Neonatology Today

Two major health care problems in the general population of industrialized countries like the United States and the United Kingdom are obesity and Adult Onset or Type 2 Diabetes Mellitus. The United Kingdom has the highest population obesity in Western Europe. Obesity in childhood and in women of childbearing age is also becoming a significant public health burden with negative shortand long-term economical impacts. In the United States, one third of the adult population is considered to be obese, with a body mass index (BMI) equal or greater than 30. According to the World Health Organization, this healthcare problem is on the rise even in developing countries like those found in the Middle East. A sedentary life style, Western diet and excessive food consumption are the principal causes for such a phenomenon. Perinatal morbidity and mortality are significantly increased with pregnancies in obese and diabetic women. Diabetic women have increased comorbidities during pregnancy, such as hypertension and preeclampsia; their infants have associated fetal and neonatal problems, such as the excessive occurrences of congenital anomalies, macrosomia, birth injuries, Respiratory Distress Syndrome, hypoglycemia and other clinically significant morbidities with long-term sequelae and increased mortality. Based on current literature, this is an attempt to provide a review of the subject of obesity and diabetes mellitus, as well as the multitude of morbidities in infants of diabetic mothers, with emphasis on strategies for their diagnoses, prevention and therapy. Epidemiology Diabetes mellitus is a global public health problem with a projected 300 million diabetics by the year 2030 worldwide. In many areas around the globe, including the West as well as many developing and Middle Eastern countries, diabetes has become a major health burden affecting young adults and women in their reproductive years.1 According to the World Health Organization, the problem of population obesity is now a worldwide phenomenon. In US, approximately 1.5 million women of childbearing age have diabetes mellitus. With the current obesity epidemic in the United States, it is estimated that the rate of Type 2 Diabetes Mellitus, during pregnancy, will rise with the rate of obesity. Obese women are at increased risk of developing gestational diabetes compared with women with a normal weight and BMI. A recent meta-analysis exploring the association between Gestational Diabetes Mellitus (GDM) and BMI estimated that the risk of developing GDM is two to four times higher among overweight and obese women respectively compared with normal-weight pregnant women.2 A recent consensus statement by a European workshop group (an expert committee on women’s health) stated that obesity is associated with increased risk of almost all pregnancy complications, such as: gestational hypertension, preeclampsia, gestational diabetes mellitus, delivery of a large for gestational age infant, increased rate of cesarean section delivery. Furthermore, a higher incidence of congenital defects occur more frequently than in women with a normal BMI.3 Although it is not well-studied yet, maternal obesity may have an imprinting effect and epigenetic changes on the fetus resulting in childhood and adult obesity and diabetes mellitus. NEONATOLOGY TODAY N e w s a n d I n f o r m a t i o n f o r B C / B E N e o n a t o l o g i s t s a n d P e r i n a t o l o g i s t s