Table 1. Diabetes: Fetal origins of adult diseasea

MaternalFetalAdultOffspring
a Fetal exposure to nutritional disturbances affects pancreatic development and influences the insulin response in adulthood that becomes manifest as diabetes. Furthermore, these offspring have an increased rate of gestational diabetes, which in turn increases the risk for future development of type 2 diabetes in their offspring. In this manner, obesity may play a role in escalating the incidence of obesity and its associated diseases, including renal disease.
Mild hyperglycemiaAsymmetric macrosomia, ↑ insulin, ↑ IGF-1Type 2 diabetes, normal pancreatic mass↑ Risk for type 2 diabetes
Gestational diabetesIslet hypertrophy and hyperplasiaImpaired glucose tolerance, impaired insulin secretion, ↑ risk for breast cancer
Severe hyperglycemiaAsymmetric microsomia, ↓ insulin, ↓ IGF-1Type 2 diabetes, ↑ pancreatic mass↑ Risk for type 2 diabetes
Poorly controlled diabetes↓ Insulin receptors, degranulation of β cellsInsulin resistance, ↑ insulin, cardiovascular disease and renal disease
Protein restrictionReduced nephron number, ↓ insulin, ↓ pancreatic mass, ↓ β cellsType 2 diabetes, women are insulin resistant, hypertension↑ Risk for type 2 diabetes
Intrauterine growth retardation