Dr SR Veena Research
Fellow, Holdsworth Memorial Hospital, Mysore Dr BDR Paul Former Medical
Director, Holdsworth Memorial Hospital, Mysore Dr Caroline Fall Reader, MRC Environmental Epidemiology
Unit,
University
of Southampton, UK Dr Claudia Stein Coordinator - WHO leadership course. Dr K Kumaran Research Fellow, Holdsworth
memorial Hospital, Mysore Dr Prasad Karat
The Holdsworth Memorial Hospital (HMH) is one of few hospitals in India
to have preserved obstetric records for more than 60 years. Birth records
survive for all babies born in the hospital since 1934. These record
the parents' names, address, religion and caste, father's occupation,
the mother's obstetric history, weight at booking and pelvic diameters,
and the baby's date of birth, sex, birthweight, length and head circumference.
As the years went by, the recorded information changed: maternal height
replaced pelvic diameters, and placental weight was also recorded.
HMH
The
obstetric records
Research using these records began in 1993. It was possible to trace
men and women born in the hospital by carrying out a house-to-house
census of an area of Mysore City immediately surrounding the hospital.
They were matched to their birth records using a strict algorithm including
the parents' names, religion and address, the number and order of older
siblings (matched to the mother's recorded obstetric history) and their
age and sex. The first study traced men and women born during 1934-1953,
and measured the prevalence of coronary heart disease and a range of
cardiovascular risk factors including blood pressure, glucose and insulin
concentrations, serum lipids, plasma fibrinogen. Subsequent studies
have traced younger men and women, and children, and people whose parents
were born in the hospital.
Tracing
Clinic
Clinic (children)
The main findings so far:
Low birthweight, short birthlength, and small head circumference
at birth, and low maternal weight were associated with an increased
risk of coronary heart disease after 45 years of age1.
Low birthweight was associated with poorer adult lung function2,
and (in men) higher insulin resistance (HOMA)3.
Unlike western populations there was no link between low birthweight
and raised blood pressure.
Unlike western populations, low birthweight was not associated with
Type2 diabetes - this was linked with short birthlength and high ponderal
index and birth, and high, maternal weight and pelvic diameters3.
Low birthweight was not associated with increased left ventricular
mass or reduced arterial compliance4.
These findings suggested that low birthweight and low maternal weight
lead to an increased risk of adult insulin resistance and cardiovascular
disease in Indian populations, not mediated by raised blood pressure,
left ventricular mass or reduced arterial elasticity. The link between
higher maternal weight and Type 2 diabetes in the offspring hinted at
an effect of maternal gestational diabetes (Figure A).
Research team, Mysore
1.
Stein C, Fall CHD, Kumaran K, Osmond C, Cox V, Barker DJP. Fetal growth and coronary heart disease in South India. Lancet 1996;348:1269-73.
2.
Stein CE, Kumaran K, Fall CHD, Shaheen S, Osmond C, Barker DJP. Relation of fetal growth to adult lung function in South India. Thorax 1997;52:895-9.
3.
Fall CHD, Stein C, Kumaran K, Cox V, Osmond C, Barker DJP, Hales CN. Size at birth, maternal weight, and non-insulin-dependent diabetes (NIDDM) in South Indian adults. Diabetic Medicine 1998;15:220-7.
4.
Kumaran K, Fall CHD, Martyn CN, Vijayakumar M, Stein CE, Shier R. Blood pressure, arterial compliance and left ventricular mass; no relation to small size at birth in South Indian adults. Heart 2000;83:272-7.
5.
Ward AMV, Fall CHD, Stein CE, Kumaran K, Veena SR, Wood PJ, Syddall HE, Phillips DIW. Cortisol and the metabolic syndrome in South Asians. Clin Endocrinol 2003:58:500-505.
6.
Veena SR, Kumaran K, Swarnagowri MN, Jayakumar MN, Leary SD, Stein CE, Cox V, Fall CHD. Intergenerational effects on size at birth in South India . Paed Perinatal Epidemiol 2004 (in press).
The study is funded by MRC Southampton and Department for International Development.
B) Gestational diabetes
- the Mysore Parthenon Study
Dr Jacqui Hill
Research Fellow, MRC Environmental Epidemiology Unit, University
of Southampton, UK Dr GV Krishnaveni Research fellow, Holdsworth Memorial
Hospital, Mysore Dr Prasad Karat Head, Department
of Paediatrics, Holdsworth Memorial Hospital, Mysore Dr Caroline Fall Reader, MRC Environmental Epidemiology Unit,
University of Southampton, UK
Studies using the old birth records suggested that gestational diabetes
may be an important factor in the inter-generational transmission of
Type 2 diabetes in Indian populations. The Parthenon study was set up
to study this. 832 mothers were recruited consecutively at the HMH ante-natal
clinic, and had an oral glucose tolerance test at 30 weeks gestation.
676 mothers delivered at HMH.
The main findings were1:
The prevalence of gestational diabetes was high at 6%.
Babies born to mothers with diabetes were larger in all birth dimensions,
especially body fat, but also skeletal measurements. Even among non-diabetic
mothers there were effects of maternal glucose concentrations on neonatal
anthropometry.
Mothers who had a low birthweight, or who had short adult stature,
were more likely to develop diabetes in pregnancy.
The Parthenon children are being followed up annually by Dr GV Krishnaveni,
to measure growth and development2.
Parthenon follow-up clinic
The Parthenon children are being followed up to assess the effects of the mother's diabetes and glucose/insulin metabolism on the childrens' growth and health. The childrens' glucose tolerance, insulin concentrations and body composition have been measured at the age of 5 years the results will be available in 2005.
1.
Hill JC, Krishnaveni GV, Fall CHD, Kellingray
SD. Glucose tolerance and insulin status during pregnancy in South
India: relationships to maternal and neonatal body composition.
J Endocrinol 2000;164 (Suppl): P252.
2.
Krishnaveni GV, Hill JC, Fall CHD, Kellingray
S, Sreenivas S. Maternal diabetes during pregnancy: relationships
to body composition at birth, one year and two years of age. First
World Congress on the Fetal Origins of Adult Disease, Mumbai, India,
Feb 2001; Pediatric Research 2001;50:20A.
3
Hill JC, Krishnaveni GV, Annamma I, Leary S, Fall CHD. Glucose tolerance in pregnancy in South India ; relationships to neonatal anthropometry. Acta Obstet Gynecol Scand 2004 (in press).
The projects in Mysore have been funded by the Medical Research Council
(UK), the Wellcome Trust, DFID and the Parthenon Trust.
