\documentclass[11pt,twoside]{article}\makeatletter \IfFileExists{xcolor.sty}% {\RequirePackage{xcolor}}% {\RequirePackage{color}} \usepackage{colortbl} \usepackage{wrapfig} \usepackage{ifxetex} \ifxetex \usepackage{fontspec} \usepackage{xunicode} \catcode`⃥=\active \def⃥{\textbackslash} \catcode`❴=\active \def❴{\{} \catcode`❵=\active \def❵{\}} \def\textJapanese{\fontspec{Noto Sans CJK JP}} \def\textChinese{\fontspec{Noto Sans CJK SC}} \def\textKorean{\fontspec{Noto Sans CJK KR}} \setmonofont{DejaVu Sans Mono} \else \IfFileExists{utf8x.def}% {\usepackage[utf8x]{inputenc} \PrerenderUnicode{–} }% {\usepackage[utf8]{inputenc}} \usepackage[english]{babel} \usepackage[T1]{fontenc} \usepackage{float} \usepackage[]{ucs} \uc@dclc{8421}{default}{\textbackslash } \uc@dclc{10100}{default}{\{} \uc@dclc{10101}{default}{\}} \uc@dclc{8491}{default}{\AA{}} \uc@dclc{8239}{default}{\,} \uc@dclc{20154}{default}{ } \uc@dclc{10148}{default}{>} \def\textschwa{\rotatebox{-90}{e}} \def\textJapanese{} \def\textChinese{} \IfFileExists{tipa.sty}{\usepackage{tipa}}{} \fi \def\exampleFont{\ttfamily\small} \DeclareTextSymbol{\textpi}{OML}{25} \usepackage{relsize} \RequirePackage{array} \def\@testpach{\@chclass \ifnum \@lastchclass=6 \@ne \@chnum \@ne \else \ifnum \@lastchclass=7 5 \else \ifnum \@lastchclass=8 \tw@ \else \ifnum \@lastchclass=9 \thr@@ \else \z@ \ifnum \@lastchclass = 10 \else \edef\@nextchar{\expandafter\string\@nextchar}% \@chnum \if \@nextchar c\z@ \else \if \@nextchar l\@ne \else \if \@nextchar r\tw@ \else \z@ \@chclass \if\@nextchar |\@ne \else \if \@nextchar !6 \else \if \@nextchar @7 \else \if \@nextchar (8 \else \if \@nextchar )9 \else 10 \@chnum \if \@nextchar m\thr@@\else \if \@nextchar p4 \else \if \@nextchar b5 \else \z@ \@chclass \z@ \@preamerr \z@ \fi \fi \fi \fi \fi \fi \fi \fi \fi \fi \fi \fi \fi \fi \fi \fi} \gdef\arraybackslash{\let\\=\@arraycr} \def\@textsubscript#1{{\m@th\ensuremath{_{\mbox{\fontsize\sf@size\z@#1}}}}} \def\Panel#1#2#3#4{\multicolumn{#3}{){\columncolor{#2}}#4}{#1}} \def\abbr{} \def\corr{} \def\expan{} \def\gap{} \def\orig{} \def\reg{} \def\ref{} \def\sic{} \def\persName{}\def\name{} \def\placeName{} \def\orgName{} \def\textcal#1{{\fontspec{Lucida Calligraphy}#1}} \def\textgothic#1{{\fontspec{Lucida Blackletter}#1}} \def\textlarge#1{{\large #1}} \def\textoverbar#1{\ensuremath{\overline{#1}}} \def\textquoted#1{‘#1’} \def\textsmall#1{{\small #1}} \def\textsubscript#1{\@textsubscript{\selectfont#1}} \def\textxi{\ensuremath{\xi}} \def\titlem{\itshape} \newenvironment{biblfree}{}{\ifvmode\par\fi } \newenvironment{bibl}{}{} \newenvironment{byline}{\vskip6pt\itshape\fontsize{16pt}{18pt}\selectfont}{\par } \newenvironment{citbibl}{}{\ifvmode\par\fi } \newenvironment{docAuthor}{\ifvmode\vskip4pt\fontsize{16pt}{18pt}\selectfont\fi\itshape}{\ifvmode\par\fi } \newenvironment{docDate}{}{\ifvmode\par\fi } \newenvironment{docImprint}{\vskip 6pt}{\ifvmode\par\fi } \newenvironment{docTitle}{\vskip6pt\bfseries\fontsize{22pt}{25pt}\selectfont}{\par } \newenvironment{msHead}{\vskip 6pt}{\par} \newenvironment{msItem}{\vskip 6pt}{\par} \newenvironment{rubric}{}{} \newenvironment{titlePart}{}{\par } \newcolumntype{L}[1]{){\raggedright\arraybackslash}p{#1}} \newcolumntype{C}[1]{){\centering\arraybackslash}p{#1}} \newcolumntype{R}[1]{){\raggedleft\arraybackslash}p{#1}} \newcolumntype{P}[1]{){\arraybackslash}p{#1}} \newcolumntype{B}[1]{){\arraybackslash}b{#1}} \newcolumntype{M}[1]{){\arraybackslash}m{#1}} \definecolor{label}{gray}{0.75} \def\unusedattribute#1{\sout{\textcolor{label}{#1}}} \DeclareRobustCommand*{\xref}{\hyper@normalise\xref@} \def\xref@#1#2{\hyper@linkurl{#2}{#1}} \begingroup \catcode`\_=\active \gdef_#1{\ensuremath{\sb{\mathrm{#1}}}} \endgroup \mathcode`\_=\string"8000 \catcode`\_=12\relax \usepackage[a4paper,twoside,lmargin=1in,rmargin=1in,tmargin=1in,bmargin=1in,marginparwidth=0.75in]{geometry} \usepackage{framed} \definecolor{shadecolor}{gray}{0.95} \usepackage{longtable} \usepackage[normalem]{ulem} \usepackage{fancyvrb} \usepackage{fancyhdr} \usepackage{graphicx} \usepackage{marginnote} \renewcommand{\@cite}[1]{#1} \renewcommand*{\marginfont}{\itshape\footnotesize} \def\Gin@extensions{.pdf,.png,.jpg,.mps,.tif} \pagestyle{fancy} \usepackage[pdftitle={A Step towards Strategy for Prevention of Diabetes}, pdfauthor={}]{hyperref} \hyperbaseurl{} \paperwidth210mm \paperheight297mm \def\@pnumwidth{1.55em} \def\@tocrmarg {2.55em} \def\@dotsep{4.5} \setcounter{tocdepth}{3} \clubpenalty=8000 \emergencystretch 3em \hbadness=4000 \hyphenpenalty=400 \pretolerance=750 \tolerance=2000 \vbadness=4000 \widowpenalty=10000 \renewcommand\section{\@startsection {section}{1}{\z@}% {-1.75ex \@plus -0.5ex \@minus -.2ex}% {0.5ex \@plus .2ex}% {\reset@font\Large\bfseries}} \renewcommand\subsection{\@startsection{subsection}{2}{\z@}% {-1.75ex\@plus -0.5ex \@minus- .2ex}% {0.5ex \@plus .2ex}% {\reset@font\Large}} \renewcommand\subsubsection{\@startsection{subsubsection}{3}{\z@}% {-1.5ex\@plus -0.35ex \@minus -.2ex}% {0.5ex \@plus .2ex}% {\reset@font\large}} \renewcommand\paragraph{\@startsection{paragraph}{4}{\z@}% {-1ex \@plus-0.35ex \@minus -0.2ex}% {0.5ex \@plus .2ex}% {\reset@font\normalsize}} \renewcommand\subparagraph{\@startsection{subparagraph}{5}{\parindent}% {1.5ex \@plus1ex \@minus .2ex}% {-1em}% {\reset@font\normalsize\bfseries}} \def\l@section#1#2{\addpenalty{\@secpenalty} \addvspace{1.0em plus 1pt} \@tempdima 1.5em \begingroup \parindent \z@ \rightskip \@pnumwidth \parfillskip -\@pnumwidth \bfseries \leavevmode #1\hfil \hbox to\@pnumwidth{\hss #2}\par \endgroup} \def\l@subsection{\@dottedtocline{2}{1.5em}{2.3em}} \def\l@subsubsection{\@dottedtocline{3}{3.8em}{3.2em}} \def\l@paragraph{\@dottedtocline{4}{7.0em}{4.1em}} \def\l@subparagraph{\@dottedtocline{5}{10em}{5em}} \@ifundefined{c@section}{\newcounter{section}}{} \@ifundefined{c@chapter}{\newcounter{chapter}}{} \newif\if@mainmatter \@mainmattertrue \def\chaptername{Chapter} \def\frontmatter{% \pagenumbering{roman} \def\thechapter{\@roman\c@chapter} \def\theHchapter{\roman{chapter}} \def\thesection{\@roman\c@section} \def\theHsection{\roman{section}} \def\@chapapp{}% } \def\mainmatter{% \cleardoublepage \def\thechapter{\@arabic\c@chapter} \setcounter{chapter}{0} \setcounter{section}{0} \pagenumbering{arabic} \setcounter{secnumdepth}{6} \def\@chapapp{\chaptername}% \def\theHchapter{\arabic{chapter}} \def\thesection{\@arabic\c@section} \def\theHsection{\arabic{section}} } \def\backmatter{% \cleardoublepage \setcounter{chapter}{0} \setcounter{section}{0} \setcounter{secnumdepth}{2} \def\@chapapp{\appendixname}% \def\thechapter{\@Alph\c@chapter} \def\theHchapter{\Alph{chapter}} \appendix } \newenvironment{bibitemlist}[1]{% \list{\@biblabel{\@arabic\c@enumiv}}% {\settowidth\labelwidth{\@biblabel{#1}}% \leftmargin\labelwidth \advance\leftmargin\labelsep \@openbib@code \usecounter{enumiv}% \let\p@enumiv\@empty \renewcommand\theenumiv{\@arabic\c@enumiv}% }% \sloppy \clubpenalty4000 \@clubpenalty \clubpenalty \widowpenalty4000% \sfcode`\.\@m}% {\def\@noitemerr {\@latex@warning{Empty `bibitemlist' environment}}% \endlist} \def\tableofcontents{\section*{\contentsname}\@starttoc{toc}} \parskip0pt \parindent1em \def\Panel#1#2#3#4{\multicolumn{#3}{){\columncolor{#2}}#4}{#1}} \newenvironment{reflist}{% \begin{raggedright}\begin{list}{} {% \setlength{\topsep}{0pt}% \setlength{\rightmargin}{0.25in}% \setlength{\itemsep}{0pt}% \setlength{\itemindent}{0pt}% \setlength{\parskip}{0pt}% \setlength{\parsep}{2pt}% \def\makelabel##1{\itshape ##1}}% } {\end{list}\end{raggedright}} \newenvironment{sansreflist}{% \begin{raggedright}\begin{list}{} {% \setlength{\topsep}{0pt}% \setlength{\rightmargin}{0.25in}% \setlength{\itemindent}{0pt}% \setlength{\parskip}{0pt}% \setlength{\itemsep}{0pt}% \setlength{\parsep}{2pt}% \def\makelabel##1{\upshape ##1}}% } {\end{list}\end{raggedright}} \newenvironment{specHead}[2]% {\vspace{20pt}\hrule\vspace{10pt}% \phantomsection\label{#1}\markright{#2}% \pdfbookmark[2]{#2}{#1}% \hspace{-0.75in}{\bfseries\fontsize{16pt}{18pt}\selectfont#2}% }{} \def\TheFullDate{2020 2020-01-15 (revised: 46 Year 2020 15 January 2020)} \def\TheID{\makeatother } \def\TheDate{2020 2020-01-15} \title{A Step towards Strategy for Prevention of Diabetes} \author{}\makeatletter \makeatletter \newcommand*{\cleartoleftpage}{% \clearpage \if@twoside \ifodd\c@page \hbox{}\newpage \if@twocolumn \hbox{}\newpage \fi \fi \fi } \makeatother \makeatletter \thispagestyle{empty} \markright{\@title}\markboth{\@title}{\@author} \renewcommand\small{\@setfontsize\small{9pt}{11pt}\abovedisplayskip 8.5\p@ plus3\p@ minus4\p@ \belowdisplayskip \abovedisplayskip \abovedisplayshortskip \z@ plus2\p@ \belowdisplayshortskip 4\p@ plus2\p@ minus2\p@ \def\@listi{\leftmargin\leftmargini \topsep 2\p@ plus1\p@ minus1\p@ \parsep 2\p@ plus\p@ minus\p@ \itemsep 1pt} } \makeatother \fvset{frame=single,numberblanklines=false,xleftmargin=5mm,xrightmargin=5mm} \fancyhf{} \setlength{\headheight}{14pt} \fancyhead[LE]{\bfseries\leftmark} \fancyhead[RO]{\bfseries\rightmark} \fancyfoot[RO]{} \fancyfoot[CO]{\thepage} \fancyfoot[LO]{\TheID} \fancyfoot[LE]{} \fancyfoot[CE]{\thepage} \fancyfoot[RE]{\TheID} \hypersetup{citebordercolor=0.75 0.75 0.75,linkbordercolor=0.75 0.75 0.75,urlbordercolor=0.75 0.75 0.75,bookmarksnumbered=true} \fancypagestyle{plain}{\fancyhead{}\renewcommand{\headrulewidth}{0pt}} \date{} \usepackage{authblk} \providecommand{\keywords}[1] { \footnotesize \textbf{\textit{Index terms---}} #1 } \usepackage{graphicx,xcolor} \definecolor{GJBlue}{HTML}{273B81} \definecolor{GJLightBlue}{HTML}{0A9DD9} \definecolor{GJMediumGrey}{HTML}{6D6E70} \definecolor{GJLightGrey}{HTML}{929497} \renewenvironment{abstract}{% \setlength{\parindent}{0pt}\raggedright \textcolor{GJMediumGrey}{\rule{\textwidth}{2pt}} \vskip16pt \textcolor{GJBlue}{\large\bfseries\abstractname\space} }{% \vskip8pt \textcolor{GJMediumGrey}{\rule{\textwidth}{2pt}} \vskip16pt } \usepackage[absolute,overlay]{textpos} \makeatother \usepackage{lineno} \linenumbers \begin{document} \author[1]{Vijayam Balaji} \author[2]{Veeraswamy Seshiah} \author[3]{Madhuri S. Balaji} \author[4]{N. Bhavatharani} \author[5]{C. Anjalakshi} \author[6]{A. Paneerselvam} \renewcommand\Authands{ and } \date{\small \em Received: 13 December 2019 Accepted: 1 January 2020 Published: 15 January 2020} \maketitle \begin{abstract} Pre-Life exposure relates to development during the time preceding the first appearance of life, a time course from ?conception to confinement?. From single cell zygote to finally formed fetus at confinement, a remarkable change occurs due to maternal fuels and hormonal influence on the fetal development. The crucial period in the fetal development is the first trimester. Early exposure to aberrant maternal metabolism in the embryonic developmental stage would result in congenital malformation and fetal wastage. Maintaining maternal glucose at the recommended level of fasting80 â??" 90 mg (4.4 â??" 5.0 mmol/dl) and 2hr postprandial plasma glucose 110 â??" 120 mg/dl (6.1 -6.7 mm0l/dl) during preconceptional period and throughout pregnancy is the assurance for the healthy offspring with ideal birth weight of 2.5 to 3.5 kg and breastfeeding is ?a step towards strategy forprevention of diabetes?. \end{abstract} \keywords{gestational diabetes mellitus; fetal maturation; maternal hyperglycaemia.} \begin{textblock*}{18cm}(1cm,1cm) % {block width} (coords) \textcolor{GJBlue}{\LARGE Global Journals \LaTeX\ JournalKaleidoscope\texttrademark} \end{textblock*} \begin{textblock*}{18cm}(1.4cm,1.5cm) % {block width} (coords) \textcolor{GJBlue}{\footnotesize \\ Artificial Intelligence formulated this projection for compatibility purposes from the original article published at Global Journals. However, this technology is currently in beta. \emph{Therefore, kindly ignore odd layouts, missed formulae, text, tables, or figures.}} \end{textblock*} \let\tabcellsep& \section[{Introduction}]{Introduction}\par he prevalence of diabetes is increasing globally from 463 million in 2019 to 700 million in 2045a 51\% increase \hyperref[b0]{1} . While several reasons are ascribed for this rising trend including aging population, urbanization, genetic predisposition, nutrition and lifestyle transition, etc., one factor that has not received adequate attention is Gestational Diabetes Mellitus (GDM) currently coined as Hyperglycemia in Pregnancy (HIP) which is defined as any degree of glucose intolerance with onset or first recognition during pregnancy \hyperref[b1]{2} . GDM may play a crucial role in the increasing prevalence of diabetes and obesity \hyperref[b2]{3} . In 2019 the global prevalence of Hyperglycemia in Pregnancy (HIP) in the age group 20-49 years was estimated to be 20.4 million or 15.8\% of live births \hyperref[b0]{1} . They had some form of hyperglycemia in pregnancy, of which 83.6\% were due to GDM \hyperref[b0]{1} . Hence, it has become necessary that all pregnant women should be screened for GDM, even if they have no symptoms \hyperref[b3]{4} . \section[{II.}]{II.} \section[{Intra Uterine Programming}]{Intra Uterine Programming}\par David Barker hypothesized that all adult diseases are of fetal origin. The human body's susceptibility to "lifestyle" disease(s) was "programmed intrauterine". The Intrauterine programming, that is Gestational programming is a process whereby stimuli (hyperglycemia) or stresses that occur at critical or sensitive periods of fetal development, permanently change structure, physiology, and metabolism, which predispose individuals to disease in adult life, "Fetal Origin of Adult Diseases 5 ". \section[{III. Maternal Hyperglycemia \& Progeny}]{III. Maternal Hyperglycemia \& Progeny}\par Exposure to a diabetic environment in utero is associated with increased occurrence of impaired glucose tolerance and a defective insulin secretary response in adult offsprings, independent of genetic predisposition to type 2 diabetes \hyperref[b5]{6} . The ovum is well supplied with mitochondria but the sperm contains a few and even those few do not persist in the offspring. At fertilization it is only the nucleus of the spermatozoon that enters the ovum and thus all the cytoplasm, mitochondria and mitochondrial DNA are exclusively maternally inherited \hyperref[b6]{7} . Maternal inheritance is attributed to mutation in the gene(s) present on mitochondrial (mt) DNA and is transmitted invariably by an affected mother to her progeny. The unique feature of mitochondrial (mt) DNA is its maternal inheritance \hyperref[b6]{7} .\par There is a great variability in fetal growth in the human, based on both genetics and environmental factors. Although one cannot control one's genes, fetal growth may be affected through alteration in the maternal environment by medical nutrition therapy (MNT). MNT plays a vital role in every stage of fetal development \hyperref[b7]{8} . \section[{a) Diagnosis of GDM}]{a) Diagnosis of GDM}\par Universal screening for GDM has to be made mandatory as intrauterine exposure of the fetus to hyperglycemia is at a higher risk of developing glucose intolerance in the future.Unfortunately, for this there is no uniformity in the guidelines for diagnosing GDM. All the diagnostic criteria require women to be in fasting, including that of International Association of Diabetes in Pregnancy Study Group guideline (IADPSG) \hyperref[b8]{9} . The concern of this guideline is that, it over diagnoses GDM without clear clinical benefit \hyperref[b10]{10} . Presently, this guideline's importance is declining because even at centers that accepted IADPSG recommendation, the approach varies and needs revision for standardization of the strategy for diagnosing GDM \hyperref[b13]{11} .\par In this context, a study established that the twohour Plasma Glucose ? 140 mg/dl (7.8 mmol/dl) with 75g oral glucose administered to a pregnant woman in the fasting or non-fasting state, without regard to the time of the last meal was able to identify woman with GDM \hyperref[b14]{12,}\hyperref[b15]{13,}\hyperref[b16]{14} . This "Single Test procedure" which isfeasible to perform in all resource settings has been adopted by Diabetes in Pregnancy Study Group India (DIPSI) for diagnosing GDM. National Institute of Clinical Excellence(NICE) guidelines also recommend 2hr PG ?7.8 mmol/dlas one of the diagnostic criteria for GDM based on the study performed in multi ethnic population of UK \hyperref[b17]{15} . The DIPSI procedure is approved by the Ministry of Health \& Family Welfare Government of India \hyperref[b18]{16} and recognized by, World Health Organization (WHO) \hyperref[b19]{17} , International Federation of Obstetrics and Gynecologists (FIGO) \hyperref[b20]{18} \& International Diabetes Federation (IDF) \hyperref[b22]{19} . \section[{b) Appropriate trimester for Screening}]{b) Appropriate trimester for Screening}\par In planning for pregnancy, the metabolic state has to be maintained at normal level. During Preconception period, the recommend target glycemic level is fasting plasma glucose ? 5.0 mmol/dl, 2hr postprandial ? 6.7 mmol/dlmg/dl and A1c ? 6\%. The current observation is that GDM manifests in all trimesters of pregnancy \hyperref[b24]{20} .In a study, out of N=11785 screened, 31.5\% were in the first trimester, 42.2\% in the second trimester and 25.3\% in the third trimester \hyperref[b26]{21} (Table \hyperref[tab_0]{-1}). The first trimester begins on the first day of the last period and lasts until the end of week 12. This means that by the time one knows for sure of her pregnancy, she might already be five or six weeks of pregnancy. By seventh week all the essential organs began to form and by ninth week almost completed (Fig- \hyperref[fig_0]{1}). A lot happens during the first three months (Fig - {\ref 2}). Hence, the present recommendation is that there is a "Need for testing glucose tolerance in the early weeks of pregnancy" {\ref 22} .\par In fetal pancreas each islet cell functions as an endocrine organ appears at 11 th week of gestation recognizes and responds to maternal glycemia at 15-16 weeks of gestation \hyperref[b29]{23} . Fetuses are exposed to increased amniotic fluid glucose before 16 th weeks of gestation, suggesting that metabolic perturbations are underway before normally recommended 24 th to 28 th weeks of gestation for diagnosis and that earlier screening and intervention may be warranted.It is wiser to test the maternal glucose level on the next day woman misses her period. Very early diagnosis of pregnancy can be made by estimating serum beta Hydroxy Chorionic Gonadotropin (HCG) at the end of 3 rd wk of menstrual cycle and by urine beta HCG by the end of 4 th wk of menstrual cycle \hyperref[b30]{24} . As alluded earlier it is advisable to screen for GDM in all the trimesters and most importantly the first trimester. \section[{IV.}]{IV.} \section[{Maternal Nutrition \& Target for Glycemic Control}]{Maternal Nutrition \& Target for Glycemic Control}\par The goal of nutrition in pregnancy is to support maternal, placental, and fetal metabolic needs, and it may be the first introduction to a lifetime of healthy eating \hyperref[b31]{25} . Postprandial hyperglycemia plays a more important role in causing fetal overgrowth. Data suggests that postprandial glucose levels more closely relates to macrosomia risk compared to fasting glucose levels \hyperref[b32]{26,}\hyperref[b33]{27} . Based on studies in preterm births renal threshold for glucose in the fetus is probably <6.7 mmol/dl. When maternal glucose level is > 6.1 mmol/dl, the fetal blood glucose load causes fetal glycosuria and consequently a glucose-enriched amniotic fluid. After 20 weeks of gestation, the fetus begins to swallow the amniotic fluid. In addition to the placental transfer of glucose, ingested high glucose amniotic fluid also stimulates insulin secretion. Thus, even transient elevations of blood glucose on the maternal side not only result in elevation of blood glucose on the fetal side but also provide for glucose ingestion by the fetus for many hours. Thus, post prandial hyperglycemia for less than1 h once a day in the mother may produce fetal insulin stimulus, through the oral route for hours. Elevations of maternal glucose levels more frequently (after every meal, for example) may produce a more prolonged oral glucose load for the fetus resulting in an overfed fat fetus \hyperref[b34]{28} .Monitoring maternal glycemia and maintaining 2 hr postprandial plasma glucose between 6.1 -6.7 mmol/dl by using plasma calibrated glucometer level every week, may be a wise decision.\par V. \section[{Conclusion}]{Conclusion}\par Fetal Development invariably involves exquisite interplay between maternal physiology, metabolism and hormones. Nature Nurtures the embryogenesis from conception to confinement. The environment that the oocyte is exposed to, during the peri-conception period can have a significant impact on oocyte developmental competence. The ability of the oocyte to support fertilisation and subsequent embryo development and the long-term health of the resulting offspringdepends upon the optimum metabolic control early in pregnancy. This will necessitate pre-pregnancy planning for women with pre-existing diabetes, as well as for those at increased risk of GDM, and better means to safely normalize glycemia. The aim in the management is, the "Growing fetus should not know that its mother has Glucose Intolerance". For that glycemic target should be that of normal pregnancy, the FPG 4.4 -5.0 mmol/dl, Post prandial glucose 6.1 -6.7 mmol/dl and Mean PG glucose 95 -105 mg/dl(5.3 -5.9 mmol/dl) \hyperref[b35]{29} . The goal is to obtain newborn babies birth weight appropriate for gestational age between 2.5 and 3.5 kg, a step to prevent offspring developing diabetes \hyperref[b36]{30} . Breastfeeding for the first 6 months protects offspring developing Type 2 DM \hyperref[b37]{31} . Preventive measures against diabetes should start during intra uterine period and continue throughout life from early childhood \hyperref[b39]{32} . GDM offers an important opportunity for the development, testing and implementation of clinical strategies for diabetes prevention \hyperref[b40]{33} . Though the fetal development is discussed in days and weeks, it is wiser to maintain recommended target glycemic level during pre-conception period and from conception to confinement. This continued care is a "A step towards strategy for prevention of diabetes". \section[{Compliance with Ethical Standards}]{Compliance with Ethical Standards}\par Conflicts of Interest: All the authors are governing council members of Diabetes in Pregnancy Study group of India (DIPSI) Financial Disclosure: The authors declare that no financial assistance was received from any organization for the conduct of this study.\par Funding/Support: The authors declare that no financial assistance was received from any organization for the conduct of this study. \section[{Ethics Approval: Ethical Approval Obtained}]{Ethics Approval: Ethical Approval Obtained}\par Acknowledgements: Nil \begin{figure}[htbp] \noindent\textbf{1}\includegraphics[]{image-2.png} \caption{\label{fig_0}Fig. - 1 :A}\end{figure} \begin{figure}[htbp] \noindent\textbf{-} \par \begin{longtable}{P{0.1337962962962963\textwidth}P{0.3384259259259259\textwidth}P{0.37777777777777777\textwidth}} Trimester\tabcellsep Number of mothers screened\tabcellsep GDM N(\%)\\ 1\tabcellsep 4300\tabcellsep 233 (31.5)\\ 2\tabcellsep 4632\tabcellsep 320 (42.2)\\ 3\tabcellsep 2853\tabcellsep 187 (25.3)\\ Total\tabcellsep 11785\tabcellsep 745 (100)\end{longtable} \par \caption{\label{tab_0}Table - 1}\end{figure} \backmatter \begin{bibitemlist}{1} \bibitem[]{b9}\label{b9} \textit{}, \xref{http://dx.doi.org/10.2337/dc09-1848}{10.2337/dc09-1848}. \url{https://doi.org/10.2337/dc09-1848} 33 p. . \bibitem[Thangaratinam et al.]{b10}\label{b10} \textit{}, Shakila ; Thangaratinam , Cooray , ; Shamil , Nithya Sukumar , Huda . Devlieger, Roland. \bibitem[Benhalima]{b11}\label{b11} \textit{}, Katrien Benhalima . \bibitem[Moshe et al.]{b20}\label{b20} \textit{}, Hod Moshe , Anil Kapur , David A Sacks , Eran Hadar , Mukesh Agarwal , Gian Carlo Di Renzo , Luis Caberoruaro , Harold David Mclyntyre , JessicaL . \bibitem[Seshiah et al.]{b24}\label{b24} \textit{}, V Seshiah , Balaji , S Madhuri , Balaji . \bibitem[Gupte]{b27}\label{b27} ‘9 Manjula Datta, 10 Anil Kapur, 1,11 and Balaji Vijayam 1 22. Seshiah Veeraswamy’. Sanjay Gupte . \textit{Hema Divakar} \bibitem[Tuomilehto]{b39}\label{b39} \textit{A paradigm shift is needed in the primary prevention of Type 2 DM, Prevention of DM}, Jaakko Tuomilehto . John Willey \& sons limited. p. . (2005 edition) \bibitem[Anajlakshi et al. ()]{b14}\label{b14} ‘A Single Test Procedure to Diagnose Gestational Diabetes Mellitus’. C Anajlakshi , V Balaji , Madhuri S Balaji , S Ashalatha , Sheela Suganthu , T Arthi , V Thamizharasi , V Seshiah . \xref{http://dx.doi.org/10.1007/s00592-008-0060-9}{10.1007/s00592-008-0060-9}. \textit{Acta Diabetologica} 2009. 46 p. . \bibitem[Pettitt et al. ()]{b16}\label{b16} ‘Abnormal glucose tolerance during pregnancy in Pima Indian women. Long-term effects on offspring’. D J Pettitt , P H Bennett , M F Saad , M A Charles , R G Nelson , W C Knowler . \textit{Diabetes} 1991. 40 (2) p. . (Suppl) \bibitem[Jovanovic ()]{b36}\label{b36} \textit{American Diabetes Association's Fourth International Workshop -Conference on Gestational Diabetes Mellitus: Summary and Discussion. Diabetes Care}, Lois Jovanovic . 1998. 21 p. . \bibitem[Atlas Ninth edition2019 International Diabetes Federation (IDF)]{b0}\label{b0} ‘Atlas Ninth edition2019’. \url{www.diabetesatlas.org} \textit{International Diabetes Federation (IDF)}, (Online version of IDF Diabetes Atlas) \bibitem[Breastfeeding and type 2 Diabetes: Systematic Review and Meta-Analysis. The updated systematic review and meta-analysis suggests that breastfeeding protects from type 2 diabetes]{b37}\label{b37} \textit{Breastfeeding and type 2 Diabetes: Systematic Review and Meta-Analysis. The updated systematic review and meta-analysis suggests that breastfeeding protects from type 2 diabetes}, \bibitem[Chittaranjan N Purandare]{b22}\label{b22} Chittaranjan N Purandare . \textit{Shaukat Sadikot (IDF), Nam Cho Han (IDF), Moshe Hod (FIGO)}, \bibitem[Diabetes in pregnancy: management from preconception to the postnatal period NICE guideline Published: 25 February ()]{b17}\label{b17} \textit{Diabetes in pregnancy: management from preconception to the postnatal period NICE guideline Published: 25 February}, \url{nice.org.uk/guidance/ng3} 2015. (National Institute for Health and Care Excellence) \bibitem[Nausheen Khan et al. ()]{b6}\label{b6} ‘Early Age at Onset and High Frequency of Associated Complications In Maternally Transmitted Type 2 Diabetes Mellitus’. Nausheen Khan , Mohd , Gazala Ishaq , E Prabhakar Khan , Sastry . \textit{Int. J. Diab. Dev. Countries} 2004. 24 p. . \bibitem[Boudou et al. (2003)]{b5}\label{b5} ‘Effect of a diabetes environment in utero on predisposition to type 2 diabetes’. Philippe Boudou , Franck Mauvais-Jarvis , Hervé Leblanc , Gilberto Velho , Patrick Vexiau , Raphaël Porcher , Richard Samyhadjadj , Antonio Pratley , Fabien Tataranni , Jean-François Calvo , Gautier . \xref{http://dx.doi.org/10.1016/S0140-6736(03)13505-2}{10.1016/S0140-6736(03)13505-2}. \textit{Eugène Sobngwi} 2003 May 31. 1 (9372) p. . (Lancet) \bibitem[Mcauliffe et al. (2020)]{b12}\label{b12} \textit{Endocrinology in the time of COVID-19: Diagnosis and Management of Gestational Diabetes Mellitus}, Fionnuala Mcauliffe , Saravanan , Ponnusamy , Helena Teede . \xref{http://dx.doi.org/10.2337/dc09-1848}{10.2337/dc09-1848}. May-2020. p. 26. (Accepted Manuscript published as EJE-20-0401.R1. Accepted for publication) \bibitem[Paneerselvam et al. (2007)]{b25}\label{b25} ‘Gestational Diabetes Mellitus manifests in all trimester of pregnancy’. T Paneerselvam , M Arthi , Manjula Thamizharasi , Datta . \xref{http://dx.doi.org/10.1016/j.diabres.2007.01.001}{10.1016/j.diabres.2007.01.001}. \textit{Diabetes Res Clin Pract} 2007 Sep. 77 (3) p. . \bibitem[Franks et al. ()]{b15}\label{b15} ‘Gestational Glucose Tolerance and Risk of Type 2 Diabetes in Young Pima Indian Offspring’. Paul W Franks , Helen C Looker , Leslie Sayukokobes , P Antonio Touger , Robert L Tataranni , William C Hanson , Knowler . \textit{Diabetes} 2006. 55 p. . \bibitem[Colagiuri et al. ()]{b19}\label{b19} ‘Hui-xia Yang. Strategies for Implementing the WHO Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy’. Stephen Colagiuri , Mukesh M Maiconfalavigna , Michel Agarwal , Edward Boulvain , Moshe Coetzee , Sara Hod , Boyd Meltzer , Yasue Metzger , Omori . \textit{DRCP} 2014. 103 p. . \bibitem[Barjaktarovic et al. (2016)]{b7}\label{b7} ‘Human Chorionic gonadotropin (HCG) concentration during the late first trimester are associated with the fetal growth inafetal sex -specific manner’. Mirjana Barjaktarovic , Tim I M Korevaar , W V Vincent , Yolanda B Jaddoe , Theo J De Rijke , Robin P Visser , Eric A P Peeters , Steegers . \xref{http://dx.doi.org/10.1007/s10654-016-0201-3}{10.1007/s10654-016-0201-3}. \textit{Eur J Epidemiol} 2017. 2016 Oct 5. 32 (2) p. . (Published online) \bibitem[Peter et al. (1969)]{b29}\label{b29} ‘Human Fetal Insulin Metabolism Early in Gestation: Response to Acute Elevation of the Fetal Glucose Concentration and Placental Transfer of Human Insulin-I-131. M.D’. A J Peter , M D Adam , Kari Teramo , MD , Niels Raiha . \xref{http://dx.doi.org/10.2337/diab.18.6.409}{10.2337/diab.18.6.409}. \url{https://doi.org/10.2337/diab.18.6.409} \textit{Diabetes} 1969 Jun. 18 (6) p. . \bibitem[Lucas et al. ()]{b4}\label{b4} \textit{In: (UK Programming by early nutrition in man, the childhood environment and adult disease}, A ; John Lucas , Wiley , Chi Sons , Chester . 1991. p. . (Review Article) \bibitem[Ferrara]{b2}\label{b2} \textit{Increasing prevalence of GDM Diabetes Care}, Asslamira Ferrara . 30 p. . \bibitem[Metzger ()]{b8}\label{b8} ‘International Association of Diabetes and Pregnancy Study Groups (IADPSG) Recommendations on the diagnosis and classification of Hyperglycemia in pregnancy’. Boyd E Metzger . \textit{Diabetes Care} 2010. (IADPSG consensus panel) \bibitem[Figo-Idf (2017)]{b23}\label{b23} \textit{Joint Statement and Declaration on Hyperglycemia in Pregnancy. IDF Congress}, Figo-Idf . \url{www.diabetesatlas.org/atlas@idf.org} 6 th December 2017. Abu Dhabi. \bibitem[Maternal Health Division Ministry of Health & Family Welfare Government of India, www.mohfw.gov.in &www.nhm.gov (2018)]{b18}\label{b18} \textit{Maternal Health Division Ministry of Health \& Family Welfare Government of India, www.mohfw.gov.in \&www.nhm.gov}, February 2018. \bibitem[Jovanovic et al. ()]{b33}\label{b33} ‘Maternal postprandial glucose levels and infant birth weight: The Diabetes in Early Pregnancy study’. L Jovanovic , C M Peterson , G F Reed . \textit{Am J} ObstetGynecol1991. 164 p. . \bibitem[Metzger and Workshop ()]{b1}\label{b1} B E Metzger , Workshop . \textit{Conference Organizing Committee: Summary and recommendations of the Third International Workshop Conference on GDM}, 1991. 40 p. . (Suppl. 2) \bibitem[Gupte ()]{b28}\label{b28} ‘Need for testing glucose tolerance in the early weeks of pregnancy’. Gupte . \textit{Indian J Endocrinol Metab} 2016. \bibitem[Indian and Metab ()]{b26}\label{b26} \textit{Need for testing glucose tolerance in the early weeks of pregnancy}, J Endocrinol Indian , Metab . PMC4743382. 2016 Jan-Feb; 20. Seshiah Veeraswamy, 1,2,3,4,5,6 Hema Divakar, 7,8. p. . \bibitem[Jovanovic and Point ()]{b34}\label{b34} ‘Oral Hypoglycaemic agents should not be used to treat diabetic pregnant women’. L Jovanovic , Point . \textit{Diabetes Care} 2007. 30 p. . \bibitem[Combs et al. ()]{b32}\label{b32} ‘Relationship of fetal macrosomia to maternal postprandial glucose control during pregnancy’. C A Combs , E Gunderson , J L Kitsmiller . \textit{Diabetes Care} 1992. 15 p. . \bibitem[Lessahortac and Peixoto De Lima (2019)]{b38}\label{b38} \textit{springer science + Business Media LLC, part of springer nature}, Bernardo Lessahortac , Natalia Peixoto De Lima . 14 Jan 2019. 2019. (Published ONLINE) \bibitem[Seshiah et al. (2019)]{b35}\label{b35} ‘Targeting Glycemic Level in Gestational Diabetes Mellitus to that of Normal Pregnancy would result in a better Maternal-Fetal Outcome’. V Seshiah , Anil Kapur , Vijayam Balaji , N Sidharth , Ashok Shah , Samar Kumar Das Hema Divakar , C Banerjee , Anjalakshi . \textit{JAPI} May 2019. 67. \bibitem[Morris and Divakar (2015)]{b21}\label{b21} ‘The International Federation of Gynecology and Obstetrics (FIGO) Initiative on Gestational Diabetes Mellitus; A Pragmatic Guide for Diagnosis, Management and Care’. Hema Morris , Divakar . \xref{http://dx.doi.org/10.1016/S0020-7292(15)30033-3}{10.1016/S0020-7292(15)30033-3}. \textit{Int J GynaecolObstet} 2015 Oct. 131 p. . \bibitem[Feldkamp and Pfeffer ()]{b30}\label{b30} ‘The Measurement of Human Chorionic Gonadotropin for Pregnancy Testing’. Carolyn S Feldkamp , William H Pfeffer . \textit{Henry Ford Hospital Medical Journal} 1982. 30 (4) p. . \bibitem[Barker and Thornburg ()]{b31}\label{b31} ‘The obstetric origins of health for a lifetime’. D J Barker , K L Thornburg . \textit{Clin ObstetGynecol} 2003. 56 p. . \bibitem[Lapolla and Metzger (2018)]{b13}\label{b13} ‘The post-HAPO situation with gestational diabetes: the bright and dark sides’. Annunziata Lapolla , Boyd E Metzger . \textit{Acta Diabetologica} 2018. September 2018. 55 p. . \bibitem[Fiore (2014)]{b3}\label{b3} \textit{United states Preventive Service Task force (USPSTF) backs Universal diabetes Screening}, Kristina Fiore . Jan 13. 2014. \bibitem[Thomas et al. (2007)]{b40}\label{b40} ‘What is gestational diabetes?’. A Thomas , Anny Buchanan , Xiang , L Siri , Richard Kjos , Watanabe . \textit{Diabetes Care} July 2007. 30 (2) p. . \end{bibitemlist} \end{document}