Determinants of Incident Hyperglycemia 6 Years After Delivery in Young Rural Indian Mothers
The Pune Maternal Nutrition Study (PMNS)
- Smita R. Kulkarni, MSC1,
- Caroline H.D. Fall, DM, FRCPCH2,
- Niranjan V. Joshi, MD, DNB1,
- Himangi G. Lubree, MSC1,
- Vaishali U. Deshpande, MSC1,
- Rashmi V. Pasarkar, MSC1,
- Dattatray S. Bhat, MSC1,
- Sadanand S. Naik, PHD1 and
- Chittaranjan S. Yajnik, MD, FRCP1
- 1Kamalnayan Bajaj Diabetology Research Centre, KEM Hospital and Research Centre, Pune, India
- 2MRC Epidemiology Resource Centre, University of Southampton, Southampton, U.K
- Address correspondence and reprint requests to Dr. Chittaranjan Sakerlal Yajnik, MD, FRCP, KEM Hospital and Research Center, 6th Floor, Banoo Coyaji Building, Sardar Mudliar Road, Rasta Peth, Pune 411011, India. E-mail: diabetes{at}vsnl.com
Abstract
OBJECTIVE—To study determinants of incident hyperglycemia in rural Indian mothers 6 years after delivery.
RESEARCH DESIGN AND METHODS—The Pune Maternal Nutrition Study collected information in six villages near Pune on prepregnant characteristics and nutrition, physical activity, and glucose tolerance during pregnancy. An oral glucose tolerance test (OGTT) was repeated 6 years after delivery.
RESULTS—A total of 597 mothers had an OGTT at 28 weeks’ gestation; 3 had gestational diabetes (by World Health Organization 1999 criteria). Six years later, 42 of 509 originally normal glucose-tolerant mothers were hyperglycemic (8 diabetic, 20 with impaired glucose tolerance, and 14 with impaired fasting glucose). The hyperglycemic women had shorter legs and thicker skinfolds before pregnancy (P < 0.01, both), were less active and more hyperglycemic (2-h plasma glucose 4.8 vs. 4.4 mmol/l, P < 0.001) during pregnancy, and gained more weight during follow-up (6.0 vs. 2.7 kg, P < 0.001). Multivariate analysis revealed that total leukocyte count and blood pressure during pregnancy were additional independent predictors of 2-h glucose concentration at follow-up.
CONCLUSIONS—Our results suggest that compromised linear growth, adiposity, inflammation, and less physical activity predispose to hyperglycemia in young rural Indian women. International cut points of diabetes risk factors are largely irrelevant in these women.
- GDM, gestational diabetes mellitus
- IFG, impaired fasting glycemia
- IGT, impaired glucose tolerance
- OGTT, oral glucose tolerance test
- PMNS, Pune Maternal Nutrition Study
- SES, socio-economic status
- TLC, total leukocyte count
Footnotes
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Published ahead of print at http://care.diabetesjournals.org on 9 July 2007. DOI: 10.2337/dc07-0329.
Additional information for this article can be found in an online appendix at http://dx.doi.org/10.2337/dc07-0329.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Accepted June 30, 2007.
- Received February 16, 2007.
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