Individuals born with a low birth weight (LBW) have an increased prevalence of type 2 diabetes, but the mechanisms responsible for this association are unknown. Given the important role of insulin resistance in the pathogenesis of type 2 diabetes, we examined insulin sensitivity in a rat model of LBW due to intrauterine fetal stress. During the last 7 days of gestation, rat dams were treated with dexamethasone and insulin sensitivity was assessed in the LBW offspring by a hyperinsulinemic euglycemic clamp. The LBW group had liver-specific insulin resistance associated with increased levels of PEPCK expression. These changes were associated with pituitary hyperplasia of the ACTHsecreting cells, increased morning plasma ACTH concentrations, elevated corticosterone secretion during restraint stress, and an ϳ70% increase in 24-h urine corticosterone excretion. These data support the hypothesis that prenatal stress can result in chronic hyperactivity of the hypothalamic-pituitary-adrenal axis, resulting in increased plasma corticosterone concentrations, upregulation of hepatic gluconeogenesis, and hepatic insulin resistance. gluconeogenesis; adrenocorticotropic hormone; corticosterone; type 2 diabetes ACCORDING TO THE BARKER HYPOTHESIS, harmful events taking place during the fetal period can induce life-long changes in different organs predisposing to development of disease (1). In accordance with this hypothesis, individuals born with a birth weight of less than 5.5 lbs [low birth weight (LBW)] are insulin resistant (3,12,15,17,22,28,30,35) and have increased prevalence of type 2 diabetes (10, 15, 28). Additionally, these patients are also prone to exhibit impaired growth in childhood and early adulthood, which may be related to alterations in the growth hormone/IGF-I homeostasis (16,18,20). The mechanisms responsible for these changes associated with LBW are unknown.Recently, fetal stress and high plasma levels of glucocorticoids have been suggested (5, 27) to lead to hypothalamicpituitary-adrenal (HPA) axis hyperactivity, which after birth may result in chronically excessive adrenal glucocorticoid secretion, and an increased risk for the development of type 2 diabetes. However, these findings have been contrasted by other studies that have found no change (32) or decreased HPA axis activity (21) in LBW rat models.To examine the mechanism and potential role of the HPA axis in causing LBW-associated insulin resistance, we assessed insulin-stimulated liver and muscle glucose metabolism, total IGF-I, and IGF-binding proteins (IGFBPs), as well as HPA axis activity in a rat model of stress-induced LBW.
MATERIALS AND METHODS
Animals.From day 7 of gestation, pregnant female Sprague-Dawley rats (Charles River, Wilmington, MA) were housed singly under temperature (22-23°C)-and light-controlled (12:12-h light-dark cycle) conditions. On day 14 of gestation, rats were randomized into three groups: control, dexamethasone treatment, or foster mother group. From day 14 to day 21 of gestation, a daily subcutaneously injection of d...