Understanding diabetic teratogenesis: where are we now and where are we going?
Maternal pregestational diabetes (type 1 or type 2) poses an increased risk for a broad spectrum of birth defects. To our knowledge, this problem first came to the attention of the Teratology Society at the 14th Annual Meeting in Vancouver, B.C. in 1974, with a presentation by Lewis Holmes, "Etiologic heterogeneity of neural tube defects". Although advances in the control of diabetes in the decades since the discovery of insulin in the 1920's have reduced the risk for birth defects during diabetic pregnancy, the increasing incidence of diabetes among women of childbearing years indicates that this cause of birth defects is a growing public health concern. Major advances in understanding how a disease of maternal fuel metabolism can interfere with embryogenesis of multiple organ systems have been made in recent years. In this review, we trace the history of the study of diabetic teratogenesis and discuss a model in which tissue-specific developmental control genes are regulated at specific times in embryonic development by glucose metabolism. The major function of such genes is to suppress apoptosis, perhaps to preserve proliferative capability, and inhibit premature senescence.
Zabihi
Sheller
S
Section on Developmental and Stem Cell Biology, Joslin Diabetes Center, One Joslin Place, Boston, MA 02215, USA.
Loeken
Mary R
MR
D000818:Animals; D017209:Apoptosis; D000013:Congenital Abnormalities / Q000209:etiology*; D003921:Diabetes Mellitus, Experimental; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D047108:Embryonic Development; D005260:Female; D005315:Fetal Diseases / Q000378:metabolism; D018507:Gene Expression Regulation, Developmental; D016158:Genes, p53; D006801:Humans; D006943:Hyperglycemia / Q000378:metabolism; D051379:Mice; D018345:Mice, Knockout; D009436:Neural Tube Defects / Q000378:metabolism; D018384:Oxidative Stress; D000072041:PAX3 Transcription Factor; D051761:Paired Box Transcription Factors / Q000235:genetics / Q000378:metabolism; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000235:genetics* / Q000378:metabolism; D051381:Rats; D013723:Teratogens / Q000378:metabolism*
D000072041:PAX3 Transcription Factor; C489409:PAX3 protein, human; D051761:Paired Box Transcription Factors; D013723:Teratogens