Diabetes exposure in utero increases risk of early ESRD

Being exposed to diabetes in utero substantially increases the risk of premature end-stage renal disease (ESRD), according to a study presented at the American Diabetes Association's 70th Scientific Sessions, held June 25-29.

The study assessed Pima Indians aged 5 to 44 years with type 2 diabetes, 102 of whom were the offspring of diabetic mothers and 1,748 of whom did not have diabetes exposure in utero.

"Pima Indians have the highest rate of type 2 diabetes in the world. We've been studying the population since 1965, so we have extensive longitudinal data that allows us to look not only at disease in the parents, but in the offspring, and follow them into adulthood," said investigator Robert G Nelson, MD.

Genetic susceptibility from the mother can partially explain the early onset of diabetes in the offspring, said Nelson. Intrauterine exposure also is associated with higher birth weight and higher weight in childhood and adolescence compared to persons without suchexposure.

In the current study, the participants were followed for a maximum of 40 years, from their onset of diabetes until either death, onset of ESRD, or age 45.

A total of 57 of the patients exposed to diabetes in utero developed ESRD before age 45, which was 4 times the rate of ESRD observed in control patients who were not exposed to diabetes in utero.

"Twenty percent of ESRD that occurs in the population before age 45 is attributable to exposure to diabetes in utero," said Nelson. Assuming this relationship is causal, "if you delayed the development of diabetes until after the onset of childbearing years, you would reduce the incidence of diabetic ESRD by about 20%," he said.

If the offspring are exposed to diabetes in utero, diabetes prevention efforts in the form of lifestyle modifications (diet and exercise) are needed to slow or prevent the development of diabetes and its complications, Nelson said.