Poor nutrition of pregnant mothers may lead to diabetes in offspring’s - Prof. Hitman


 Diabetes and Pregnancy Session during IDEC 2016

Poor nutrition of pregnant mothers may lead
to diabetes in offspring’s- Prof. Hitman

Supplementation with micronutrients like Vitamin D, B12 in
addition to iron-folate could be of potential benefit to the
mother and fetus - Prof. Akhtar Hussain

KARACHI: Prof. Rubina Sohail along with Dr.  Mesbah Kamel from Egypt chaired this session devoted to Diabetes and Pregnancy during the International Conference on Diabetes and Endocrinology 2016 organized by Baqai Institute of Diabetes and Endocrinology at Karachi from August 19-21st 2016.  Prof.  Graham Hitman from UK was the first speaker who talked on “Pregnancy and early Childhood: an opportunity for diabetes prevention. He discussed in detail the global prevalence of Type 2 Diabetes Mellitus and low birth weight related deaths and said that T2DM has a multifactorial etiology.  There are more than one hundred known genes of T2DM. Insulin resistance reduces mass and B cell function. He also discussed obesity, birth weight, fetal progress, maternal events and poor nutrition which may lead to diabetes in offspring’s.

GIFT, he said was an acronym for Genomic and Lifestyle predictors of fetal outcome relevant to diabetes and obesity and their relevance to South Asian People. Diabetes and obesity are disorders which are caused by combination of inherited factors in the genes and a changing environment that involves choosing life style which are known to aggravate the tendency to put on weight, make poor food choices besides less exercise. All these are further aggravated by poverty and rapidly changing life style and in South Asians, it has led to epidemic of diabetes.

Continuing Prof. Hitman said that at present diabetes prevention strategies are focused on adult life and target over nutrition with interventions designed to reduce obesity in high-risk adults. However, many population groups the world over, strategies ignore the important determinant of nutritional deficiencies driven by poverty and rapid westernization.  These conditions are of particular importance during pregnancy and may affect early development stages of the baby’s growth when environmental insults may interact with genetic risk to program the developing baby to later become overweight and develop diabetes and related disorders. The primary goal of GIFT programme, Prof. Hitman remarked was to enhance understanding of the convergence of genetic and environmental factors involved in developing diabetes and obesity and their transmission through parent child unit. Proper intervention has resulted in relative risk reduction of 37% and 27% in maternal mortality and neonatal mortality. Micronutrient deficiency is common in Bangladesh and Pakistanis. Under a special project all pregnant women attend six meetings before delivering a baby. Preventive strategies target all over weight Pakistani, Bangladesh women living in London. A study done in Bangladesh has also shown cardio metabolic benefits in the long term, he added.

Prof. Akhtar Hussain

Prof. Akhtar Hussain from Oslo Norway was the second speaker in this session and his presentation was on Micronutrient intervention in pregnancy and cardio metabolic risk in newborn.  He discussed in detail the fetal under nutrition and maternal demands, placental supply. Many chronic diseases, he opined start in early stage of life in the offspring’s. Underweight mothers have favorable micronutrient status. They give birth of high low birth weight baby as compared to large size babies born to mothers with normal BMI.

Prof. Akhtar Hussain pointed out that in view of the widespread prevalence of micronutrient decencies in developing counties during pregnancy, supplementation with micronutrients like Vitamin D, B12 in addition to iron-folate alone could be of potential benefit to the mother and fetus. Pregnancy is associated with physiologic changes which results in increased plasma volume and red blood cells and decreased concentrations of circulating nutrient binding proteins and micronutrients.  Occurrence of low birth in developing countries varies from 6-30% especially in areas with high rates of maternal under nutrition.  A vast majority of low birth weight, small for gestational age are due to fetal growth problems which occur during pregnancy including intra uterine growth retardation. Supplementation, he opined, could prevent some of these maternal complications and other pregnancy related outcomes like small for gestations age births, low birth weight, still births, perinatal and neonatal mortality.

There is evidence that concentrations of vitamin D can predispose toward diabetes and cardio metabolic diseases. However, safety and effectiveness of vitamin D supplementation in pregnancy has been considered and given from 400-4000 IU daily from 12-16 weeks gestation. Studies have shown that maternal B12 deficiency is associated with hyperhomocysteinaemia and low birth weight.  There is also association between   maternal B12 deficiency and increased insulin resistance and adiposity in the offspring’s. All these issues are being addressed by WHO Guidelines but South Asian women  who are between the extremes of underweight an overweight, and specific nutritional guidelines  for key development regulators such as Vitamin D and Folate and vitamin B12.

Dr. Anders Dejgaard Managing Director WDF, Prof. Chandrika and
Dr. Nusrat Shah photographed during the IDEC 2016 conference.

Currently there are no international guidance on how to achieve optimal conditions during this reproductive and early childhood period. He concluded his presentation by stating that Vitamin D level decrease with advance of pregnancy. There is high deficiency of Vitamin D in first trimester. BMI predicts better birth weight than Vitamin D and B12 levels. There is need to identify normal vitamin D levels in mothers and birth weight in offspring’s. Paucity of birth weight in Asia needs to be identified in South Asian population.

Session on Gestational Diabetes Mellitus

According to another report, Maternal and Child Health (MCH) stream of recently concluded IDEC 2016 arranged a session dedicated to Gestational Diabetes Mellitus (GDM). During the conference. Renowned speakers from abroad and Pakistan delivered lectures covering various aspects of GDM.

Prof. Chandrika N Wijeyaratne from Sri Lanka in her presentation talked about Unifying Maternal and Child health (MCH) with Non Communicable Diseases (NCDS). She discussed in detail the NIROGI Lanka Project (National Initiative to Reinforce and Organize General diabetes Care in Sri Lanka). Through this Project they were able to achieve a common approach to GDM by MCH and NCD programmes at national level; thereby achieving national commitment to universal screening for GDM and sensitizing a life cycle approach to GDM by mother and baby long term follow up.

DrAnders Dejgaard (Managing Director WDF) described the role of World Diabetes Foundation (WDF) in the fight against GDM throughout the world specially focusing on South East Asia with a huge burden of GDM patients.  During his presentation he mentioned various initiatives and projects funded by WDF regarding maternal and child health and GDM. He specifically appreciated the initiatives for GDM taken by Prof. Abdul Basit in Pakistan.

Dr. Ashma Rana (President SAFOG) from Nepal in her presentation highlighted the importance of antenatal care of women with diabetes. She discussed various cases of GDM presenting with complications including eclampsia, hypertensive crises, obstructed labour etc. because of poor antenatal care in these patients. She emphasized on making antenatal care more client friendly giving required time to patients and focusing on counseling.

Prof. Shabeen Naz Masood discussed Screening and diagnostic criteria of GDM, while Dr. Nusrat Shah talked about obstetric management and post-partum follow up of GDM patients.

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