Invited lecture delivered in an RTM organized by British Biologicals in June 2018 at Kolkata

2. PRO-PL LITE
Dr Sujoy Dasgupta
MBBS (Gold Medalist, Hons)
MS (OBGY- Gold Medalist)
DNB (OBGY)
MRCOG (London)
Consultant, Genome: The Fertility Centre, Kolkata
Secretary, Subfertility & Reproductive Endocrinology Committee,
Bengal Obstetric and Gynaecological Society (BOGS)- 2018-19
Managing Committee Member, BOGS- 2018-19
Member, Quiz Committee, FOGSI East Zone, 2018-19
Member, Food and Drug Committee, FOGSI, 2018-19
Peer Reviewer, BMJ Case Reports

3. Prevalence of Underweight and
Overweight/Obesity among women in Urban &
Rural Setup
0
5
10
15
20
25
30
35
Urban Rural
Underweight
Overweight
25 % 24 %
31 %
13 %

4. Survey Inference at FOGSI
• Percentage of Overweight & Obese Pregnancy is 25% to 40%
(Gynaecologist)
• Percentage of Overweight & Obese Pregnancy is 40% to 60% (IVF Centers)
• Percentage of GDM women is 10% to 15% (Gynaecologist)
• Percentage of GDM women is 40% to 50% (IVF Centers)

5. Understanding the segments
An Internal Survey
As per the internal survey conducted, any nutritional supplement is
prescribed in either
• Underweight & normal weight and not in overweight or obese
women.
(Around 95% of Gynecologist mentioned they would prescribe a
nutritional supplement only to a underweight or normal weight
women)

7. Complications of Obese Pregnancy
Effects on Mother
• GDM
• Preeclampsia (For each increase in BMI of 5 to 7 kg/m2, there is a
corresponding 2-fold increase in the risk of developing preeclampsia)
• Operative delivery (C-Section)
• VTE
• PPH
• Wound healing problems
Effects on Foetus

8. Inference
• Hence a new product which caters to overweight & obese population is an
unexplored pasture (Equivalent to the whole underweight population or
existing market)
• Brand for overweight & Obese Pregnancy for preventing the complications
or onset of GDM

9. Introducing

12. PRO-PL Lite Formulation
Composition Per 100g Per 30 g % DV per Serving
Energy(Kcal) 411 123.3 6.2
Energy from fat(Kcal) 135 40.5 -
Fat(g) 15.0 4.5 7.1
MUFA(g) 5.0 1.5 -
PUFA(g) 1.4 0.4 -
Saturated Fatty Acids(g) 1.0 0.3 1.9
Transfat(g) 0.0 0.0 -
Cholestrol(mg) 0.0 0.0 -
Total Carbohydrate(g) 45.0 13.5 4.5
Added sugar(g) 0.0 0.0 -
Dietary Fibre(g) 6.5 1.9 7.8
FOS (g) 6.0 1.8 -
Protein(g) 24.0 7.2 14.4
Glycine (mg) 550.0 165.0 -
L-Lysine (mg) 2040.0 612.0 -
L Histidine (mg) 600.0 180.0 -
L Arginine (mg) 640.0 192.0 -
L-Glutamine (mg) 4350.0 1305.0 -
Vitamin A(IU) 5000.0 1500.0 30.0
Vitamin D(IU) 400.0 120.0 30.0
Vitamin E(IU) 30.0 9.0 30.0
Vitamin K(mcg) 50.0 15.0 18.8
Vitamin C(mg) 100.0 30.0 50.0
Vitamin B1(mg) 1.3 0.4 26.7
Vitamin B2(mg) 1.0 0.3 17.6
Vitamin B3(mg) 13.3 4.0 20.0
Vitamin B6(mg) 2.0 0.6 30.0
Vitamin B12(mcg) 8.0 2.4 40.0

13. PRO-PL Lite Formulation
Composition Per 100g Per 30 g % DV per Serving
Folic acid(mcg) 800.0 240.0 60.0
Pantothenic acid(mg) 5.0 1.5 15.0
Biotin(mcg) 100.0 30.0 10.0
Calcium(mg) 1000.0 300.0 30.0
Zinc(mg) 15.0 4.5 30.0
Iron(mg) 22.0 6.6 36.7
Phosphorus(mg) 1000.0 300.0 30.0
Magnesium(mg) 200.0 60.0 15.0
Potassium(mg) 1530.0 459.0 13.1
Sodium(mg) 500.0 150.0 6.3
Molybdenum(mcg) 75.0 22.5 30.0
Copper(mg) 2.0 0.6 30.0
Iodine(mcg) 150.0 45.0 30.0
Manganese(mg) 2.0 0.6 30.0
Selenium(mcg) 50.0 15.0 21.4
Chromium(mcg) 100.0 30.0 25.0
Choline (mg) 200.0 60.0 -
DHA (mg) 500.0 150.0 -
EPRO (mg) 250.0 75.0 -
Myo-Inositol (mg) 6666.7 2000.0 -

14. Ingredients
• Whey Protein, Milk Protein, Maltodextrin, High Oleic Sunflower Oil
Powder, Cocoa powder, Inulin, DHA powder, Sucralose, Vitamins , Minerals

15. Calorific Distribution
• Protein – 23%
• Fat – 33%
• Carbohydrate – 44%

16. Directions to use
• Add 2 table spoons (30g) to 240 ml of luke warm skimmed
milk or water. Stir Well. Once prepared consume
immediately.

17. GESTATIONAL DIABETES MELLITUS
Risk factor of obesity

18. What is GDM &
Difference between Type 2 Diabetes and GDM?
• GDM is Gestational Diabetes Mellitus which occurs during pregnancy and
the condition often gets normalized postpartum
• Unlike Type 2 diabetes where the onset is related to the insufficient Insulin
hormone, here in GDM it is the, hormones produced by Placenta which
affects how insulin is utilized in the body. This ultimately leads to Insulin
resistance and hyperglycemia.
• “As the placenta grows, it makes more of the hormones. The risk for
insulin resistance becomes greater. Normally the pancreas is able to
make more insulin to overcome insulin resistance. But if it cannot make
enough to overcome the effects of the placenta’s hormones, the person
can develop gestational diabetes”

19. Who are at risk of GDM?
• BMI >30 kg/m2
• previous macrosomic baby weighing ≥4.5 kg
• previous GDM
• family history of diabetes (1st degree relative
with diabetes)
• minority ethnic family origin with a high
prevalence of diabetes

21. Complications of GDM
Uncontrolled glycemic level effects on mothers
• Undiagnosed preexisting DM- Micro vascular complications (Retino,
Nephro & Neuro)
• GDM associated Hydraminos
• Urinary tract infections
• Preeclampsia
• PPH
Uncontrolled glycemic levels effects on fetus
• Fetal macrosomia
• Perinatal mortality- Sudden unexplained IUFD
• Neonatal respiratory problems (Respiratory distress syndrome)
• Congenital anomalies (Previously unexplained DM)
• Childhood & later adult obesity and DM (Baker’s Hypothesis)

22. Challenge in GDM management
• Women with GDM should have normal, stable blood glucose levels but at
the same time should achieve adequate nutrition and weight gain*
• Diet for GDM with normal BMI – 30 cal/kg based on pre pregnancy body
weight*
• Diet for GDM with overweight – 30 to 33% caloric restriction*
i.e., Eat less but nutritious
*Donna Zazworsky, Jane Nelson Bolin & Vicki B Gaubeca, Page 195, Handbook of
Diabetes Management

23. ADA Guidelines for lowering risk of GDM
• Eating enough fresh vegetables and fruits, and whole grains. Limit fat to
30% or less of your daily calories, and watch the portion sizes.
• Regular exercise can help prevent type 2 diabetes postpartum. Plus it can
help lose weight, manage stress, and feel better.
• Breastfeeding can provide both short- and long-term benefits to both the
baby and the mother.
• ADA recommends special meal plans and scheduled physical activity

24. Rationale for nutritional supplement in
overweight & obese pregnancy
Rationale of a nutritional supplement in Overweight & Obese population with
or without GDM
• Weight gain is still required even when the women is overweight or obese
pre-pregnancy, but relatively in a lower level
(Controlled weight Gain is the key to healthy pregnancy)
• Apart from Insulin there is a scope for nutrition to play role in optimal
weight gain, preventing complications of GDM and providing the deficit
nutrients required in obese / GDM pregnancy

25. Deficient Nutrients in GDM &
Obese Pregnancy
The following are the micronutrients which various studies have mentioned
• Vitamin D
• Vitamin B6
• Chromium deficiency
• Magnesium
• Potassium

26. Nutrients which helps in GDM &
Obese Pregnancy
Apart from the micronutrients which are required in pregnancy, the following
are the ingredients which are needed in a obese pregnancy (Either in
more quantity compared to normal recommendation or found to be
useful in GDM)
• Myo-Inositol
• DHA
• Folic acid
• Biotin
• Vitamin D, B6 & B12

28. Myoinositol
• Also known as Inositol hexa
phosphate (IP6)
• Synthesized from Inositol
• It functions as antioxidant, prevent
ROS, modulates insulin secretion

29. PCOS
Hyperinsulenemia/IR
Hyperglycemia
Decrease glucose uptake
Decrease level of PI3 kinase
Deficiency of Inositol
Hormonal Imbalance
↑Testosterone levels
Inositol deficiency pathway & PCOS

30. Mode of action of Myo-Inositol

31. Myo-Inositol in infertility

32. Myo-Inositol
1. Reduced incidence of GDM in women (High risk cases)
2. Women randomized to receive myo-inositol:
• Required less insulin therapy
• Delivered at a later gestational age
• Had significantly smaller babies (Lesser Fetal macrosomia) with fewer
episodes of neonatal hypoglycemia

33. Myo-Inositol
Myo-inositol supplementation (2 g Myo-inositol + 200 mcg Folic acid - bid)
• Prevents GDM occurrence in women with a family history of type 2
diabetes
• Reduced incidence of GDM and fetal macrosomia

34. Myo-Inositol
• In overweight pregnant women Myo-inositol treatment was associated
with a 67% risk reduction of developing GDM
• Myo-Inositol supplementation in women with family history of type 2
diabetes reduces incidences of GDM as well as fetal macrosomia

35. DHA
• The concentrations of labeled LC-PUFA were significantly lower in
maternal, placental, and fetal compartments
• Placental LC-PUFA uptake is impaired in GDM
• Lower levels of DHA has to be compensated with supplementation

36. THANK
YOU