anil kapur. women and diabetes 123.8 192.3 155.6 233.5

Anil Kapur

Women and Diabetes

123.8

192.3

155.6

233.5

Estimates of DM & IGT in women 20-39 years

19.0 (15.3%)

49.7 (32%)

68.8 (24.6%)

25.0 (13.0%)

57.0 (24.4%)

82.1 (19.3%)

GDMGDM IGTIGT

2% Agarwal S, Gupta AN. Gestational

Diabetes. J Assoc Physicians India 1982;30:203

2% Ramachandran A, et .al., High prevalence of

diabetes in an urban population in south India. BMJ 1988;3; 297(6648):587-90

1980s1980s

7.6%Narendra J, Munichoodappa C, et al, Prevalence of glucose intolerance during pregnancy. Int J Diab Dev Countries 1991;11:2-4

8.2%Ramachandran A, Snehalatha c, Dharmaraj D, Viswanathan M. Prevalence of glucose intolerance in Asian Indians. Diabetes Care 1992; 15:1348-55

1990s1990s

16.6%V Seshiah, V Balaji, Madhuri S Balaji, CB Sanjeevi, A. Green. Gestational Diabetes Mellitus in India. J Assoc Physicians India 2004;52:707

14.5%Ramachandran A, Snehalatha C, Kapur A, Vijay V, Mohan V,Das AK, Rao PV, Yajnik CS, Prasanna Kumar KM, Nair JD.For the Diabetes Epidemiology Study Group in India (DESI).Diabetologia 2001;44:1094-1101.

2000s2000s

GDM prevalence linked to background IGT rates

GDM & Pre gestational DM

Diabetes and Pregnancy – Why it is relevant?

Diabetes and PregnancyMaternal hyperglycaemia is associated with high risk of maternal and perinatal morbidity and mortality and poor pregnancy outcome

It has been shown beyond reasonable doubt that treatment of GDM significantly improves pregnancy outcomes

Risk of maternal diabetes after GDM

Glucose tolerance at follow-up

J Lauenborg et al, Diab Care 2004

Diabetes Begets Diabetes

Offspring's of women with GDM, have a 4 to 8 fold increased risk of diabetes.

Clausen TD et al., Diabetes Care 2008

Foetal Programming

Foetal Programming

Yajnik et al, Diabetes Care 2007

Foetal Programming

Foetal Programming and Economic Transition

Fetal under nutrition

Undernourished (small) mother

Postnatal under nutrition

Insulin resistance

Small baby (Thin-fat)

Postnatal over nutrition (Urbanization)

Under nutrition

Nutrient-mediated Teratogenesis

Over nutrition

Altered fuels

Pre gestational and gestational hyperglycemia

Obesity and hyperglycemia

Macrosomia

Fetal adiposity & islet dysfunction

Yajnik et al, Diabetes Care 2007

Fuel-mediated Teratogenesis

IUGR vis a vis Macrosomia

SolutionOptimal birth weight

3000 – 3500 g.

Diabetes and Pregnancy – public health relevance