The hypothesis of fuel-mediated teratogenesis proposes that intrauterine exposure to an excess of fuels (for example, glucose) causes permanent fetal changes. In pregnancies complicated by diabetes, this would lead to malformations, greater birth weight, and an increased risk of developing type 2 diabetes in later life. Recently, obesity in the offspring has been included as an outcome in pregnancies complicated by diabetes. The hypothesis is now widely accepted, although the relatively few studies that have examined the question are poorly comparable and focus almost exclusively on growth and glucose regulation.
This article reviews the evidence that intrauterine exposure to maternal diabetes conveys high risks for obesity and type 2 diabetes in the offspring, in addition to genetic predisposition, and regardless of maternal diabetes type. It also discusses potential mediators as well as possible public health consequences of fuel-mediated teratogenesis driven by maternal hyperglycemia in utero.