 and ω-6 polyunsaturated fatty acid imbalance on the programming of fetal brain development. J Neuroendocrinol 2023; 35:e13320. [PMID: 37497857 PMCID: PMC10909496 DOI: 10.1111/jne.13320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 05/18/2023] [Accepted: 06/10/2023] [Indexed: 07/28/2023]
Abstract
Obesity is a key medical challenge of our time. The increasing number of children born to overweight or obese women is alarming. During pregnancy, the circulation of the mother and her fetus interact to maintain the uninterrupted availability of essential nutrients for fetal organ development. In doing so, the mother's dietary preference determines the amount and composition of nutrients reaching the fetus. In particular, the availability of polyunsaturated fatty acids (PUFAs), chiefly their ω-3 and ω-6 subclasses, can change when pregnant women choose a specific diet. Here, we provide a succinct overview of PUFA biochemistry, including exchange routes between ω-3 and ω-6 PUFAs, the phenotypes, and probable neurodevelopmental disease associations of offspring born to mothers consuming specific PUFAs, and their mechanistic study in experimental models to typify signaling pathways, transcriptional, and epigenetic mechanisms by which PUFAs can imprint long-lasting modifications to brain structure and function. We emphasize that the ratio, rather than the amount of individual ω-3 or ω-6 PUFAs, might underpin physiologically correct cellular differentiation programs, be these for neurons or glia, during pregnancy. Thereupon, the PUFA-driven programming of the brain is contextualized for childhood obesity, metabolic, and endocrine illnesses.
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Affiliation(s)
- Valentina Cinquina
- Department of Molecular NeurosciencesCenter for Brain Research, Medical University of ViennaViennaAustria
| | - Erik Keimpema
- Department of Molecular NeurosciencesCenter for Brain Research, Medical University of ViennaViennaAustria
| | - Daniela D. Pollak
- Department of Neurophysiology and NeuropharmacologyCenter for Physiology and Pharmacology, Medical University of ViennaViennaAustria
| | - Tibor Harkany
- Department of Molecular NeurosciencesCenter for Brain Research, Medical University of ViennaViennaAustria
- Deaprtment of NeuroscienceBiomedicum 7D, Karolinska InstitutetStockholmSweden
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3
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Angelis D, Jaleel MA, Brion LP. Hyperglycemia and prematurity: a narrative review. Pediatr Res 2023; 94:892-903. [PMID: 37120652 DOI: 10.1038/s41390-023-02628-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/11/2023] [Accepted: 04/15/2023] [Indexed: 05/01/2023]
Abstract
Hyperglycemia is commonly encountered in extremely preterm newborns and physiologically can be attributed to immaturity in several biochemical pathways related to glucose metabolism. Although hyperglycemia is associated with a variety of adverse outcomes frequently described in this population, evidence for causality is lacking. Variations in definitions and treatment approaches have further complicated the understanding and implications of hyperglycemia on the immediate and long-term effects in preterm newborns. In this review, we describe the relationship between hyperglycemia and organ development, outcomes, treatment options, and potential gaps in knowledge that need further research. IMPACT: Hyperglycemia is common and less well described than hypoglycemia in extremely preterm newborns. Hyperglycemia can be attributed to immaturity in several cellular pathways involved in glucose metabolism in this age group. Hyperglycemia has been shown to be associated with a variety of adverse outcomes frequently described in this population; however, evidence for causality is lacking. Variations in definitions and treatment approaches have complicated the understanding and the implications of hyperglycemia on the immediate and long-term effects outcomes. This review describes the relationship between hyperglycemia and organ development, outcomes, treatment options, and potential gaps in knowledge that need further research.
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Affiliation(s)
- Dimitrios Angelis
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Mambarambath A Jaleel
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Luc P Brion
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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4
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Ahmed S, Cano MÁ, Sánchez M, Hu N, Ibañez G. Effect of exposure to maternal diabetes during pregnancy on offspring's brain cortical thickness and neurocognitive functioning. Child Neuropsychol 2023; 29:588-606. [PMID: 35867480 PMCID: PMC9867783 DOI: 10.1080/09297049.2022.2103105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Little is known about the long-term effects of maternal diabetes during pregnancy (DP), either gestational diabetes or preexisting diabetes (type 1 or type 2), on offspring's brain morphometry and neurocognitive functioning (NCF). This study examined the effect of prenatal exposure to maternal DP on the brain structure and NCF in children between 9 and 10 years of age. This study used cross-sectional neuroimaging and NCF data from the baseline wave of the Adolescent Brain and Cognitive Development® study. Exposure to maternal DP was assigned from the developmental history questionnaire. Differences in the brain cortical thickness (CTh) and five cognitive abilities (executive function, working and episodic memory, processing speed, and language abilities) were examined in diabetes-exposed and diabetes-unexposed children. Linear mixed effect models and generalized linear models were used to adjust for the effect of confounding variables. A total of 9,967 children (718 diabetes-exposed and 9249 unexposed) were included in the analysis. Diabetes-exposed children had lower whole-brain CTh [mean: exposed vs unexposed = 2.725 mm vs 2.732 mm; difference (95%CI): -0.007 mm (-0.013, -0.001)] compared to unexposed children after adjusting for confounding variables. Diabetes-exposed children had lower CTh in most part of the occipital lobe of both hemispheres, right postcentral gyrus, and left superior parietal cortex. Diabetes-exposed children also had lower scores in processing speed task [mean difference (95%CI): -1.7 (-2.8, -0.6)] and total cognition [mean difference (95%CI): -0.6 (-1.2, -0.02)]. Diabetes-exposed children have reduced CTh and NCF during preadolescence, which might have implications for psychomotor development during later life. Prospective studies are needed to confirm our findings.
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Affiliation(s)
- Shyfuddin Ahmed
- Corresponding author: Shyfuddin Ahmed, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC-5 (level 4), Miami, Florida 33199, (786) 461-5574,
| | - Miguel Ángel Cano
- Corresponding author: Shyfuddin Ahmed, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC-5 (level 4), Miami, Florida 33199, (786) 461-5574,
| | - Mariana Sánchez
- Corresponding author: Shyfuddin Ahmed, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC-5 (level 4), Miami, Florida 33199, (786) 461-5574,
| | - Nan Hu
- Corresponding author: Shyfuddin Ahmed, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC-5 (level 4), Miami, Florida 33199, (786) 461-5574,
| | - Gladys Ibañez
- Corresponding author: Shyfuddin Ahmed, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC-5 (level 4), Miami, Florida 33199, (786) 461-5574,
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You L, Deng Y, Li D, Lin Y, Wang Y. GLP-1 rescued gestational diabetes mellitus-induced suppression of fetal thalamus development. J Biochem Mol Toxicol 2023; 37:e23258. [PMID: 36424357 DOI: 10.1002/jbt.23258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/19/2022] [Accepted: 11/15/2022] [Indexed: 11/26/2022]
Abstract
Diabetes can be classified as type 1, type 2, and gestational diabetes mellitus (GDM). It has been reported that children born from mothers with GDM present motor impairment, however, underlying mechanisms of GDM-induce fetal neurological diseases remain unknown. In this study, NOD (nonobese diabetic) mice were used to construct the GDM model; after 2 weeks of gestation, thalamocortical axon development of fetal was evaluated by immunofluorescence. PCR of LRRC4C was used to confirm axon development of the thalamus cortex. RNA array was used to predict possible targets affected by GDM during fetal neurodevelopment. Western blot was used to investigate the underlying mechanism, PI3K inhibitor, and MAPK inhibitor was used to determine key pathway involved in this model, in vitro axonal growth was evaluated using neural stem cells, tactile sensory behavior of offspring was assessed to confirm neurological influence further. The result shown that maternal diabetes significantly suppressed axonal development of fetal thalamus cortex, PCR array of GDM fetal brain indicated that upregulation of GLP-1R compared with normal fetal, ELISA confirmed that GLP-1 level was decreased in GDM maternal serum compared with that of wild type pregnant mice. In vitro study observed enhanced axonal elongation after supplements of GLP-1 analog, GLP-1 analog PI3K-dependently active ROCK1 activity, IP injection of GLP-1 analog could partly reverse GDM-induced suppression of fetal thalamocortical axon development and improve tactile sensory behavior of GDM offspring. Our study provided a novel mechanism of GDM induced-neurological diseases and predicted GLP-1 as possible prevention supplement during gestation.
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Affiliation(s)
- Longfei You
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yujie Deng
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dan Li
- Interventional Center, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yangyang Lin
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuling Wang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Maternal obesity, gestational diabetes mellitus, and diet in association with neurodevelopment of 2-year-old children. Pediatr Res 2023:10.1038/s41390-022-02455-4. [PMID: 36596942 DOI: 10.1038/s41390-022-02455-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 11/08/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Maternal metabolic disturbances and diet may influence long-term infantile neurodevelopment. We investigated whether maternal gestational diabetes mellitus (GDM), obesity, and diet could affect the neurodevelopment of 2-year-old children. METHODS Neurodevelopment of children (n = 243) born to mothers with overweight or obesity was assessed with the Bayley Scales of Infant and Toddler Development-Third Edition, and the Hammersmith Infant Neurological Examination. Maternal adiposity was determined by air displacement plethysmography, and GDM with an oral glucose tolerance test. Dietary assessment included diet quality and fish consumption questionnaires, and three-day food diaries, from which dietary inflammatory index (DII®) scores were computed. RESULTS GDM was associated with weaker expressive language skills (adj.β = -1.12, 95% CI = -2.10;-0.15), and higher maternal adiposity with weaker cognitive, language, and motor skills in children (adj.p < 0.05). Maternal good dietary quality (adj.β = 0.87, 95% CI = 0.004;1.73) and higher fish consumption (adj.p = 0.02) were related to better expressive language skills. DII scores were not associated with children's neurodevelopment. CONCLUSIONS Findings suggest that GDM and higher maternal adiposity may lead to weaker neurodevelopmental skills, although still within the mean normative range in this population of children. Good dietary quality and higher fish consumption during pregnancy could benefit a child's language development. IMPACT Gestational diabetes mellitus and maternal higher adiposity may have unfavorable effects on a 2-year-old child's neurodevelopment. An overall good quality of diet and higher fish consumption during pregnancy may result in more favorable cognitive and language skills when the child is 2-year-old. Our findings reveal that women with overweight or obesity, a risk group for pregnancy complications, could benefit from dietary counseling to support their children's neurodevelopment.
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Gajagowni S, Nair P, Bapat AC, Vachharajani AJ. Diabetic Embryopathies. Neoreviews 2022; 23:e677-e688. [PMID: 36180736 DOI: 10.1542/neo.23-10-e677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Diabetic embryopathy is defined as congenital anomalies that are linked to maternal diabetes. The association between diabetes and fetal, neonatal, and long-term complications is well-established. These complications include organ or structural maldevelopment, fetal growth abnormalities, and learning/psychiatric comorbidities. Recent studies have elucidated the pathophysiology behind these conditions and outlined new management approaches. Caudal regression syndrome, also known as sacral agenesis, is a well-known but less described complication of maternal diabetes. The purpose of this review is to summarize existing research on common neonatal morbidities in infants of mothers with diabetes with a focus on caudal regression syndrome and its long-term associations.
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Affiliation(s)
| | - Pooja Nair
- University of Missouri School of Medicine, Columbia, MO
| | - Alka C Bapat
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, NY
| | - Akshaya J Vachharajani
- Division of Neonatology, Department of Child Health, University of Missouri School of Medicine, Columbia, MO
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Järvinen I, Launes J, Lipsanen J, Virta M, Vanninen R, Lehto E, Schiavone N, Tuulio-Henriksson A, Hokkanen L. No Clinically Relevant Memory Effects in Perinatal Hyperglycemia and Hypoglycemia: A 40-Year Follow-Up of a Small Cohort. Front Public Health 2022; 10:858210. [PMID: 35844845 PMCID: PMC9283869 DOI: 10.3389/fpubh.2022.858210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Maternal diabetes mellitus in pregnancy is associated with impairments in memory functions of the offspring in childhood and adolescence but has not been studied in adulthood. The association of perinatal hypoglycemia with memory has not been studied in adulthood either. The combined sequelae of these two risk factors have not been directly compared. We studied general cognitive ability and memory functions in a prospective follow-up of a cohort born in 1971 to 1974. The sample included participants exposed to prenatal hyperglycemia (n = 24), perinatal hypoglycemia (n = 19), or both (n = 7). It also included controls with no early risks (n = 82). We assessed the participants' Intelligence quotient (IQ), working memory, and immediate and delayed recall of both verbal and visual material at the age of 40. We did not find significant differences in IQ or the memory tests between the groups. We did identify an interaction (p = 0.03) of the early risk with the type of digit span task: compared to the controls, the participants exposed to perinatal hypoglycemia had a larger difference between the forward digit span, a measure of attention, and the backward digit span, a measure of working memory processing (p = 0.022). The interaction remained significant when birth weight was controlled for (p = 0.026). Thus, in this small cohort, prenatal hyperglycemia, perinatal hypoglycemia, and their combination appeared relatively benign disorders. The association of these conditions with neurocognitive impairments in adulthood remains unconfirmed. The significance of the working memory difference needs to be verified with a larger sample.
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Affiliation(s)
- Ilkka Järvinen
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Jyrki Launes
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Jari Lipsanen
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Maarit Virta
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Ritva Vanninen
- University of Eastern Finland, Institute of Clinical Medicine, Radiology, Kuopio, Finland
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Eliisa Lehto
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Nella Schiavone
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | | | - Laura Hokkanen
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- *Correspondence: Laura Hokkanen
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Abstract
This article summarizes the available evidence reporting the relationship between perinatal dysglycemia and long-term neurodevelopment. We review the physiology of perinatal glucose metabolism and discuss the controversies surrounding definitions of perinatal dysglycemia. We briefly review the epidemiology of hypoglycemia and hyperglycemia in fetal, preterm, and term infants. We discuss potential pathophysiologic mechanisms contributing to dysglycemia and its effect on neurodevelopment. We highlight current strategies to prevent and treat dysglycemia in the context of neurodevelopmental outcomes. Finally, we discuss areas of future research and the potential role of continuous glucose monitoring.
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Affiliation(s)
- Megan E Paulsen
- Department of Pediatrics, University of Minnesota Medical School, Academic Office Building, 2450 Riverside Avenue S AO-401, Minneapolis, MN 55454, USA; Masonic Institute for the Developing Brain, 2025 East River Parkway, Minneapolis, MN 55414.
| | - Raghavendra B Rao
- Department of Pediatrics, University of Minnesota Medical School, Academic Office Building, 2450 Riverside Avenue S AO-401, Minneapolis, MN 55454, USA; Masonic Institute for the Developing Brain, 2025 East River Parkway, Minneapolis, MN 55414
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10
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Pérez-Martín SM, Quintero-Prado R, Lara-Barea A, López-Tinoco C, Torrejón R, Bugatto F. Fetal cerebral three-dimensional power Doppler vascularization indices and their relationships with maternal glucose levels in pregnancies complicated with gestational diabetes. Diab Vasc Dis Res 2022; 19:14791641221078109. [PMID: 35236142 PMCID: PMC8907605 DOI: 10.1177/14791641221078109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES We aimed to evaluate fetal cerebral circulation using three-dimensional power Doppler (3DPD) vascular indices and to study their relationships with maternal lipid and glycaemic profiles. METHODS Case-control study in women with and without gestational diabetes mellitus (GDM) at 28-32 weeks in which feto-maternal Doppler study and 3DPD cerebral vascularization indices (FI, VI and VFI) were determined. Maternal lipid and glycaemic profiles were also analysed. Both groups were compared and the correlations of the 3DPD indices with studied variables were analysed. RESULTS There were significant differences between groups in cerebral FI (p= 0.02), mean maternal Uterine artery PI (p= 0.009) and glucose levels (p= 0.001), being higher in the GDM group. Significant negative correlations were found in GDM group between VFI and MCA PI (p = 0.02) and between VI and MCA PI (p= 0.01). In the GDM group we found a negative significant correlation between FI, VI, VFI and maternal glucose (r= -0.52, p<0.001; r= -0.32, p=0.03 and r= -0.36, p= 0.01, respectively). CONCLUSIONS Fetal cerebral FI values were higher in GDM pregnancies. All 3DPD vascular indices showed an inverse correlation with maternal glucose levels. These findings support the view that GDM may also represent a fetal vascular disorder influencing fetal neurodevelopment.
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Affiliation(s)
- Sara M Pérez-Martín
- Division of Maternal-Fetal
Medicine, Obstetrics and Gynaecology Department, Puerta del Mar University
Hospital, Cádiz, Spain
| | - Rocío Quintero-Prado
- Department of Obstetrics and
Gynaecology, Puerto Real University
Hospital, Puerto Real, Cádiz, Spain & Ginemed Clínicas, San
Fernando, Cádiz, Spain
| | - Almudena Lara-Barea
- Department of Endocrinology and
Nutrition, Puerta del Mar University
Hospital, Cádiz, Spain
| | - Cristina López-Tinoco
- Department of Endocrinology and
Nutrition, Puerta del Mar University
Hospital, Cádiz, Spain
- Biomedical Research and Innovation
Institute of Cádiz (INiBICA), Cádiz, Spain
| | - Rafael Torrejón
- Division of Maternal-Fetal
Medicine, Obstetrics and Gynaecology Department, Puerta del Mar University
Hospital, Cádiz, Spain
- Department of Endocrinology and
Nutrition, Puerta del Mar University
Hospital, Cádiz, Spain
| | - Fernando Bugatto
- Division of Maternal-Fetal
Medicine, Obstetrics and Gynaecology Department, Puerta del Mar University
Hospital, Cádiz, Spain
- Department of Endocrinology and
Nutrition, Puerta del Mar University
Hospital, Cádiz, Spain
- Fernando Bugatto, Obstetrics and
Gynaecology Department, Puerta del Mar University Hospital, Avda, Ana de Viya,
21, Cádiz 11009, Spain.
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Arabiat D, Jabery MA, Kemp V, Jenkins M, Whitehead LC, Adams G. Motor Developmental Outcomes in Children Exposed to Maternal Diabetes during Pregnancy: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1699. [PMID: 33578786 PMCID: PMC7916519 DOI: 10.3390/ijerph18041699] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/03/2021] [Accepted: 02/06/2021] [Indexed: 12/11/2022]
Abstract
Studies on the association of maternal diabetes with motor development in children provide inconsistent findings. We searched MEDLINE/PubMed, EMBASE, Emcare, PsycINFO, and Google Scholar databases for primary observational, case-control, or cohort studies that report on the motor development of children exposed to maternal diabetes during pregnancy. Quality appraisal and data extraction were performed independently and in duplicate. A meta-analysis of summary measures was performed using random-effect models. Eighteen studies were identified for inclusion, however, only 13 were included in the meta-analysis. Exposure to maternal diabetes during pregnancy was associated with a lower pooled motor development in children and a decrease in both gross and fine motor development. Among all other factors, pre-existing diabetes and other gestational comorbidities, such as hypertension and obesity, or low socioeconomic status, also affect child development. Therefore, among children of diabetic mothers, those with other gestational comorbidities or pre-existing diabetes were more likely to be at risk developmentally.
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Affiliation(s)
- Diana Arabiat
- School of Nursing and Midwifery, Edith Cowan University, Perth 6027, Australia
- Maternal and Child Nursing Department, Faculty of Nursing, The University of Jordan, Amman 11942, Jordan
| | - Mohammad Al Jabery
- Counselling and Special Education Department, Faculty of Educational Sciences, The University of Jordan, Amman 11942, Jordan
| | - Vivien Kemp
- School of Nursing and Midwifery, Edith Cowan University, Perth 6027, Australia
| | - Mark Jenkins
- School of Nursing and Midwifery, Edith Cowan University, Perth 6027, Australia
| | - Lisa C Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Perth 6027, Australia
| | - Gary Adams
- Queen's Medical Centre, School of Health Sciences, The University of Nottingham, Nottingham NG7 2HA, UK
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12
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Morgan JE, Lee SS, Mahrer NE, Guardino CM, Davis EP, Shalowitz MU, Ramey SL, Schetter CD. Prenatal maternal C-reactive protein prospectively predicts child executive functioning at ages 4-6 years. Dev Psychobiol 2020; 62:1111-1123. [PMID: 32441781 PMCID: PMC7680271 DOI: 10.1002/dev.21982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 04/01/2020] [Accepted: 04/09/2020] [Indexed: 11/08/2022]
Abstract
This prospective longitudinal study evaluated multiple maternal biomarkers from the preconception and prenatal periods as time-sensitive predictors of child executive functioning (EF) in 100 mother-child dyads. Maternal glycated hemoglobin (HbA1C ), C-reactive protein (CRP), and blood pressure (BP) were assayed before pregnancy and during the second and third trimesters. Subsequently, children were followed from birth and assessed for EF (i.e. cognitive flexibility, response inhibition) at ages 4-6 years. Perinatal data were also extracted from neonatal records. Higher maternal CRP, but not maternal HbA1C or BP, uniquely predicted poorer child cognitive flexibility, even with control of maternal HbA1C and BP, relevant demographic factors, and multiple prenatal/perinatal covariates (i.e. preconception maternal body mass index, maternal depression, maternal age at birth, child birth weight, child birth order, child gestational age, and child birth/neonatal complications). Predictions from maternal CRP were specific to the third trimester, and third trimester maternal CRP robustly predicted child cognitive flexibility independently of preconception and second trimester CRP. Child response inhibition was unrelated to maternal biomarkers from all time points. These findings provide novel, prospective evidence that maternal inflammation uniquely predicts child cognitive flexibility deficits, and that these associations depend on the timing of exposure before or during pregnancy.
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Affiliation(s)
- Julia E. Morgan
- Department of Psychology, University of California, Los Angeles,Department of Psychiatry, University of California, San Francisco
| | - Steve S. Lee
- Department of Psychology, University of California, Los Angeles
| | | | | | - Elysia Poggi Davis
- Department of Psychology, University of Denver,Department of Psychiatry and Human Behavior, University of California, Irvine
| | - Madeleine U. Shalowitz
- Department of Pediatrics, NorthShore University HealthSystem Research Institute,Department of Pediatrics, University of Chicago
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13
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Valle-Bautista R, Márquez-Valadez B, Fragoso-Cabrera AD, García-López G, Díaz NF, Herrera-López G, Griego E, Galván EJ, Arias-Montaño JA, Molina-Hernández A. Impaired Cortical Cytoarchitecture and Reduced Excitability of Deep-Layer Neurons in the Offspring of Diabetic Rats. Front Cell Dev Biol 2020; 8:564561. [PMID: 33042999 PMCID: PMC7527606 DOI: 10.3389/fcell.2020.564561] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/17/2020] [Indexed: 12/26/2022] Open
Abstract
Maternal diabetes has been related to low verbal task scores, impaired fine and gross motor skills, and poor performance in graphic and visuospatial tasks during childhood. The primary motor cortex is important for controlling motor functions, and embryos exposed to high glucose show changes in cell proliferation, migration, and differentiation during corticogenesis. However, the existing studies do not discriminate between embryos with or without neural tube defects, making it difficult to conclude whether the reported changes are related to neural tube defects or other anomalies. Furthermore, postnatal effects on central nervous system cytoarchitecture and function have been scarcely addressed. Through molecular, biochemical, morphological, and electrophysiological approaches, we provide evidence of impaired primary motor cerebral cortex lamination and neuronal function in pups from diabetic rats, showing an altered distribution of SATB2, FOXP2, and TBR1, impaired cell migration and polarity, and decreased excitability of deep-layer cortical neurons, suggesting abnormalities in cortico-cortical and extra-cortical innervation. Furthermore, phase-plot analysis of action potentials suggests changes in the activity of potassium channels. These results indicate that high-glucose insult during development promotes complex changes in migration, neurogenesis, cell polarity establishment, and dendritic arborization, which in turn lead to reduced excitability of deep-layer cortical neurons.
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Affiliation(s)
- Rocío Valle-Bautista
- Departamento de Fisiología, Biofísica y Neurociencias, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico.,Laboratorio de Investigación en Células Troncales y Biología del Desarrollo, Departamento de Fisiología y Desarrollo Celular, Subdirección de Investigación Biomédica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Berenice Márquez-Valadez
- Laboratorio de Investigación en Células Troncales y Biología del Desarrollo, Departamento de Fisiología y Desarrollo Celular, Subdirección de Investigación Biomédica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - América D Fragoso-Cabrera
- Laboratorio de Investigación en Células Troncales y Biología del Desarrollo, Departamento de Fisiología y Desarrollo Celular, Subdirección de Investigación Biomédica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Guadalupe García-López
- Laboratorio de Investigación en Células Troncales y Biología del Desarrollo, Departamento de Fisiología y Desarrollo Celular, Subdirección de Investigación Biomédica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Néstor Fabián Díaz
- Laboratorio de Investigación en Células Troncales y Biología del Desarrollo, Departamento de Fisiología y Desarrollo Celular, Subdirección de Investigación Biomédica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Gabriel Herrera-López
- Departamento de Farmacobiología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico
| | - Ernesto Griego
- Departamento de Farmacobiología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico
| | - Emilio J Galván
- Departamento de Farmacobiología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico
| | - José-Antonio Arias-Montaño
- Departamento de Fisiología, Biofísica y Neurociencias, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico
| | - Anayansi Molina-Hernández
- Laboratorio de Investigación en Células Troncales y Biología del Desarrollo, Departamento de Fisiología y Desarrollo Celular, Subdirección de Investigación Biomédica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
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Chemerin-induced macrophages pyroptosis in fetal brain tissue leads to cognitive disorder in offspring of diabetic dams. J Neuroinflammation 2019; 16:226. [PMID: 31733653 PMCID: PMC6858779 DOI: 10.1186/s12974-019-1573-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 08/29/2019] [Indexed: 02/06/2023] Open
Abstract
Background Chemerin is highly expressed in the serum, placenta tissue, and umbilical cord blood of diabetic mother; however, the impact of chemerin on cognitive disorders of offspring from mothers with diabetes in pregnancy remains unclear. Methods A diabetic phenotype in pregnant mice dams was induced by streptozocin (STZ) injection or intraperitoneal injection of chemerin. Behavioral changes in offspring of diabetic dams and nondiabetic controls were assessed, and changes in chemerin, two receptors of chemerin [chemerin receptor 23 (ChemR23) and chemokine (C-C motif) receptor-like 2 (CCRL2)], macrophages, and neurons in the brain tissue were studied to reveal the underlying mechanism of the behavioral changes. Results Chemerin treatment mimicked the STZ-induced symptom of maternal diabetes in mice along with the altered behavior of offspring in the open field test (OFT) assay. In the exploring process for potential mechanism, the brain tissues of offspring from chemerin-treated dams were observed with an increase level of macrophage infiltration and a decrease number of neuron cells. Moreover, an increased level of NOD-like receptor family pyrin domain containing 3 (NLRP3) and apoptosis-associated speck-like (Asc) protein as well as pyroptosis [characterized by increased active caspase-1 content and secretion of cytokines such as interleukin (IL) 1 beta (IL-1β) and IL-18] more activated in macrophages is also observed in the brain of these diabetic dam’s offspring, in the presence of ChemR23. In vitro, it was found that pyroptosis activation was increased in macrophages separated from the abdominal cavity of normal mice, after chemerin treatment. However, depletion of CCRL2 decreased the level of chemerin in the brain tissues of diabetic dams’ offspring; depletion of ChemR23 decreased macrophage pyroptosis, and depletion of either receptor reversed chemerin-mediated neurodevelopmental deficits and cognitive impairment of offspring of diabetic pregnant dams. Conclusions Chemerin induced diabetic pregnant disease and CCRL2 were required to enrich chemerin in the brain of offspring. Aggregation of chemerin could lead to macrophage recruitment, activation of pyroptosis, the release of inflammatory cytokines, a decrease in the number of neurons, and cognitive impairment in offspring in a ChemR23-dependent manner. Targeting CCRL2 and/or ChemR23 could be useful for treating neuropsychological deficits in offspring of dams with diabetes in pregnancy. Electronic supplementary material The online version of this article (10.1186/s12974-019-1573-6) contains supplementary material, which is available to authorized users.
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Risk Factors for Preoperative Developmental Delay in Patients with Nonsyndromic Sagittal Craniosynostosis. Plast Reconstr Surg 2019; 143:133e-139e. [PMID: 30589799 DOI: 10.1097/prs.0000000000005108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Some patients with isolated sagittal craniosynostosis have demonstrated mild neurodevelopmental delays. This study examined potential preoperative risk factors for developmental delay. METHODS Patients completed preoperative Bayley Scales of Infant and Toddler Development, Third Edition, and medical records were reviewed. Multivariate analyses of covariance and correlations were calculated. RESULTS Participants (n = 77) were predominantly male (77.9 percent) and were aged 2 to 12 months (mean, 5.1 ± 2.3 months). Patients were classified with no delays [n = 63 (82 percent)] or delays [n = 14 (18 percent)] in one or more developmental area(s). There were no group sociodemographic differences. Prenatally, patients with delays versus no delays had lower mean gestational age in weeks (36.9 ± 2.8 weeks versus 39.1 ± 1.7 weeks; p = 0.001) with higher rates of gestational diabetes (36 percent versus 5 percent; p = 0.006) and premature rupture of membranes (14 percent versus 2 percent; p = 0.026). At birth, patients with delays had lower mean birth weight (2982 ± 714 g versus 3374 ± 544 g; p = 0.053), higher rates of respiratory distress (29 percent versus 5 percent; p = 0.005), additional medical diagnoses (57 percent versus 13 percent; p = 0.001), and longer mean neonatal intensive care unit stays (1.4 ± 1.8 weeks versus 0.2 ± 0.9 week; p = 0.002). Variables differing by group had moderate correlations. CONCLUSIONS Patients with nonsyndromic sagittal craniosynostosis that had delays in development had lower gestational age and birth weight, with more prenatal and birth complications. These factors can help identify patients who might be at risk for delay and need close monitoring. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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16
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Egan AM, Simmons D. Lessons learned from lifestyle prevention trials in gestational diabetes mellitus. Diabet Med 2019; 36:142-150. [PMID: 29939439 DOI: 10.1111/dme.13772] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2018] [Indexed: 01/01/2023]
Abstract
Gestational diabetes mellitus (GDM) is associated with an increased risk of adverse outcomes for mother and infant both at birth and later in life. A large body of evidence is now available relating to antenatal prevention of GDM. Overall, despite some individual trials of a variety of lifestyle interventions revealing benefit, many more have shown no effect from the second trimester onwards, even with significant gestational weight gain limitation. At-risk women often seem reluctant to engage in lifestyle changes and frequently cannot adhere to recommended interventions even within a clinical trial setting. Many trials have not considered the heterogeneity of diabetes first discovered in pregnancy, something of importance into the future. Future work should focus on designing interventions acceptable to the population at risk, whether those taking place before or during the first trimester of pregnancy are effective, and whether greater individualization can identify those women most likely to benefit.
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Affiliation(s)
- A M Egan
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - D Simmons
- Macarthur Clinical School, Western Sydney University, Sydney, Australia
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Huang K, Yan S, Wu X, Zhu P, Tao F. Elective caesarean section on maternal request prior to 39 gestational weeks and childhood psychopathology: a birth cohort study in China. BMC Psychiatry 2019; 19:22. [PMID: 30642307 PMCID: PMC6332907 DOI: 10.1186/s12888-019-2012-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 01/04/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The recommendation of non-indicated caesarean section (CS) after 39 gestational weeks has been announced based on evidence of maternal and infant physiological effects. The potential psychological risks have not been acknowledged. This study aims to investigate emotional and behavioral problems in pre-school children born with elective CS (ECS) on maternal request prior to 39 weeks. METHODS Pregnant women within 12 gestational weeks between November 2008 and October 2010 were invited to participate in the China-Anhui Birth Cohort Study (C-ABCS). They were asked to complete a self-administered questionnaire respectively in 1st and 3rd trimester of pregnancy to collect basic maternal characteristics. Pregnant complications and delivery modes were abstracted from medical notes. Their singleton live births were followed up at preschool age. Strengths and Difficulties Questionnaires (SDQ) were completed by parents to assess children's emotional and behavioral problems. A total of 3319 mother-child pairs were put into the final analysis. Descriptive analysis and binary logistic regression analysis were used to assess the impact of delivery modes on abnormalities in SDQ dimensions at various gestational ages. RESULTS The prevalence of ECS on maternal request prior to 39 weeks, at 39-40 weeks, and after 41 weeks was 16.6, 23.7 and 15.9%, respectively. Compared with those born vaginally, children born with ECS on maternal request were more likely to have total difficult problems (RR 1.519, 95% confidence interval 1.077 to 2.142). ECS on maternal request was the independent predictor of emotional problems (3.479, 1.676 to 7.222) and total difficult problems (2.172, 1.175 to 4.016) in children born prior to 39 gestational weeks. CONCLUSION Children delivered by ECS on maternal request have an increased risk to have emotional and behavioral problems prior to 39 gestational weeks at preschool age. The potential psychological implication prior to 39 weeks has been added to the roster of impacts of ECS on maternal request. Further research is needed to probe the potential biological mechanisms.
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Affiliation(s)
- Kun Huang
- School of Public Health, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui Province China
| | - Shuangqin Yan
- Ma’anshan Maternal and Child Health Center, No 72 Jiashan Road, Ma’anshan, Anhui Province China
| | - Xiaoyan Wu
- School of Public Health, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui Province China
| | - Peng Zhu
- School of Public Health, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui Province China
| | - Fangbiao Tao
- School of Public Health, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui Province China
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Paz Levy D, Wainstock T, Sheiner E, Sergienko R, Landau D, Walfisch A. Maternal recurrent pregnancy loss is associated with an increased risk for long-term neurological morbidity in offspring. Dev Med Child Neurol 2019; 61:91-97. [PMID: 30058166 DOI: 10.1111/dmcn.13976] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2018] [Indexed: 12/24/2022]
Abstract
AIM To determine whether maternal history of recurrent pregnancy loss (RPL) impacts on the long-term neurological health of the offspring. METHOD A population-based cohort analysis was performed, including all singletons born between 1991 and 2014 at a single regional tertiary centre. Neurological morbidity up to age 18 years (including cognitive, motor, and psychiatric disorders) in children born to mothers with and without a history of RPL was compared. Cumulative neurological morbidity incidence was compared with survival curves and a Weibull multivariable survival model to control for follow-up time and relevant confounders. RESULTS A total of 242 187 deliveries met the inclusion criteria during the study period, 5% (n=12 182) of which were in mothers with RPL. Epilepsy and developmental disorders were significantly more common in the group with RPL (0.95 vs 0.74/1000 person-years [p=0.009] and 0.22 vs 0.09/1000 person-years [p<0.001]). The survival curves demonstrated significantly higher cumulative incidences of epilepsy and developmental disorders in the group with RPL. The multivariable model exhibited an independent association between maternal RPL and childhood epilepsy (adjusted hazard ratio 1.23; 95% confidence interval 1.01-1.50) and developmental disorders in the offspring (adjusted hazard ratio 2.41; 95% confidence interval 1.60-3.64). INTERPRETATION A history of maternal RPL appears to be independently associated with long-term neurological morbidity of the offspring. WHAT THIS PAPER ADDS Hospitalizations for epilepsy and developmental disorders are significantly more common among children of mothers with a history of recurrent pregnancy loss.
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Affiliation(s)
- Dorit Paz Levy
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruslan Sergienko
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniella Landau
- Department of Neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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De Sousa RAL. Gestational diabetes is associated to the development of brain insulin resistance in the offspring. Int J Diabetes Dev Ctries 2018. [DOI: 10.1007/s13410-018-0618-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Márquez-Valadez B, Valle-Bautista R, García-López G, Díaz NF, Molina-Hernández A. Maternal Diabetes and Fetal Programming Toward Neurological Diseases: Beyond Neural Tube Defects. Front Endocrinol (Lausanne) 2018; 9:664. [PMID: 30483218 PMCID: PMC6243582 DOI: 10.3389/fendo.2018.00664] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/25/2018] [Indexed: 12/20/2022] Open
Abstract
The purpose of this review was to search for experimental or clinical evidence on the effect of hyperglycemia in fetal programming to neurological diseases, excluding evident neural tube defects. The lack of timely diagnosis and the inadequate control of diabetes during pregnancy have been related with postnatal obesity, low intellectual and verbal coefficients, language and motor deficits, attention deficit with hyperactivity, problems in psychosocial development, and an increased predisposition to autism and schizophrenia. It has been proposed that several childhood or adulthood diseases have their origin during fetal development through a phenomenon called fetal programming. However, not all the relationships between the outcomes mentioned above and diabetes during gestation are clear, well-studied, or have been related to fetal programming. To understand this relationship, it is imperative to understand how developmental processes take place in health, in order to understand how the functional cytoarchitecture of the central nervous system takes place; to identify changes prompted by hyperglycemia, and to correlate them with the above postnatal impaired functions. Although changes in the establishment of patterns during central nervous system fetal development are related to a wide variety of neurological pathologies, the mechanism by which several maternal conditions promote fetal alterations that contribute to impaired neural development with postnatal consequences are not clear. Animal models have been extremely useful in studying the effect of maternal pathologies on embryo and fetal development, since obtaining central nervous system tissue in humans with normal appearance during fetal development is an important limitation. This review explores the state of the art on this topic, to help establish the way forward in the study of fetal programming under hyperglycemia and its impact on neurological and psychiatric disorders.
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Affiliation(s)
- Berenice Márquez-Valadez
- Department of Physiology and Cell Development, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
- Department of Physiology, Biophysics and Neurosciences, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico
| | - Rocío Valle-Bautista
- Department of Physiology and Cell Development, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
- Department of Physiology, Biophysics and Neurosciences, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico
| | - Guadalupe García-López
- Department of Physiology and Cell Development, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Néstor Fabián Díaz
- Department of Physiology and Cell Development, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Anayansi Molina-Hernández
- Department of Physiology and Cell Development, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
- *Correspondence: Anayansi Molina-Hernández
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Denison FC, Macnaught G, Semple SIK, Terris G, Walker J, Anblagan D, Serag A, Reynolds RM, Boardman JP. Brain Development in Fetuses of Mothers with Diabetes: A Case-Control MR Imaging Study. AJNR Am J Neuroradiol 2017; 38:1037-1044. [PMID: 28302607 DOI: 10.3174/ajnr.a5118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 12/20/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Offspring exposed to maternal diabetes are at increased risk of neurocognitive impairment, but its origins are unknown. With MR imaging, we investigated the feasibility of comprehensive assessment of brain metabolism (1H-MRS), microstructure (DWI), and macrostructure (structural MRI) in third-trimester fetuses in women with diabetes and determined normal ranges for the MR imaging parameters measured. MATERIALS AND METHODS Women with singleton pregnancies with diabetes (n = 26) and healthy controls (n = 26) were recruited prospectively for MR imaging studies between 34 and 38 weeks' gestation. RESULTS Data suitable for postprocessing were obtained from 79%, 71%, and 46% of women for 1H-MRS, DWI, and structural MRI, respectively. There was no difference in the NAA/Cho and NAA/Cr ratios (mean [SD]) in the fetal brain in women with diabetes compared with controls (1.74 [0.79] versus 1.79 [0.64], P = .81; and 0.78 [0.28] versus 0.94 [0.36], P = .12, respectively), but the Cho/Cr ratio was marginally lower (0.46 [0.11] versus 0.53 [0.10], P = .04). There was no difference in mean [SD] anterior white, posterior white, and deep gray matter ADC between patients and controls (1.16 [0.12] versus 1.16 [0.08], P = .96; 1.54 [0.16] versus 1.59 [0.20], P = .56; and 1.49 [0.23] versus 1.52 [0.23], P = .89, respectively) or volume of the cerebrum (243.0 mL [22.7 mL] versus 253.8 mL [31.6 mL], P = .38). CONCLUSIONS Acquiring multimodal MR imaging of the fetal brain at 3T from pregnant women with diabetes is feasible. Further study of fetal brain metabolism in maternal diabetes is warranted.
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Affiliation(s)
- F C Denison
- From the Medical Research Council Centre for Reproductive Health (F.C.D., D.A., A.S., J.P.B.), University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - G Macnaught
- Clinical Research Imaging Centre (G.M., S.I.K.S.)
| | - S I K Semple
- Clinical Research Imaging Centre (G.M., S.I.K.S.).,University/British Heart Foundation Centre for Cardiovascular Science (S.I.K.S., R.M.R.)
| | - G Terris
- Simpson Centre for Reproductive Health (G.T., J.W.), Royal Infirmary, Edinburgh, UK
| | - J Walker
- Simpson Centre for Reproductive Health (G.T., J.W.), Royal Infirmary, Edinburgh, UK
| | - D Anblagan
- From the Medical Research Council Centre for Reproductive Health (F.C.D., D.A., A.S., J.P.B.), University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK.,Centre for Clinical Brain Sciences (D.A., J.P.B.), University of Edinburgh, Edinburgh, UK
| | - A Serag
- From the Medical Research Council Centre for Reproductive Health (F.C.D., D.A., A.S., J.P.B.), University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - R M Reynolds
- University/British Heart Foundation Centre for Cardiovascular Science (S.I.K.S., R.M.R.)
| | - J P Boardman
- From the Medical Research Council Centre for Reproductive Health (F.C.D., D.A., A.S., J.P.B.), University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK.,Centre for Clinical Brain Sciences (D.A., J.P.B.), University of Edinburgh, Edinburgh, UK
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Burakevych N, Mckinlay CJD, Alsweiler JM, Wouldes TA, Harding JE. Bayley-III motor scale and neurological examination at 2 years do not predict motor skills at 4.5 years. Dev Med Child Neurol 2017; 59:216-223. [PMID: 27543144 PMCID: PMC5209275 DOI: 10.1111/dmcn.13232] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2016] [Indexed: 11/30/2022]
Abstract
AIM To determine whether Bayley Scales of Infant and Toddler Development (3rd edition) (Bayley-III) motor scores and neurological examination at 2 years corrected age predict motor difficulties at 4.5 years corrected age. METHOD A prospective cohort study of children born at risk of neonatal hypoglycaemia in Waikato Hospital, Hamilton, New Zealand. Assessment at 2 years was performed using the Bayley-III motor scale and neurological examination, and at 4.5 years using the Movement Assessment Battery for Children (2nd edition) (MABC-2). RESULTS Of 333 children, 8 (2%) had Bayley-III motor scores below 85, and 50 (15%) had minor deficits on neurological assessment at 2 years; 89 (27%) scored less than or equal to the 15th centile, and 54 (16%) less than or equal to the 5th centile on MABC-2 at 4.5 years. Motor score, fine and gross motor subtest scores, and neurological assessments at 2 years were poorly predictive of motor difficulties at 4.5 years, explaining 0 to 7% of variance in MABC-2 scores. A Bayley-III motor score below 85 predicted MABC-2 scores less than or equal to the 15th centile with a positive predictive value of 30% and a negative predictive value of 74% (7% sensitivity and 94% specificity). INTERPRETATION Bayley-III motor scale and neurological examination at 2 years were poorly predictive of motor difficulties at 4.5 years.
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Affiliation(s)
| | - Christopher Joel Dorman Mckinlay
- Liggins Institute, University of Auckland, Auckland,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland
| | - Jane Marie Alsweiler
- Liggins Institute, University of Auckland, Auckland,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland
| | - Trecia An Wouldes
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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