Insulin and insulin-like growth factors in human development: implications for the perinatal period.

The physiologic and cellular mechanisms regulating fetal growth cannot be adequately described by regulatory mechanisms important postnatally. This review summarizes recent advances in clinical medicine, cell and molecular biology, and physiology showing the central and essential roles of insulin and the insulin-like growth factor family of peptides in regulating fetal growth. Moreover, the importance of insulin-like growth factors in tissue-specific growth regulation during critical periods of development suggest that these mechanisms may also be relevant to the pathogenesis of tissue injury in the preterm infant, and may offer therapeutic strategies aimed at reducing morbidity associated with prematurity. Illustrations of how the insulin-like growth factor axis may represent potential therapeutic targets for specific clinical problems facing the newborn are briefly discussed.