Anthropometry, glucose tolerance and insulin concentrations in South Indian children: relationships to maternal glucose tolerance during pregnancy


Krishnaveni, Ghattu Vedamurthy (2005) Anthropometry, glucose tolerance and insulin concentrations in South Indian children: relationships to maternal glucose tolerance during pregnancy. University of Southampton, School of Medicine, Doctoral Thesis , 251pp.

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Description/Abstract

Earlier studies have shown that individuals whose mothers were diabetic when they
were in utero, have an increased risk of early obesity, and impaired glucose tolerance
(lGT) and type 2 diabetes in adult life. This study was designed to test whether
adiposity, glucose tolerance and insulin concentrations are altered in Indian children
born to mothers with gestational diabetes (GDM), and are related to maternal glucose
and insulin concentrations in pregnancy even in the absence of GDM.

830 pregnant women attending the antenatal clinics of the Holdsworth Memorial
Hospital (HMH), Mysore, India underwent an Oral Glucose Tolerance Test (OGTT) at
30+/-2 weeks. 674 of these women delivered at HMH. Detailed anthropometry was
performed on the offspring at birth, and annually thereafter. 585 mothers returned with
their offspring at 5 years of age for detailed investigations including OGTT for glucose
and insulin concentrations, bio-impedance for fat estimation and blood pressure
measurement. OGTT was administered to mothers and fasting plasma glucose and
insulin concentrations were measured in fathers.

The Mysore babies were small compared to UK neonates, but the deficit varied for
different body measurements. While birthweight (-1.1 SD) was considerably lower,
crown-heel length (-0.3 SD) and subscapular skinfold thickness (-0.2 SD) were
relatively spared. At five years, subscapular skinfold thickness was larger than the UK
standards (+0.23 SD, p<O.OOl) despite all other body measurements being significantly
smaller. Findings at 5 years were similar in comparison with another standard, based on
Dutch children. At 5 years, girls in the cohort had higher insulin concentrations and
were more insulin resistant. Body fat was the strongest predictor of glucose and insulin
concentrations independent of other body components and parental characteristics.

Newborns of the mothers with gestational diabetes were larger in all body
measurements than control neonates (born to non-GDM mothers and non-diabetic
fathers). At one year, these differences had diminished and were not statistically
significant. At five years, female, but not male offspring of diabetic mothers had larger
subscapular and triceps skinfolds (P=O.Ol) and higher 30- and 120-minute insulin
concentrations (P<0.05) than control females. Even in the control offspring maternal
insulin area-under-the-curve was positively associated with 30-minute insulin
concentrations, after adjusting for sex and maternal skinfolds (P<O.OOl). Offspring of
diabetic fathers (n=41) were lighter at birth than controls; they showed no differences in
anthropometry at five years.

In conclusion, Maternal GDM is associated with adiposity and higher insulin
concentrations in female offspring at 5 years. The absence of similar associations in
offspring of diabetic fathers suggests a programming effect of the diabetic intra-uterine
environment. With increasing levels of obesity and IGT among Indian mothers, these
effects may be contributing to the rise of type 2 diabetes in India. Our continuing
follow-up aims to study the long-term effects of higher maternal glucose concentrations
in the absence of GDM.

Item Type: Thesis (Doctoral)
Subjects: H Social Sciences > HT Communities. Classes. Races
R Medicine > RG Gynecology and obstetrics
R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Divisions: Faculty of Medicine
ePrint ID: 210920
Date Deposited: 10 Feb 2012 16:56
Last Modified: 27 Mar 2014 19:50
URI: http://eprints.soton.ac.uk/id/eprint/210920

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