Programming of cardiometabolic health: the role of maternal and fetal hyperinsulinaemia

Obesity and gestational diabetes during pregnancy have multiple short- and long-term consequences for both mother and child. One common feature of pregnancies complicated by maternal obesity and gestational diabetes is maternal hyperinsulinaemia, which has effects on the mother and her adaptation to pregnancy. Even though insulin does not cross the placenta insulin can act on the placenta as well affecting placental growth, angiogenesis and lipid metabolism. Obese and gestational diabetic pregnancies are often characterised by maternal hyperglycaemia resulting in exposure of the fetus to high levels of glucose, which freely crosses the placenta. This leads to stimulation of fetal beta-cells and insulin secretion in the fetus. Fetal hyperglycaemia/hyperinsulinaemia has been shown to cause multiple complications in fetal development, such as altered growth trajectories, impaired neuronal and cardiac development and early exhaustion of the pancreas. These changes could increase the susceptibility of the offspring to develop cardiometabolic diseases later in life. In this review, we aim to summarize and review the mechanisms by which maternal and fetal hyperinsulinaemia impact on (i) maternal health during pregnancy; (ii) placental and fetal development; (iii) offspring energy homeostasis and long-term cardiometabolic health; (iv) how interventions can alleviate these effects.

Automated summary

Obesity and gestational diabetes during pregnancy can have both short-term and long-term consequences for both mother and child. One common feature of these conditions is maternal hyperinsulinaemia, which can affect placental growth, angiogenesis, and lipid metabolism. The fetus is exposed to high levels of glucose due to maternal hyperglycaemia, leading to fetal hyperglycaemia/hyperinsulinaemia and complications in fetal development. These changes may increase the risk of cardiometabolic diseases in the offspring later in life. This review summarizes the impact of maternal and fetal hyperinsulinaemia on various aspects and discusses interventions to alleviate these effects.