1. Maternal Antecedents of Adiposity and Studying the Transgenerational role of Hyperglycemia and Insulin (MAASTHI). An Intermediate Fellowship. Hyperglycemia in Pregnancy and risk of chronic diseases. Giridhara R Babu (PI) Wellcome Trust-DBT India Alliance, 07/16/15 to 07/15/20; The aim of this study is to prospectively assess the effects of glucose levels in pregnancy on the risk of adverse infant outcomes, especially in predicting the possible risk markers of later chronic diseases.
2. Full meal supplementation: Evaluation of Effect in Pregnant and Lactating women  (FEEL)  Department of Women and Child, Government of Karnataka/UNICEF,   04/01/17-02/28/18,.   Giridhara   R   Babu  (PI); The aim of the state level intervention study is to study the impact of hot nutritious meals provided   to pregnant women in improving pregnancy and infant.
3. Ambient and Indoor Air Pollution in Pregnancy on the risk of Low birth weight and Ensuing Effects in Infants (APPLE); A cohort study in South India. Giridhara R Babu, Principal Investigator (PI). Department of Science and Technology. 04/01/17-02/28/19. The aim of this study is to prospectively  assess the effects of ambient and indoor air pollutant levels in pregnancy on the risk of low birth weight and ensuing obesity in infants.
4. Effect of exposure to ambient Air Pollution during Pregnancy on Infant birth outcomeS (E-APPS)

Details of the Ongoing Research Projects

1. Maternal Antecedents of Adiposity and Studying the Transgenerational role of Hyperglycemia and Insulin (MAASTHI): a prospective cohort study. Funded by Wellcome Trust DBT India Alliance: Link1 Link2 Link3

India is experiencing an epidemic of obesity-hyperglycaemia, which can be sustained and augmented through transgenerational transmission of adiposity and glucose intolerance in women. This presents an opportunity for exploring a clear strategy for the control of this epidemic in India. We conducted a study between November 2013 and May 2015 to inform the design of a large pregnancy cohort study. Based on the findings of this pilot, Currently, we are recruiting women in a birth cohort since April 2016. The protocol of the study documents the processes which aim at advancing the available knowledge, linking several steps in the evolution of obesity led hyperglycemia.

Maternal Antecedents of Adiposity and Studying the Transgenerational role of Hyperglycemia and Insulin (MAASTHI) is a cohort study in the public health facilities in Bangalore, India. The objective of MAASTHI is to prospectively assess the effects of glucose levels in pregnancy on the risk of adverse infant outcomes, especially in predicting the possible risk markers of later chronic diseases. The primary objective of the proposed study is to investigate the effect of glucose levels in pregnancy on skinfold thickness (adiposity) in infancy as a marker of future obesity and diabetes in offspring. The secondary objective is to assess the association between the psychosocial environment of mothers and adverse neonatal outcomes including adiposity. The study aims to recruit 5000 pregnant women and follow them and their offspring for a period of 4 years.

The carbohydrate ‘fuel’ metabolism in a pregnant woman may have a long-term impact on the development of her offspring (‘fuel-mediated teratogenesis’ hypothesis) including in utero exposure to maternal hyperglycemia leading to fetal hyperinsulinemia, and the consequent increase in fetal fat cells. Therefore, a feed-forward loop can exist of rising adiposity and hyperinsulinemia throughout childhood, perhaps leading to obesity and diabetes in later life. There is a need for prospective examination of body fat distribution in children born to mothers with different glycemic levels to understand the plausible association between glucose metabolism and future risk of diabetes in offspring.

We published detailed protocols of the study and pilot in open access peer-reviewed journals. (BMC,  BMJOpen)  In order to extend the recruitment, complete the follow-up and create a bio-repository, I have been awarded intermediate fellowship from Wellcome trust-DBT India alliance. With the funding support of WT-DBT India alliance, I am currently expanding the cohort study to aim to recruit more than 3000 pregnant women. Extending the study to multiple centers will provide the robust data for valid inferences.

Accomplishments

• The knowledge from this study may be extremely important for developing an effective strategy for the control of the obesity-hyperglycaemia epidemic in low-income and middle-income countries. The results from our study can provide insights into the relation of adiposity during infancy and childhood into adult adiposity and Type 2 Diabetes Mellitus (T2DM).
• We have been able to recruit more than 700 pregnant women. All women have undergone Hb and OGTT (Fasting and 2 Hr PPBS with 75g glucose).
• Additional funding requests are underway for expansion of the birth cohort and for testing the additional hypotheses.

Publications from this project are as follows:- (also visit, publications)

• Babu, G. R., Garadi, L., Murthy, G. V. S., & Kinra, S. (2014). Effect of hyperglycemia in pregnancy on adiposity in their infants in India: a protocol of a multicentre cohort study. BMJ open, 4(6), e005417.
• Babu, G R., B. Tejaswi, M. Kalavathi, G. M. Vatsala, G. V. S. Murthy, Sanjay Kinra, and Sara E. Benjamin Neelon. “Assessment of screening practices for gestational hyperglycemia in public health facilities: a descriptive study in Bangalore, India.” Journal of Public Health Research 4, no. 1 (2015).
• Babu GR, Murthy GV, Deepa R, Kumar HK, Karthik M, Deshpande K, Neelon SE, Prabhakaran D, Kurpad A, Kinra S. Maternal antecedents of adiposity and studying the transgenerational role of hyperglycemia and insulin (MAASTHI): a prospective cohort study. BMC pregnancy and childbirth. 2016 Oct 14;16(1):311.
• Giridhara R Babu, GVS Murthy, R Deepa, A Yamuna, Nolita Saldanha, Prafulla Shriyan, Maithili Karthik, Keerthi Deshpande, Sara E Benjamin Neelon, Anura Kurpad, Sanjay Kinra. Screening for Gestational Hyperglycemia in Public Hospitals: Baseline Results from piloting MAASTHI, a Cohort Study. BMC Pregnancy and Childbirth (In Press)
• “Association of Obesity with hypertension and Type-2 Diabetes Mellitus in India A meta-analysis of observational studies”  (In Peer review)
• Two more papers in review

2. Full meal supplementation: Evaluation of Effect in Pregnant and Lactating women (FEEL): Funded by Department of Women and Child, Government of Karnataka 

Understanding the relation between maternal nutrition and birth outcomes provides a basis for developing nutritional interventions that will improve- birth outcomes, childhood growth and development long-term quality of life and reduce mortality, morbidity, and health-care costs. To address the issue of maternal undernutrition and consequential adverse effects on birth outcomes or growth of children, Department of Women and Child Development, Government of Karnataka is piloting a new strategy on the provision of One full meal served to Pregnant and Lactating mothers at AWC along with IFA supplement in order to ensure consumption the food meeting 40% of the day’s nutrient requirement. This initiative provides a unique opportunity to understand the impact of nutritious food on pregnancy outcome and child development.

 Primary Objective The overall aim of the intervention study is to study the impact of hot fully cooked meals provided to pregnant women in improving pregnancy and infant outcomes.

Secondary Objectives

• To estimate the impact of the intervention on change in mean Hb% in the intervention arm compared to control arm.
• To estimate the impact of the intervention on weight for length in the intervention arm compared to control arm.

3. Ambient and Indoor Air Pollution in Pregnancy on the risk of Low birth weight and Ensuing Effects in Infants (APPLE); A cohort study in South India.  Funded by Department of Science & Technology, Government of India

Exposure to indoor air pollution (IAP) from the combustion of solid fuels is an important cause of morbidity and mortality in developing countries. Ambient air pollution is the fifth largest killer in India. Women are engaged in traditional roles as a family caregiver are more vulnerable to the effects of climate change . Pregnant women who are exposed to higher indoor pollutants are at higher risk of delivering a low-birth-weight baby. The babies with reduced fetal growth have a higher risk of developing obesity, and NCDs in later life during adulthood. There is a lack of standardized data for most risk factors including the levels and roles of specific pollutants and how they impact chronic diseases in India. The current prospective cohort study will be conducted in slums of Bangalore. The study population comprises of households having pregnant women. The duration of the study is three years from 2017 to 2020. The objectives of the current study are to prospectively assess the association between ambient and indoor air pollution level in pregnancy and adverse infant outcomes, especially in predicting the risk of chronic diseases in infants.The current study aims to recruit 1706 pregnant women in the Slum population and follow their offspring at birth and the following birth until the child is two years old.

4. Effect of exposure to ambient Air Pollution during Pregnancy on Infant birth outcomeS (E-APPS)

We conducted a study at the ecological level assessing the exposure data on air pollutants using custom-built software. The objectives of the proposed project are to compare the trend of air pollutants across lower and middle-income countries (LMIC) and high-income countries (HICs) and to assess the impact of exposure to air pollutants during pregnancy on the risk of infant birth outcomes. The primary outcomes of interest were low birthweight and secondary outcomes are neonatal mortality rate, infant mortality rate, under-five mortality rate, and the incidence of pneumonia/ acute respiratory infections.

Data on health outcomes were secondary data that we different sources like Demographic Health Surveys (DHS) and World health statistics 2015 and Health, Nutrition and Population Statistics and National Family Health Survey – 4, District Level Household Survey. We performed visual analytics using Tableau software. The statistical analysis was performed using SPSS.

We reported that higher levels of PM2.5 levels in India highly correlated with poor infant health

outcomes; namely, low birth weight (LBW) and mortality and morbidity in the children. At the national level, Delhi was the highest polluted city and also had the highest child mortality rate. Our study provides a tip of the iceberg; suggesting the greater burden of ill health related to environmental pollution. There is limited causal inference due to ecological nature of the study, these can be addressed using a prospective design and conducting the study at individual levels. Alternatively, the interventions aiming to reduce the environmental pollutants can help people live in healthier environments.