Anil Kapur. Women and Diabetes. 123.8. 82.1 (19.3%). 68.8 (24.6%). 57.0 (24.4%). 49.7 (32%). 25.0 (13.0%). 19.0 (15.3%). Estimates of DM & IGT in women 20-39 years . IGT. GDM. GDM prevalence linked to background IGT rates. 2%
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Women and Diabetes 123.8
82.1 (19.3%) 68.8 (24.6%) 57.0 (24.4%) 49.7 (32%) 25.0 (13.0%) 19.0 (15.3%) Estimates of DM & IGT in women 20-39 years
IGT GDM GDM prevalence linked to background IGT rates 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 1980s 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 1990s 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. 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 2000s
Hyperglycaemia during pregnancy is associated with high risk of maternal and perinatal morbidity and mortality and poor pregnancy outcome Maternal hyperglycaemia is associated with development of metabolic problems including type 2 diabetes in the offspring Diagnosis of GDM identifies women at high risk of future diabetes, offers opportunity of primary prevention Diabetes and Pregnancy – Why it is relevant?
Diabetes and Pregnancy Maternal 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
Glucose tolerance at follow-up J Lauenborg et al, Diab Care 2004
Offspring's of women with GDM, have a 4 to 8 fold increased risk of diabetes. Diabetes Begets Diabetes Clausen TD et al., Diabetes Care 2008
Foetal Programming Yajnik et al, Diabetes Care 2007
Undernourished (small) mother Fetal under nutrition Postnatal under nutrition Small baby (Thin-fat) Insulin resistance Foetal Programming and Economic Transition Altered fuels Nutrient-mediated Teratogenesis Fuel-mediated Teratogenesis Fetal adiposity & islet dysfunction Pre gestational and gestational hyperglycemia Macrosomia Under nutrition Over nutrition Obesity and hyperglycemia Postnatal over nutrition (Urbanization) Yajnik et al, Diabetes Care 2007
IUGR vis a vis Macrosomia SolutionOptimal birth weight3000 – 3500 g.