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Maternal Origins of type-2 Diabetes in India (MODI)

Funded By: The Wellcome Trust, UK
Month & Year of Commencement: December 2000
Current Status: Completed

Principal Investigator: Dr.C.S.Yajnik, Director, KEM Hospital and Research Centre, Pune, India
Co-Investigator: Prof. Caroline Fall, Professor of International Paediatric Epidemiology, Southampton General Hospital, UK

» Background
» Objectives
» Methodology and Design
» Results


Recent studies have highlighted associations between maternal factors during pregnancy and adult health. Maternal size and nutrition are important determinants of fetal growth. The Pune Maternal Nutrition Study (PMNS) is a prospective, population-based study of maternal nutrition, pregnancy outcome and cardiovascular risk in the children, being carried out in a rural community in Western India since 1993. At 6 yr 698 (97%) children and their parents (682 mothers and 643 fathers) were followed-up in the MODI study.


  • To study determinants of maternal hyperglycemia 6 years after delivery in the Pune Maternal Nutrition Study (PMNS)
  • To study the effect of maternal B12 and folate status during pregnancy in the Pune maternal nutrition study on the birth size and development of insulin resistance in the offspring at 6 years of age
  • To study the relationship between birth weight, subsequent growth patterns and the development of Insulin resistance and Cardiovascular risks.

Methodology and Design

These mothers underwent an OGTT. They were classified into normoglycemic and hyperglycemic (IFG + IGT + Diabetes) based on the WHO criteria. We analysed their pre-pregnant body composition, intra-partum glucose concentrations and postpartum weight gain as determinants of incident hyperglycemia.

The major findings of MODI were as follows

1. Determinants of hyperglycemic women were:
  • shorter, more obese and more adipose pre-pregnancy
  • physically less active and had higher 2h glucose during pregnancy
  • heavier, more obese and more adipose at 6y
2. Effect of maternal B12 and folate status during pregnancy on the offspring at 6 years of age:
  • High maternal folate and low vitamin B12 status predicted higher insulin resistance in the offspring, adjusted for current size, gender, birth size and socio-economic status. Relation of HOMA was independent of adiposity.
  • High maternal folate predicted higher HDL in the offspring at 6y.
  • Low vitB12 status and normal to high folate status in pregnant mothers predicted larger birth weight in the offspring, and higher insulin resistance (HOMA- R) at 6y.
3. Relationship between birth weight, subsequent growth:
  • Relatively smaller birth weight and rapid childhood growth predicted some CV risk factors at 6y.