Background/Objectives: Vitamin D is required for bone growth and normal insulin secretion. Maternal hypovitaminosis D may impair fetal growth and increase the risk of gestational diabetes. We have related maternal vitamin D status in pregnancy to maternal and newborn glucose and insulin concentrations, and newborn size, in a South Indian population. Subjects/Methods: Serum 25 hydroxy vitamin D (25(OH)D) concentrations, glucose tolerance, and plasma insulin, proinsulin and 32-33 split proinsulin concentrations were measured at 30 weeks gestation in 559 women who delivered at the Holdsworth Memorial Hospital, Mysore. The babies' anthropometry and cord plasma glucose, insulin and insulin precursor concentrations were measured. Results: In total 66% of women had hypovitaminosis D (25(OH)D concentrations o50 nmol l À1 ) and 31% were below 28 nmol l À1 . There was seasonal variation in 25(OH)D concentrations (Po0.0001). There was no association between maternal 25(OH)D and gestational diabetes (incidence 7% in women with and without hypovitaminosis D). Maternal 25(OH)D concentrations were unrelated to newborn anthropometry or cord plasma variables. In mothers with hypovitaminosis D, higher 25(OH)D concentrations were associated with lower 30-min glucose concentrations (P ¼ 0.03) and higher fasting proinsulin concentrations (P ¼ 0.04). Conclusions: Hypovitaminosis D at 30 weeks gestation is common in Mysore mothers. It is not associated with an increased risk of gestational diabetes, impaired fetal growth or altered neonatal cord plasma insulin secretory profile.

Aim-To test the hypothesis that low plasma vitamin B12 concentrations combined with high folate concentrations in pregnancy are associated with higher incidence of gestational diabetes (GDM) and later diabetes.Methods-Women (N=785) attending the antenatal clinics of the Holdsworth Memorial Hospital, Mysore, India had their anthropometry, insulin resistance (Homeostasis Model Assessment) and glucose tolerance assessed at 30 weeks gestation (100g Oral Glucose Tolerance Test/ OGTT; Carpenter-Coustan criteria), and five years after delivery (75g OGTT, WHO 1999). Vitamin B12 and folate concentrations in pregnancy were measured in stored frozen plasma samples.Results-Low vitamin B12 concentrations (<150 pmol/l, B12 deficiency) were observed in 43% of women and low folate concentrations (<7 nmol/l) in 4%. Women with vitamin B12 deficiency had higher body mass index (BMI; P<0.001), sum of skinfolds (P<0.001), insulin resistance (P=0.02) and a higher incidence of GDM (8.7% v 4.6%; OR=2.14, P=0.02; P=0.1 after adjusting for maternal BMI) than non-deficient women. Among vitamin B12-deficient women the incidence of GDM increased with folate concentration (5.6%, 8.8%, 12.8% respectively from lowest to highest third; P for interaction=0.2). B12 deficiency during pregnancy predicted larger skinfolds, increased insulin resistance (P<0.05) and incident diabetes at 5-year follow-up (P=0.02, after adjusting for current BMI).Conclusion-Maternal vitamin B12 deficiency is associated with increased adiposity and, in turn, with increased insulin resistance and GDM, especially in the presence of high folate concentrations. Vitamin B12 deficiency may be an important factor underlying the high risk of diabesity in south Asian Indians.

OBJECTIVETo test the hypothesis that maternal gestational diabetes increases cardiovascular risk markers in Indian children.RESEARCH DESIGN AND METHODSAnthropometry, blood pressure, and glucose/insulin concentrations were measured in 514 children at 5 and 9.5 years of age (35 offspring of diabetic mothers [ODMs], 39 offspring of diabetic fathers [ODFs]). Children of nondiabetic parents were control subjects.RESULTSAt age 9.5 years, female ODMs had larger skinfolds (P < 0.001), higher glucose (30 min) and insulin concentrations, and higher homeostasis model assessment (HOMA) of insulin resistance and systolic blood pressure (P < 0.05) than control subjects. Male ODMs had higher HOMA (P < 0.01). Associations were stronger than at age 5 years. Female ODFs had larger skinfolds and male ODFs had higher HOMA (P < 0.05) than control subjects; associations were weaker than for ODMs. Associations between outcomes in control subjects and parental BMI, glucose, and insulin concentrations were similar for mothers and fathers.CONCLUSIONSThe intrauterine environment experienced by ODMs increases diabetes and cardiovascular risk over genetic factors; the effects strengthen during childhood.

Intrauterine exposure to low 25(OH)D concentrations is associated with less muscle mass and higher insulin resistance in children.

OBJECTIVE -The purpose of this study was to test the hypothesis that the environment experienced by fetuses of mothers with gestational diabetes mellitus (GDM) and mothers with higher glucose concentrations that are in the normal range causes increased adiposity and altered glucose/insulin metabolism in childhood.RESEARCH DESIGN AND METHODS -Children (n ϭ 630) whose mothers were tested for glucose tolerance during pregnancy had detailed anthropometry performed at birth and annually thereafter. At 5 years, plasma glucose and insulin concentrations were measured in the children (2-h oral glucose tolerance test) and their fathers (fasting samples only).RESULTS -Newborns of diabetic mothers (n ϭ 41) were larger in all body measurements than control newborns (babies with nondiabetic parents). At 1 year, these differences had diminished and were not statistically significant. At 5 years, female offspring of diabetic mothers had larger subscapular and triceps skinfold thicknesses (P ϭ 0.01) and higher 30-and 120-min insulin concentrations (P Ͻ 0.05) than control children. Offspring of diabetic fathers (n ϭ 41) were lighter at birth than control children (P Ͻ 0.001); they showed no differences in anthropometry at 5 years. In control children, skinfold thickness and 30-min insulin concentrations were positively related to maternal insulin area under the curve, and skinfold thicknesses were related to paternal fasting insulin concentrations independently of the parents' skinfold thickness and socioeconomic status.CONCLUSIONS -Maternal GDM is associated with adiposity and higher glucose and insulin concentrations in female offspring at 5 years. The absence of similar associations in offspring of diabetic fathers suggests a programming effect in the diabetic intrauterine environment. More research is needed to determine whether higher maternal glucose concentrations in the nondiabetic range have similar effects. Diabetes Care 28:2919 -2925, 2005T he prevalence of type 2 diabetes is escalating in developing countries undergoing the "epidemiologic transition." India is predicted to have 79 million people with type 2 diabetes by the year 2030 (32 million in 2000) (1). Studies in western populations, predominantly among the Pima Indian communities of North America, have shown that individuals whose mothers were diabetic when they were in utero have an increased risk of early obesity and impaired glucose tolerance (IGT) and type 2 diabetes in adult life (2-4). The risk is increased compared with offspring of diabetic fathers and siblings born before the onset of maternal diabetes (3,5), suggesting that it results from the fetal environment in gestational diabetes mellitus (GDM) rather than from genes. Even in nondiabetic pregnancies, variations within the normal range of maternal fasting glucose concentrations are associated with altered neonatal adiposity (6). It is not known whether this is associated with changes in later body size and glucose/insulin concentrations in the offspring.There are few data from India on the preval...

People with schizophrenia are at greater risk of obesity, Type 2 diabetes, dyslipidaemia and hypertension than the general population. This results in an increased incidence of cardiovascular disease (CVD) and reduced life expectancy, over and above that imposed by their mental illness through suicide. Several levels of evidence from data linkage analyses to clinical trials demonstrate that treatment-related metabolic disturbances are commonplace in this patient group, and that the use of certain second-generation antipsychotics may compound the risk of developing the metabolic syndrome and CVD. In addition, smoking, poor diet, reduced physical activity and alcohol or drug abuse are prevalent in people with schizophrenia and contribute to the overall CVD risk. Management and minimization of metabolic risk factors are pertinent when providing optimal care to patients with schizophrenia. This review recommends a framework for the assessment, monitoring and management of patients with schizophrenia in the UK clinical setting.

The incidence of gestational diabetes was high in this unselected sample of mothers booking into one urban Indian maternity unit. Community-based studies are required to confirm this. The effect of maternal glucose concentrations on neonatal anthropometry is continuous and extends into the "normal" glycemic range.

Aims/hypothesis Our aim was to test the hypothesis that gestational diabetes mellitus (GDM) in mothers is associated with poorer cognitive ability in their offspring in India. Methods During 1997 to 1998 maternal GDM status was assessed by OGTT at 30±2 weeks of gestation. Between 2007 and 2008, at a mean age of 9.7 years, 515 children (32 offspring of GDM mothers [ODM]; 483 offspring of non-GDM mothers [controls]) from the Mysore Parthenon birth cohort underwent cognitive function assessment using tests from the Kaufman Assessment Battery for ChildrenSecond Edition and additional tests measuring learning, long-term storage/retrieval, short-term memory, reasoning, attention and concentration, and visuo-spatial and verbal abilities. Results Compared with controls, ODM scored higher in tests for learning, long-term retrieval/storage (p=0.008), reasoning (p=0.02), verbal ability (p=0.01), and attention and concentration (p=0.003). In multiple regression, adjusted for the child's age, sex, gestation, neonatal weight and head circumference, maternal age, parity and BMI, and the parent's socioeconomic status, education and rural/urban residence, this difference remained significant only for learning, long-term retrieval/storage (β=0.4 SD (95% CI 0.01-0.75); p=0.04) and verbal ability (β=0.5 SD (95% CI 0.09-0.83); p=0.02), and not with other test scores. Conclusions/interpretation In this population of healthy Indian children, there was no evidence of lower cognitive ability in ODM. In fact some cognitive scores were higher in ODM.