Anil Kapur
Mar 27, 2015
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