Preventing diabetes before birth, to offer hope for future generations Premium

Transform diabetes prevention by screening in early pregnancy, safeguarding future generations from metabolic diseases.

India stands at a defining public health crossroads. With 101 million people living with diabetes and another 136 million classified as prediabetic, the country carries one of the heaviest burdens of metabolic disease in the world. According to the International Diabetes Federation, global diabetes numbers are projected to rise to 783 million by 2045. India’s share of that burden will be substantial unless prevention strategies move upstream — further upstream than they are now.

The critical intervention point may not lie in adulthood, adolescence, or even childhood. It may lie in the earliest weeks of pregnancy.

Gestational Diabetes Mellitus (GDM), defined as glucose intolerance first detected during pregnancy, affects nearly one in five pregnancies globally. Though often perceived as transient, its implications are enduring. Women with GDM face a significantly increased risk of developing type 2 diabetes later in life. More concerning is the risk passed on to their children.

The concept of “foetal programming” — often linked to the foetal origins hypothesis — explains how adverse metabolic conditions in utero can permanently alter a child’s physiology. When a foetus is exposed to the mother’s high blood sugar, it responds by increasing insulin production. This early metabolic adaptation predisposes the child to obesity, insulin resistance, and diabetes in adulthood.

In effect, diabetes risk is not merely inherited genetically; it is metabolically programmed.

Emerging evidence, including analyses supported by the United States’ National Institutes of Health, suggests that foetal pancreatic beta cells begin insulin secretion around the 11th week of gestation. If maternal blood glucose levels are elevated before this period, foetal hyperinsulinaemia may become established — setting in motion long-term metabolic consequences.