Skip to main content
SpringerLink
Log in

Prävention der kindlichen Adipositas während der Schwangerschaft

Prenatal prevention of childhood obesity

  • Leitthema
  • Published:
Monatsschrift Kinderheilkunde Aims and scope Submit manuscript

Zusammenfassung

Eine große Zahl von epidemiologischen und tierexperimentellen Befunden weist darauf hin, dass Einflüsse während der Schwangerschaft das lebenslange Risiko für die Entwicklung von Adipositas sowie Stoffwechsel- und Herz-Kreislauf-Erkrankungen programmieren können. Entscheidend für die Erkenntnis dieser Zusammenhänge waren Studien an Kindern von Müttern mit Diabetes mellitus während der Schwangerschaft sowie an Kindern mit einem verminderten Geburtsgewicht. Unter Fokussierung auf die Folgen eines mütterlichen Übergewichts/Diabetes mellitus während der Schwangerschaft sowie einer pränatalen Unterernährung wird anhand ausgewählter epidemiologischer und tierexperimenteller Daten der derzeitige Kenntnisstand zum Phänomen einer perinatalen Programmierung von adipogenen und diabetogenen Risiken diskutiert. Die hieraus erwachsenden weitreichenden Konsequenzen für die Primärprävention von chronischen Erkrankungen sowie der Modellcharakter dieser Hypothesen und Beobachtungen für das grundlegende Verständnis der Entwicklung von Gesundheit und Krankheit werden hervorgehoben.

Abstract

Currently, epidemiological and experimental data are being intensively discussed which indicate that exposures during prenatal life have lifelong consequences for the risk of developing obesity and subsequent metabolic and cardiovascular diseases. In this context, observations in offspring of mothers with diabetes during pregnancy as well as studies in children with low birth weight were most influential. This paper illustrates the current knowledge on perinatal programming of obesity and associated diseases and discusses possible aetiopathogenic mechanisms, focussing on epidemiological and animal studies on the consequences of exposure to maternal obesity/diabetes and prenatal undernutrition. The resultant far-reaching potential for primary prevention of chronic diseases as well as the paradigmatic character of these hypotheses and observations for the general understanding of health and disease are highlighted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Bergmann RL, Richter R, Bergmann KE et al (2003) Secular trends in neonatal macrosomia in Berlin: influences of potential determinants. Paediatr Perinat Epidemiol 17:244–249

    Article  PubMed  Google Scholar 

  2. Bray GA, Fisler J, York DA (1990) Neuroendocrine control of the development of obesity: understanding gained from studies of experimental animal models. Front Neuroendocrinol 12:128–181

    Google Scholar 

  3. Brooks AA, Johnson MR, Steer PJ (1995) Birth weight: nature or nuture? Early Hum Dev 42:29–35

    Article  CAS  PubMed  Google Scholar 

  4. Catalano P, Ashmead GG, Huston-Presley L (2005) The obesity cycle comes full circle: increasing trends in birth weight. Diabetic Pregnancy Study Group, 37th Annual Meeting, Abstract 15. Myconos, Greece

  5. Cedergren MI (2004) Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 103:219–224

    PubMed  Google Scholar 

  6. Dabelea D, Hanson RL, Lindsay RS et al (2000) Intrauterine exposure to diabetes conveys risks for type II diabetes and obesity: a study of discordant sibships. Diabetes 49:2208–2211

    Article  CAS  PubMed  Google Scholar 

  7. Dörner G (1975) Perinatal hormone levels and brain organization. In: Stumpf W, Grant LD (eds) Anatomical neuroendocrinology. Karger, Basel, S 245–252

  8. Dörner G (1976) Hormones and brain differentiation. Elsevier, Amsterdam New York

  9. Dörner G, Plagemann A (1994) Perinatal hyperinsulinism as possible predisposing factor for diabetes mellitus, obesity, and enhanced cardiovascular risk in later life. Horm Metab Res 26:213–221

    Article  PubMed  Google Scholar 

  10. Dubos R, Savage D, Schaedler R (1966) Biological freudianism: lasting effects of early environmental influences. Pediatrics 38:789–800

    CAS  PubMed  Google Scholar 

  11. Hales CN, Barker DJP (1992) Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis. Diabetologia 35:595–601

    Article  CAS  PubMed  Google Scholar 

  12. Harder T, Rodekamp E, Schellong K et al (2007) Birth weight and subsequent risk of type 2 diabetes: a meta-analysis. Am J Epidemiol 165:849–857

    Article  PubMed  Google Scholar 

  13. Harder T, Schellong K, Stupin J et al (2007) Where is the evidence that low birth weight leads to subsequent obesity? Lancet 369:1859

    Article  PubMed  Google Scholar 

  14. Hedley AA, Ogden CL, Johnson CL (2004) Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA 291:2847–2850

    Article  CAS  PubMed  Google Scholar 

  15. Hofman PL, Regan F, Jackson WE et al (2004) Premature birth and later insulin resistance. N Engl J Med 351:2179–2186

    Article  CAS  PubMed  Google Scholar 

  16. Kurth BM (2007) Die Verbreitung von Übergewicht und Adipositas bei Kindern und Jugendlichen in Deutschland. Ergebnisse des bundesweiten Kinder- und Jugendgesundheitssurveys (KiGGS). Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 50:736–743

    Article  Google Scholar 

  17. Lamarck JB (1809) Philosophie zoologique. Dentu et l’Auteur, Paris

  18. Petry CJ, Ozanne SE, Wang CL, Hales CN (1997) Early protein restriction and obesity independently induce hypertension in 1-year-old rats. Clin Sci 93:147–152

    CAS  PubMed  Google Scholar 

  19. Plagemann A (2001) Fetale Programmierung und funktionelle Teratologie: Ausgewählte Mechanismen und Konsequenzen. In: Gortner L, Dudenhausen JW (Hrsg) Vorgeburtliches Wachstum und gesundheitliches Schicksal: Störungen – Risiken – Konsequenzen. Medizinische Verlagsgesellschaft Umwelt und Medizin, Frankfurt am Main, S 65–78

  20. Plagemann A (2004) Fetal programming and ‚functional teratogenesis’: on epigenetic mechanisms and prevention of perinatally acquired lasting health risks. J Perinat Med 32:297–305

    Article  CAS  PubMed  Google Scholar 

  21. Plagemann A (2005) Fetale Programmierung und funktionelle Teratologie. In: Ganten D, Ruckpaul W (Hrsg) Molekularmedizinische Grundlagen von fetalen und neonatalen Erkrankungen. Springer, Berlin Heidelberg New York, S 325–342

  22. Plagemann A (2008) A matter of insulin: developmental programming of body weight regulation. J Matern Fetal Neonatal Med 21:143–148

    Article  CAS  PubMed  Google Scholar 

  23. Plagemann A, Harder T, Kohlhoff R et al (1997) Overweight and obesity in infants of mothers with long-term insulin dependent diabetes or gestational diabetes. Int J Obes 21:451–456

    Article  CAS  Google Scholar 

  24. Plagemann A, Harder T, Rake A et al (1998) Hypothalamic insulin and neuropeptide Y in the offspring of gestational diabetic mother rats. Neuroreport 9:4069–4073

    Article  CAS  PubMed  Google Scholar 

  25. Plagemann A, Harder T (2005) Premature birth and insulin resistance. N Engl J Med 352:939

    Article  PubMed  Google Scholar 

  26. Plagemann A, Harder T, Dudenhausen JW (2008) The diabetic pregnancy, macrosomia, and perinatal nutritional programming. Nestle Nutr Workshop Ser Pediatr Program 61:91–102

    Article  CAS  PubMed  Google Scholar 

  27. Plagemann A, Harder T, Brunn M et al (2009) Hypothalamic proopiomelanocortin promoter methylation becomes altered by early overfeeding: an epigenetic model of obesity and the metabolic syndrome. J Physiol 587:4963–4976

    Article  CAS  PubMed  Google Scholar 

  28. Ravelli GP, Stein ZA, Susser MW (1976) Obesity in young men after famine exposure in utero and early infancy. N Engl J Med 295:349–353

    Article  CAS  PubMed  Google Scholar 

  29. Rooth G (2003) Increase in birthweight: a unique biological event and an obstetrical problem. Eur J Obstet Gynecol Reprod Biol 106:86–87

    Article  PubMed  Google Scholar 

  30. Schwartz MW, Porte D (2005) Diabetes, obesity, and the brain. Science 307:375–379

    Article  CAS  PubMed  Google Scholar 

  31. Silverman BL, Rizzo T, Green OC et al (1991) Long-term prospective evaluation of offspring of diabetic mothers. Diabetes [Suppl 2] 40:121–125

    Google Scholar 

  32. Silverman BL, Metzger BE, Cho NH, Loeb CA (1996) Impaired glucose tolerance in adolescent offspring of diabetic mothers. Diabetes Care 18:611–617

    Article  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. AG Experimentelle Geburtsmedizin, Klinik für Geburtsmedizin, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland

    A. Plagemann, T. Harder & E. Rodekamp

Authors
  1. A. Plagemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Harder
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Rodekamp
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Plagemann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Plagemann, A., Harder, T. & Rodekamp, E. Prävention der kindlichen Adipositas während der Schwangerschaft. Monatsschr Kinderheilkd 158, 542–552 (2010). https://doi.org/10.1007/s00112-009-2157-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00112-009-2157-9

Schlüsselwörter

Keywords

Search

Navigation