The relationship between maternal obesity and diabetes during pregnancy on offspring kidney structure and function in humans: a systematic review

Abstract

Evidence from animal models indicates that exposure to an obesogenic or hyperglycemic intrauterine environment adversely impacts offspring kidney development and renal function. However, evidence from human studies has not been evaluated systematically. Therefore, the aim of this systematic review was to synthesize current research in humans that has examined the relationship between gestational obesity and/or diabetes and offspring kidney structure and function. Systematic electronic database searches were conducted of five relevant databases (CINAHL, Cochrane, EMBASE, MEDLINE and Scopus). Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed, and articles screened by two independent reviewers generated nine eligible papers for inclusion. Six studies were assessed as being of ‘neutral’ quality, two of ‘negative’ and one ‘positive’ quality. Observational studies suggest that offspring exposed to a hyperglycemic intrauterine environment are more likely to display markers of renal dysfunction and are at higher risk of end-stage renal disease. There was limited and inconsistent evidence for a link between exposure to an obesogenic intrauterine environment and offspring renal outcomes. Offspring renal outcome measures across studies were diverse, with a large variation in offspring age at follow-up, limiting comparability across studies. The collective current body of evidence suggests that intrauterine exposure to maternal obesity and/or diabetes adversely impacts renal programming in offspring, with an increased risk of kidney disease in adulthood. Further high-quality, longitudinal, prospective cohort studies that measure indicators of offspring renal development and function, including fetal kidney volume and albuminuria, at standardized follow-up time points, are warranted.

The relationship between maternal adiposity during pregnancy and fetal kidney development and kidney function in infants: theGomeroi gaaynggalstudy

“…Evidence from both human and animal studies suggests that maternal obesity has a major influence on the risk of chronic disease in offspring, including cardiovascular disease (CVD), hypertension, obesity, type 2 diabetes and metabolic syndrome (Forsen et al ; Laitinen et al ; Barker ; Filler et al ; Schack‐Nielsen et al ; Reynolds et al ; Eriksson et al ; ; Wankhade et al ). However, in humans, limited studies have specifically evaluated the effect of maternal obesity on offspring renal health and their risk of chronic kidney disease (CKD) (Lee et al ). CKD is one of the fast rising diseases, affecting over 10% of the population globally (Hill et al ).…”

“…These data suggest that maternal obesity may be an important prenatal factor for kidney development and predisposition to CKD in adulthood. However, this is the only human study to date that has investigated the potential contribution of maternal obesity to CKD, highlighting that more research is needed (Lee et al ).…”

“…Indigenous mothers are 1.6 times more likely to be obese with BMI ≥ 30.0 kg/m 2 than non‐Indigenous mothers (33% vs. 20%) (Australian Institute of Health and Welfare ). Our recent systematic review of human studies found that the influence of maternal obesity on offspring kidney development and kidney function in infants has not been extensively investigated (Lee et al ).…”

Normal foetal kidney volume in offspring of women treated for gestational diabetes

“…31 The period between onset, and diagnosis and treatment, coincides with a period of rapid nephron formation and kidney growth. [34][35][36][37] Despite the high prevalence of GDM, only a handful of studies have examined kidney development or renal function in offspring of women with GDM. [34][35][36][37] Despite the high prevalence of GDM, only a handful of studies have examined kidney development or renal function in offspring of women with GDM.…”

“…32,33 In humans, renal dysfunction and disease have been reported in adults whose mothers had Type 1 or Type 2 diabetes. [34][35][36][37] Despite the high prevalence of GDM, only a handful of studies have examined kidney development or renal function in offspring of women with GDM.…”