Relevance to clinical management – insulin dosing and maternal diet
hyperglycaemia, metabolic abnormality, adiposity
DIABETES PREGNANCY, TYPE 1 DIABETES, INSULIN RESISTANCE, ADIPOSITY, HYPERGLYCAEMIA
This study demonstrates for the first time a possible metabolic link between maternal hyperglycaemia and offspring adiposity in diabetes pregnancy mediated partially through altered maternal and offspring lipid metabolism. Increases in the abundance of many classes of lipids were common in all analyses performed, likely to be caused by insufficient insulin availability, the key pathophysiological feature of type 1 diabetes. Our work suggests that despite improved access to CGM and insulin pumps, current efforts to address glycaemia do not fully correct the underlying metabolic abnormality.While it is well established that maternal diet influences insulin dose requirements, our work also identified an association between cord C-peptide and number of metabolite changes in the first trimester (phenols, lipids) which may be associated with maternal dietary intake of sugar substitutes, high-glycaemic-index carbohydrates and phenol compounds. These findings suggest that maternal diet is a key modifiable determinant of offspring health, independently of maternal glycaemia. Future work on optimising insulin dosing from the first trimester, with better matching of insulin to dietary intake and insulin resistance, is needed to improve maternal and neonatal health.