Type 2 Diabetes and Fetal Origins: The Promise of Prevention Programs Focusing on Prenatal Health in High Prevalence Native American Communities

Abstract

Recent diabetes research is challenging the longstanding emphasis on the primary role genes play in the type 2 diabetes epidemic among Native American and other high prevalence populations. Increasingly, “thrifty genotype” models are being reevaluated and modi?ed in order to accommodate experimental and epidemiological research that highlights the powerful effects of the prenatal environment in the development of the disorder. This body of research suggests that, especially in high-risk populations, diabetes may result initially from prenatal malnutrition followed by calorically adequate diets in adulthood, and then be propagated in subsequent generations via maternal hyperglycemia during pregnancy. The present paper highlights the recent research that is challenging the dominant genetic-predisposition model of diabetes, and then explores the promise of future community-based diabetes intervention strategies informed by this research. It suggests that prevention programs that focus on improved prenatal care have the best chance of signi?cantly reducing the incidence and prevalence of diabetes in high risk Native American communities, and explains why such programs are likely to enjoy improved community support and participation.