Key result
Antioxidants and exercise mitigate maternal diabetes-induced congenital heart defect risk in preclinical models.
Why the study?
With diabetes rising among women of childbearing age and elevating congenital heart defect risk more than four-fold, investigating underlying mechanisms and preventative strategies is needed.
Does maternal treatment with antioxidants or exercise reduce the incidence of congenital heart defects in offspring of diabetic mice?
Does maternal treatment with antioxidants or exercise reduce the incidence of congenital heart defects in offspring of diabetic mice?
Imbalance of NO and ROS signaling drives pregestational diabetes-induced CHDs, and maternal antioxidant treatment or exercise can reduce CHD incidence in animal models.
Congenital heart defects (CHDs) are the most prevalent and serious birth defect, occurring in 1% of all live births. Pregestational maternal diabetes is a known risk factor for the development of CHDs, elevating the risk in the child by more than four-fold. As the prevalence of diabetes rapidly rises among women of childbearing age, there is a need to investigate the mechanisms and potential preventative strategies for these defects. In experimental animal models of pregestational diabetes induced-CHDs, upwards of 50% of offspring display congenital malformations of the heart, including septal, valvular, and outflow tract defects. Specifically, the imbalance of nitric oxide (NO) and reactive oxygen species (ROS) signaling is a major driver of the development of CHDs in offspring of mice with pregestational diabetes. NO from endothelial nitric oxide synthase (eNOS) is crucial to cardiogenesis, regulating various cellular and molecular processes. In fact, deficiency in eNOS results in CHDs and coronary artery malformation. Embryonic hearts from diabetic dams exhibit eNOS uncoupling and oxidative stress. Maternal treatment with sapropterin, a cofactor of eNOS, and antioxidants such as N-acetylcysteine, vitamin E, and glutathione as well as maternal exercise have been shown to improve eNOS function, reduce oxidative stress, and lower the incidence CHDs in the offspring of mice with pregestational diabetes. This review summarizes recent data on pregestational diabetes-induced CHDs, and offers insights into the important roles of NO and ROS in embryonic heart development and pathogenesis of CHDs in maternal diabetes.
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Engineer et al. (2019) conducted a review in Congenital heart defects in maternal diabetes. Pregestational maternal diabetes vs. Non-diabetic pregnancy was evaluated. Pregestational maternal diabetes increases congenital heart defect risk via nitric oxide and reactive oxygen species imbalance, which is mitigated in animal models by antioxidants and exercise.
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