Determinants of Incident Hyperglycemia 6 Years After Delivery in Young Rural Indian Mothers

Determinants of Incident Hyperglycemia 6 Years After Delivery in Young Rural Indian Mothers The Pune Maternal Nutrition Study (PMNS) Smita R. Kulkarni , MSC 1 , Caroline H.D. Fall , DM, FRCPCH 2 , Niranjan V. Joshi , MD, DNB 1 , Himangi G. Lubree , MSC 1 , Vaishali U. Deshpande , MSC 1 , Rashmi V. Pasarkar , MSC 1 , Dattatray S. Bhat , MSC 1 , Sadanand S. Naik , PHD 1 and Chittaranjan S. Yajnik , MD, FRCP 1 1 Kamalnayan Bajaj Diabetology Research Centre, KEM Hospital and Research Centre, Pune, India 2 MRC 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 P