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Fetal brain activity influenced by maternal insulin resistance
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Evidence for a direct link between fetal brain response and maternal insulin resistance points to obesity and diabetes risks being pre-programmed in the womb, according to study results published in Diabetologia.
Researchers at the University of Tübingen in Germany and the German Center for Diabetes Research evaluated 13 healthy pregnant women who underwent an oral glucose tolerance test.
Participants’ insulin sensitivity was determined through glucose and insulin measurements at 0, 60 and 120 minutes. At those points, researchers also recorded fetal brain responses elicited by sounds with a magnetoencephalographic device.
There was a significant correlation between maternal insulin sensitivity and response latency of the fetus (r=0.68, P=.02) 60 minutes after the participants received the dose of glucose; the higher the insulin sensitivity, the shorter the fetus response latency. There was no significant correlation at baseline (r=0.03, P=.93) or after 120 minutes (r=0.21, P=.48).
“Lower maternal insulin sensitivity is associated with slower fetal brain responses,” the researchers wrote. “These findings provide the first evidence of a direct effect of maternal metabolism on fetal brain activity and suggest that central insulin resistance may be programmed during fetal development.”
The researchers said this type of “metabolic imprinting of insulin resistance” could affect children as they age: “Compared with newborns of non-diabetic women, children of diabetic mothers with poorly controlled glycaemia show neurophysiological impairment and have a higher risk for metabolic syndrome, obesity and type 2 diabetes mellitus in later life.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Robert Rapaport, MD
It’s a very nice, new and intriguing paper — though the results are entirely preliminary and mostly speculative. The concerns about whether or not in utero programming exists, how it’s accomplished, and what the consequences are for both childhood and adulthood remain very intriguing questions for science.
These authors looked at 13 women, and during a glucose tolerance test found there was a change in auditory evoked potential in the fetus. This is consistent with some other findings in the literature; however, it certainly needs to be replicated.
The important questions are: What is the possible significance of these findings? How often does blood glucose vary during the course of a normal pregnancy? What effect does it have on fetal brain programming?
They found that women at higher levels of insulin resistance showed more significant delays in fetal auditory responses. Unfortunately there was no control — in other words, women ingesting just water, to see what happens with their blood sugar, to see what happens with the latency period — and I realize that would be difficult to do.
One needs to interpret these data quite cautiously, but it may be a promising avenue for getting a handle on potential fetal programming, period. Lots of data have shown that insulin has an effect on brain function. The long term consequences of varying insulin remain to be studied.
Certainly one needs to look as early as possible, because we know that genetic as well as epigenetic factors have an influence on the development of both the fetus, child and adult. Children who are born small for gestational age and the adult consequences of that is a topic of interest for me, both research-wise and otherwise. The earlier one looks into it, the earlier one may be able to influence and prevent long term consequences of adverse in utero programming.
The impact on daily practice from this paper is really to support data form all other avenues — that it’s important to treat the pregnant woman with particular care, to avoid hyperglycemia, and that’s the main take-home message. The healthier the pregnant woman is, the greater the likelihood of a healthier fetus, therefore a healthier newborn, and subsequently a healthier child and adult.
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