Pregnancy Glycemia Reflects Life Course Glycemia of the Mother

Abstract

Background: Current practice of diagnosis and treatment of GDM is largely restricted to late pregnancy, ignoring peri-conceptional window which is crucial for fetal programming of diabetes. A few longitudinal studies reported that metabolic risk factors of GDM are present before pregnancy but there are no reports on a ‘lifecourse’ trajectory of pregnancy glucose insulin metabolism. Pune Maternal Nutrition Study (PMNS) offers a unique opportunity to investigate the association between gestational glycaemia and pre-pregnancy lifecourse glycaemia because of serial measurements from childhood to pregnancy. Methods: We studied 328 female offspring of PMNS born in 1993-96 for glucose insulin measurements at 6, 12, and 18 year of age. Girls who became pregnant underwent a 75 gm OGTT at 28 weeks gestation. We studied the association between gestational fasting plasma glucose (FPG) with their earlier measurements using multiple linear regression analysis. Results: Up to October 2017, 110 women had an OGTT at 28 weeks gestation and have delivered. Thirteen (11.8%) were diagnosed GDM (IADPSG criteria 2011) In lifecourse analysis, FPG tracked from 6 years of age to pregnancy through 12 and 18 years. FPG at 28 weeks was directly associated with her own FPG at 18, 12 and 6 years of age (β= ∼0.3, p<0.001), and it was inversely associated with disposition index at 18 and 12 years (p<0.05). Conclusions: The world’s first description of lifecourse evolution of pregnancy glycaemia suggests that it tracks from early childhood and is associated with impaired beta cell function. The analysis provides an important clue that GDM women have higher pre and peri-conceptional glycaemia which is a risk factor for fetal programming of diabetes. Current clinical approach to GDM ignores this important window. This could be a potential explanation of the failure of current practice of GDM treatment in late pregnancy to reduce long term risks in the offspring. Disclosure N.S. Memane: None. D. Bhat: None. D.A. Raut: None. S.J. Bondarde: None. R. Ladkat: None. P.C. Yajnik: None. C. Fall: None. C.S. Yajnik: None.