Diabetes, pregnancy, and the developmental origins of health and disease

Multiple fields of inquiry support the “developmental origins of health and disease” (DOHaD) concept, which suggests that the risk of developing some chronic, non-communicable diseases (NCDs) in adulthood is influenced not only by genetic and adult lifestyle factors but also by environmental factors acting in early life. ¹ Thus, the risk of disease as an adult depends on a range of influences acting across the life course, starting with preconceptional attributes of the parents, such as nutrition and health behaviors, the intrauterine environment, birth phenotype, and aspects of the postnatal environment. These factors do not initiate disease in the developing embryo, fetus, or infant but have substantial influence on the ways in which the individual will respond to the challenges of their later lifestyle. Research in a range of species has shown that signals such as maternal nutritional state, stress levels, or body composition “prime” her offspring to respond to challenges such as living in an obesogenic environment. ² Thus, the emerging epidemic of obesity with its resulting effects on risk of adult diabetes and metabolic abnormalities, cardiovascular disease, and some forms of cancer is not only due to the adoption of a Western lifestyle but also in part due to the intrauterine environment and other environmental factors early in life.