Feto-Placental lipid metabolism in maternal diabetes

JAWERBAUM A

Concepción, Chile

Workshop; 8TH IPW International Postgraduate Workshop; 2009

Pontificia Universidad Católica de Chile

Diabetes in pregnancy leads to alterations in lipid metabolism in the mother, the placenta, and the fetus. The main feature is the excess of lipids, that is present in the mother, the placenta and the fetuses. Fetal lipid accretion is related to the increased placental transport of glucose and lipids. The complex process that leads to the transfer of lipids through the placenta is profoundly affected by maternal diabetes, as many enzymes and transporter proteins involved are upregulated, and alterations are found in several placental lipid metabolic pathways. These changes lead to an excess of lipids and, due to the intrauterine pro-inflammatory environment, to an increase in lipid peroxidation during development.  On the other hand, the other important feature of the impaired lipid metabolism that arise in diabetic pregnancies is the deficiency in essential fatty acids, which will profoundly affect embryo development. Essential fatty acid deficiency are clearly involved in the induction of embryo malformations in maternal diabetes. In addition essential fatty acids have important functions as signaling molecules in feto-placental development and metabolism. Indeed, they are ligands of the nuclear receptors PPARs, and substrates for the synthesis of prostaglandins that are also ligands of this nuclear receptors. Interestingly, the three known PPAR isotypes have been recently identified as important regulators of lipid homeostasis in the placenta and the fetuses. Moreover, dietary activation of PPARs in maternal diabetes were able to prevent lipid accretion and reduce lipid peroxidation in the fetuses.  In conclusion, both lipid excess and deficiency in essential fatty acids are processes that characterize the embryonic and feto-placental development in maternal diabetes, have developmental consequences during pregnancy and the offspring. Future research is needed to be able to define the quantity and quality of lipids needed to regulate lipid metabolism, pro-inflammation and development in the placenta and the fetus in diabetic pregnancies.