Preventing diabetes before birth, to offer hope for future generations

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.

Intrauterine origins

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.

Why timing matters

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.

This biological insight has profound clinical implications. Conventional screening for gestational diabetes typically occurs in the second trimester. By then, foetal programming may already have occurred. A shift in strategy is therefore warranted: screening and intervention must occur in the first trimester — ideally by the 8th week of pregnancy.

Practical, scalable approach

A simple two-hour postprandial blood glucose (PPBG) test at eight weeks of pregnancy could serve as an early warning marker. If levels exceed 110 mg/dL, the condition may be classified as Early Gestational Glucose Intolerance (EGGI) — a pre-GDM stage.

Crucially, this creates a narrow but actionable window of approximately two weeks to normalise maternal glucose levels before the 10th week of gestation. Medical nutrition therapy, lifestyle modification, and, where appropriate, low-dose metformin under supervision can help achieve a target PPBG below 110 mg/dL. Such an approach is not technology-intensive. It does not rely on expensive biomarkers. It is feasible even within district hospitals and primary health systems, provided early antenatal registration becomes universal.

Also Read: Navigating pregnancy sugar level changes and managing gestational diabetes

Evidence from India

Recent multicentre work conducted between 2022 and 2024 at Madras Medical College and Lady Hardinge Medical College, New Delhi, has provided supportive evidence for early prediction and intervention. The findings suggest that first-trimester identification of elevated postprandial glucose can help reduce progression to overt GDM. For a country managing an escalating non-communicable disease crisis, the implications are significant.

A policy opportunity

India has successfully implemented large-scale preventive programmes in the past — from polio elimination to expanded immunisation coverage. A national policy mandating universal early pregnancy glucose screening could represent a similarly transformative intervention.

Three measures merit consideration: Preconception counselling to optimise metabolic health, mandatory antenatal registration by eight weeks, and universal first-trimester postprandial glucose testing.

The long-term dividends could extend beyond reducing GDM incidence. By interrupting intergenerational metabolic transmission, India could reduce future diabetes prevalence, cardiovascular disease burden, and associated healthcare expenditure.

Focus on future

India intends to transform into a fully-developed nation by 2047, and conversations around development must include measurable improvements in population health. Preventing diabetes before birth is not an abstract aspiration; it is a scientifically-grounded strategy rooted in foetal physiology.

If implemented with seriousness and at scale, early gestational screening may help bend the diabetes curve downward — not over decades, but across generations. The most powerful diabetes prevention strategy may not begin in clinics treating adults. It may begin in antenatal clinics — within the first 10 weeks of life.

(Dr. V. Seshiah is founder and patron of the Diabetes in Pregnancy Study Group India, vseshiah@gmail.com; Dr. Anjalakshi C. is a senior consultant in obstetrics and gynaecology, dranjalakshi@gmail.com, Dr. Pikee Saxena, is director-professor, department of obstetrics and gynaecology, Lady Hardinge Medical College, New Delhi. pikeesaxena@gmail.com)

Published – March 06, 2026 06:00 am IST