Zusammenfassung
Hintergrund
Schon intrauterin wird die menschliche Entwicklung von äußeren Faktoren beeinflusst. In dieser sensiblen Phase liegen entwicklungsbedingte Ursprünge von Gesundheit und potenziellen Erkrankungen. Ein zentraler Einflussfaktor ist der materne Metabolismus.
Umfang der Übersichtsarbeit
Im vorliegenden Beitrag sind Studien zusammengefasst und eingeordnet, in denen die Einflüsse mütterlicher Parameter mit Bezug zum Metabolismus auf die fetale Entwicklung des zentralen und des autonomen Nervensystems untersucht wurden.
Schlussfolgerung
Mütterliche Faktoren in der Schwangerschaft (Gewichtszunahme, Insulinsensitivität, Gestationsdiabetes) sowie vor dieser (BMI [Body-Mass-Index], präkonzeptioneller Diabetes) können verschiedene fetale Faktoren, wie die fetale postprandiale Hirnaktivität auf Stimulation, die spontane Hirnaktivität, die fetale Herzrate und die fetale postprandiale Herzratenvariabilität beeinflussen.
Abstract
Background
Human development is already influenced by external factors in utero. During this vulnerable period, developmental origins of health and disease emerge, with maternal metabolism playing a central role.
Scope of review
In this article, studies that examine the influence of maternal parameters related to metabolism on fetal development of the central and autonomous nervous system are summarized.
Conclusion
Maternal factors during pregnancy (weight gain, insulin sensitivity, gestational diabetes) and before pregnancy (body mass index, preconceptional diabetes) can influence a number of fetal factors, like postprandial brain activity in response to stimulation, spontaneous brain activity, fetal heart rate, and fetal postprandial heart rate variability.
Literatur
Verwendete Literatur
Avci R, Whittington JR, Blossom SJ et al (2020) Studying the effect of maternal pregestational diabetes on fetal neurodevelopment using magnetoencephalography. Clin EEG Neurosci. https://doi.org/10.1177/1550059420909658
Castro Conde JR, González González NL, González Barrios D et al (2013) Video-EEG recordings in full-term neonates of diabetic mothers: observational study. Arch Dis Child Fetal Neonatal Ed 98:F493–F498. https://doi.org/10.1136/archdischild-2013-304283
David M, Hirsch M, Karin J et al (2007) An estimate of fetal autonomic state by time frequency analysis of fetal heart rate variability. J Appl Physiol 102:1057–1064. https://doi.org/10.1152/japplphysiol.00114.2006
Fehlert E, Willmann K, Fritsche L et al (2016) Gestational diabetes alters the fetal heart rate variability during an oral glucose tolerance test: a fetal magnetocardiography study. BJOG 124:1891–1898. https://doi.org/10.1111/1471-0528.14474
Gluckman PD, Hanson MA (2006) The developmental origins of health and disease. In: Wintour EM, Owens JA (Hrsg) Early life origins of health and disease. Advances in experimental medicine and biology, Bd. 573. Springer, Boston https://doi.org/10.1007/0-387-32632-4_1
Godfrey KM, Barker DJ (2001) Fetal programming and adult health. Public Health Nutr 4:611–624. https://doi.org/10.1079/phn2001145
Godfrey KM, Reynolds RM, Prescott SL et al (2017) Influence of maternal obesity on the long-term health of offspring. Lancet Diabetes Endocrinol 5:53–64. https://doi.org/10.1016/S2213-8587(16)30107-3
HAPO Study Cooperative Research Group, Metzger BE, Lowe LP et al (2008) Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 358:1991–2002. https://doi.org/10.1056/NEJMoa0707943
Heni M, Kullmann S, Preissl H et al (2015) Impaired insulin action in the human brain: causes and metabolic consequences. Nat Rev Endocrinol 11:701–711. https://doi.org/10.1038/nrendo.2015.173
Kiefer ID, Siegel ER, Preissl H et al (2008) Delayed maturation of auditory evoked responses in growth-restricted fetuses revealed by magnetoencephalographic recordings. Am J Obstet Gynecol 199:503.e1–503.e7. https://doi.org/10.1016/j.ajog.2008.04.014
Lain KY, Catalano PM (2007) Metabolic changes in pregnancy. Clin Obstet Gynecol 50:938–948. https://doi.org/10.1097/GRF.0b013e31815a5494
Li X, Andres A, Shankar K et al (2016) Differences in brain functional connectivity at resting state in neonates born to healthy obese or normal-weight mothers. Int J Obes 40:1931–1934. https://doi.org/10.1038/ijo.2016.166
Linder K, Schleger F, Ketterer C et al (2014) Maternal insulin sensitivity is associated with oral glucose-induced changes in fetal brain activity. Diabetologia 57:1192–1198. https://doi.org/10.1007/s00125-014-3217-9
Linder K, Schleger F, Kiefer-Schmidt I et al (2015) Gestational diabetes impairs human fetal postprandial brain activity [published correction appears in J Clin Endocrinol Metab 2017,102:336]. J Clin Endocrinol Metab 100:4029–4036. https://doi.org/10.1210/jc.2015-2692
Mat Husin H, Schleger F, Bauer I et al (2020) Maternal weight, weight gain and metabolism are associated with changes in fetal heart rate and variability. Obesity 28:114–121. https://doi.org/10.1002/oby.22664
Melchior H, Kurch-Bek D, Mund M (2017) The prevalence of gestational diabetes. Dtsch Arztebl Int 114:412–418. https://doi.org/10.3238/arztebl.2017.0412
Mensink GB, Schienkiewitz A, Haftenberger M et al (2013) Übergewicht und Adipositas in Deutschland: Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1) [Overweight and obesity in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56:786–794. https://doi.org/10.1007/s00103-012-1656-3
Nehring I, Lehmann S, von Kries R (2013) Gestational weight gain in accordance to the IOM/NRC criteria and the risk for childhood overweight: a meta-analysis. Pediatr Obes 8:218–224. https://doi.org/10.1111/j.2047-6310.2012.00110.x
Pedersen J (1967) The pregnant diabetic and her newborn: problems and management. William & Wilkins, Baltimore
Preissl H, Lowery CL, Eswaran H (2004) Fetal magnetoencephalography: current progress and trends. Exp Neurol 190:28–36. https://doi.org/10.1016/j.expneurol.2004.06.016
Russell NE, Higgins MF, Kinsley BF et al (2016) Heart rate variability in neonates of type 1 diabetic pregnancy. Early Hum Dev 92:51–55. https://doi.org/10.1016/j.earlhumdev.2015.11.003
Salzwedel AP, Gao W, Andres A et al (2019) Maternal adiposity influences neonatal brain functional connectivity. Front Hum Neurosci 12:514. https://doi.org/10.3389/fnhum.2018.00514
Sanchez CE, Barry C, Sabhlok A et al (2018) Maternal pre-pregnancy obesity and child neurodevelopmental outcomes: a meta-analysis. Obes Rev 19:464–484. https://doi.org/10.1111/obr.12643
Schäfer-Graf UM, Gembruch U, Kainer F et al (2018) Gestational Diabetes Mellitus (GDM)—Diagnosis, Treatment and Follow-Up. Guideline of the DDG and DGGG (S3 Level, AWMF Registry Number 057/008, February 2018). Geburtshilfe Frauenheilkd 78:1219–1231. https://doi.org/10.1055/a-0659-2596
Schleger F, Linder K, Walter L et al (2018) Family history of diabetes is associated with delayed fetal postprandial brain activity. Front Endocrinol 9:673. https://doi.org/10.3389/fendo.2018.00673
Sobngwi E, Boudou P, Mauvais-Jarvis F et al (2003) Effect of a diabetic environment in utero on predisposition to type 2 diabetes. Lancet 361:1861–1865. https://doi.org/10.1016/S0140-6736(03)13505-2
Tamayo T, Tamayo M, Rathmann W et al (2016) Prevalence of gestational diabetes and risk of complications before and after initiation of a general systematic two-step screening strategy in Germany (2012–2014). Diabetes Res Clin Pract 115:1–8. https://doi.org/10.1016/j.diabres.2016.03.001
Thomason M, Scheinost D, Manning J et al (2017) Weak functional connectivity in the human fetal brain prior to preterm birth. Sci Rep 7:39286. https://doi.org/10.1038/srep39286
Truong YN, Yee LM, Caughey AB et al (2015) Weight gain in pregnancy: does the Institute of Medicine have it right? Am J Obstet Gynecol 212:362.e361–362.e368. https://doi.org/10.1016/j.ajog.2015.01.027
Wakai RT (2004) Assessment of fetal neurodevelopment via fetal magnetocardiography. Exp Neurol 190:S65–S71. https://doi.org/10.1016/j.expneurol.2004.04.019
Young JB (2006) Developmental origins of obesity: a sympathoadrenal perspective. Int J Obes 30:S41–S49. https://doi.org/10.1038/sj.ijo.0803518
http://www.euro.who.int/en/health-topics/noncommunicable-diseases/diabetes/data-and-statistics Zugegriffen: 07.Juni.2020
Weiterführende Literatur
Fritsche L, Hummel J, Heni M (2019) Langzeitfolgen und Präventionsstrategien für Frauen nach Gestationsdiabetes. Diabetologe 15:717–728. https://doi.org/10.1007/s11428-019-00544-3
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Interessenkonflikt
F. Schleger, L. Fritsche, A. Birkenfeld, M. Heni, H. Preissl und A. Fritsche geben an, dass kein Interessenkonflikt besteht.
Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
Rights and permissions
About this article
Cite this article
Schleger, F., Fritsche, L., Birkenfeld, A. et al. Materner Metabolismus und fetale Entwicklung. Diabetologe 16, 647–653 (2020). https://doi.org/10.1007/s11428-020-00667-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11428-020-00667-y
Schlüsselwörter
- Magnetenzephalographie
- Gestationsdiabetes
- Insulinsensitivität
- Fetale Herzaktivität
- Hirnaktivitätsmessung, Fetus