Secular trend for increasing birthweight in offspring of pregnant women with type 1 diabetes: is improved placentation the reason? – published online 26/10/2022

Gernot Desoye, Lene Ringholm, Peter Damm, Elisabeth R. Mathiesen, Mireille N. M. van Poppel

In pregnant women with type 1 diabetes, whenever metabolism is disturbed, the fetus is at risk of growing too large. This may lead to complications during delivery and also has long term consequences for the child’s health, including childhood obesity. As such, normalising metabolism during pregnancy would be expected to reduce fetal overgrowth. Paradoxically, however, in the past few decades, improved healthcare and blood glucose control in women with type 1 diabetes, especially in the periconception period, have had the opposite effect, i.e. an increase in birthweight. In this review, Desoye et al (https://doi.org/10.1007/s00125-022-05820-4) discuss that improved blood glucose control may lead to better placentation in women with type 1 diabetes, which exposes the fetus to changes in metabolism more than in earlier decades. The resulting fetal overgrowth may then result in excess fat, independent of birthweight. The authors highlight that this calls for even stricter glucose control during the whole pregnancy period and suggest taking advantage of new diabetes technology. They conclude that evaluation of diabetes management should focus on neonatal fat, rather than birthweight. The figures from this review are available as a downloadable slideset.

All News