Understanding type 2 diabetes among Aboriginal and Torres Strait Islander youth in northern Australia and assessing the child health impact of maternal diabetes

Understanding type 2 diabetes among Aboriginal and Torres Strait Islander youth in northern Australia and assessing the child health impact of maternal diabetes Thesis

Menzies School of Health Research

• Author(s): Titmuss, Angela Therese
• Published: 2022
• Publisher: Charles Darwin University
• Volume: PhD

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Abstract: The prevalence of youth-onset type 2 diabetes (T2D) and hyperglycaemia in pregnancy are increasing worldwide, disproportionately affecting First Nations populations. Early life represents a critical opportunity for prevention of later disease. Aims were to: 1) describe prevalence of T2D among Aboriginal and Torres Strait Islander youth aged ≤24 years; 2) explore associations of maternal hyperglycaemia in pregnancy (in this thesis defined as gestational diabetes (GDM) or T2D in pregnancy) with growth trajectories of offspring; 3) explore whether predominant breastfeeding at 6 months influences early growth in children exposed to hyperglycaemia; 4) describe associations of maternal hyperglycaemia with offspring anthropometry; and 5) describe associations of maternal hyperglycaemia with developmental risk of offspring. For Aim 1, an audit of primary health care records was undertaken across the northern Australia region. Aims 2-5 involved the Pregnancy And Neonatal Diabetes Outcomes in Remote Australia (PANDORA) study, a birth cohort (n=1138 women, 1163 children). Glycaemic status was assessed in pregnancy, with detailed anthropometry at birth, and again at 18-60 months of age in a sub-group of children, along with developmental screening. This research identified a high prevalence of youth-onset T2D (6.7/1000 population), to our knowledge higher than recently reported internationally in any population of youth. Maternal hyperglycaemia was associated with offspring growth trajectories after adjustment for other factors, including maternal body mass index (BMI). Predominant breastfeeding to 6 months was protective against excess weight gain among infants of mothers with GDM. Both GDM and maternal BMI were associated with offspring anthropometry at 18-60 months of age. Both T2D and GDM were associated with developmental vulnerability and reduced head circumference of children. The findings have informed development of Australasian screening pathways for youth at risk of T2D. They have worldwide implications for policy and care of women with hyperglycaemia in pregnancy, their children, and youth with T2D.

• Urls: https://ris.cdu.edu.au/ws/portalfiles/portal/60700720/Thesis_Angela_Titmuss.pdf