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World J Diabetes. Jul 15, 2022; 13(7): 482-497
Published online Jul 15, 2022. doi: 10.4239/wjd.v13.i7.482
Fetal programming of obesity and type 2 diabetes
Sumudu Nimali Seneviratne, Shaman Rajindrajith
Sumudu Nimali Seneviratne, Shaman Rajindrajith, Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
Author contributions: Seneviratne SN and Rajindrajith S conceptualized and designed this manuscript; Seneviratne SN reviewed the literature and wrote the manuscript; both authors read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sumudu Nimali Seneviratne, MD, PhD, Senior Lecturer, Department of Paediatrics, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo 08, Sri Lanka. sumudu@pdt.cmb.ac.lk
Received: July 9, 2021
Peer-review started: July 9, 2021
First decision: August 8, 2021
Revised: August 18, 2021
Accepted: June 3, 2022
Article in press: June 3, 2022
Published online: July 15, 2022
Processing time: 367 Days and 2.8 Hours
Abstract

The prevalence of obesity and type 2 diabetes mellitus has increased rapidly over the past few decades, and prevention efforts have not been successful. Fetal programming involves the earliest stage of obesity development, and provides a novel concept to complement other strategies for lifelong prevention of obesity and type 2 diabetes mellitus. The World Health Organization now advocates a life-course approach to prevent/control obesity, starting with pre-conceptional and antenatal maternal health. Maternal overnutrition, gestational diabetes mellitus and excessive gestational weight gain lead to fetal overgrowth, and “programs” the offspring with an increased risk of obesity and type 2 diabetes mellitus in childhood and adulthood. This review summarizes current data on fetal programming of obesity and type 2 diabetes mellitus including potential causative factors, mechanisms and interventions to reduce its impact.

Keywords: Developmental programming; Metabolic syndrome; Intergenerational obesity cycle; Insulin resistance; In utero environment

Core Tip: Fetal programming targets the earliest stages in the development of obesity and type 2 diabetes. It provides a novel paradigm to complement other strategies for lifelong prevention of obesity and type 2 diabetes. Maternal undernutrition/overnutrition, maternal diabetes, excessive gestational weight gain and certain paternal factors are now recognized as factors associated with adverse fetal programming of obesity and type 2 diabetes in the offspring. This review provides up-to date evidence on fetal programming of obesity and type 2 diabetes including potential causative factors and mechanisms as well as potential interventions to minimize its impact on future generations.