A group of physiological abnormalities such as an increase in blood pressure, diabetes, increase in cholesterol levels and obesity is known as Metabolic Syndrome. Women in their pregnancy period are highly prone to this problem. Doctors are taking the issue of metabolic syndrome in obstetric practice seriously as it may risk the pregnancy.

1. Dr. Laxmi Shrikhande MD; FICOG; FICMU
•Director-Shrikhande Fertility Clinic, Nagpur
•President Menopause Society, Nagpur
•National Corresponding Editor-The Journal of Obstetrics & Gynecology of India
•Senior Vice President FOGSI 2012
•Vice Chairperson ICOG
•Governing Council member ICOG 2012-2017
•Governing Council Member ISAR 2014-2019
•Governing Council Member IAGE for 3 terms
•Patron-Vidarbha Chapter ISOPARB
•Chairperson-HIV/AIDS Committee, FOGSI (2007-09)
•Received Best Committee Award of FOGSI
•Received Bharat excellence Award for women’s health
•President Nagpur OB/GY Society 2005-06
•Associate member of RCOG
•Member of European Society of Human Reproduction
•Visited 96 FOGSI Societies as invited faculty
•Delivered 5 orations
•Publications-Twenty National & eleven International
•Presented Papers in FIGO, AICOG, SAFOG, AICC-RCOG conferences
•Conducted adolescent health programme for more than 15,000 adolescent girls

2. Metabolic syndrome in
Obstetric practice in
South Asia
Dr Laxmi Shrikhande
Director-Shrikhande IVF & Surrogacy
Centre

3. MS
• Metabolic syndrome (MS) is a complex disorder that
affects more and more people nowadays.
• It’s considered as an epidemic of the 21st
century.
• Today, it is a matter of concern in both developed
and developing countries
Hajian-Tilaki, K. (2015) Metabolic Syndrome and Its Associated Risk Factors in Iranian
Adults: A Systematic Review. Caspian Journal of Internal Medicine, 6, 51-61.

4. MS
• The rural prevalence of MetS is found to be
reasonably low compared to the urban prevalence
• The prevalence of MS is commoner in females and
increases with the age and urban housing
Okafor Christian, I. (2012) Prevalence of Metabolic Syndrome—Emerging Data from
Africa. Indian Journal of Endo-crinology and Metabolism, 16, 56-66.

5. Main components

6. South Asia
• South Asia is home to well over one-fifth of the
world's population, making it both the most
populous and the most densely populated geographic
region in the world.

7. Prevalence in south asia
• Nationally representative studies regarding the
prevalence of the metabolic syndrome (MetS) are
generally not available from any South Asian country.
• Despite the high rates of metabolic risk factors,
research is extremely sparse in South Asia
preventing knowledge of actual burden
International Journal of Diabetes in Developing Countries
September 2016, Volume 36, Issue 3, pp 255–262

8. USA
Ford, E.S., Giles, W.H. and Dietz, W.H. (2002) Prevalence of the Metabolic Syndrome among US
Adults: Findings from the Third National Health and Nutrition Examination Survey.
Journal of the American Medical Association, 287, 356-359

9. Incidence in USA
• It is associated with the rising incidence of obesity in
developed and developing countries and is reaching
epidemic proportions affecting between 24% and
34% of the US population and up to 36% of
Europeans aged 40 - 55 years
Balkau, B., Charles, M.A., Drivsholm, T., et al. (2002) Frequency of the WHO Metabolic
Syndrome in European Co-horts, and an Alternative Definition of an Insulin Resistance
Syndrome. Diabetes & Metabolism, 28, 364-376.

10. How SA is different from west ??
• Studies in South Asian adults as well as children have
shown that hyperglycemia, hypertension, and
hypertriglyceridemia occur at lower levels of BMI
and WC
Misra A, Wasir JS, Vikram NK. Waist circumference criteria for the diagnosis of abdominal obesity are not
applicable uniformly to all populations and ethnic groups. Nutrition. 2005;21:969–76.
Mehta S. Relationship between measures of fatness, lipids and ethnicity in a cohort of adolescent boys.
Ann Nutr Metab. 2002;46:192–9.

11. How SA is different from west ??
• a consensus has been reached regarding lowering
WC cut-offs (≥90 cm in males and ≥80 cm in
females) in South Asians based on adequate
evidence, which has henceforth been adopted in the
modified NCEP ATP III and IDF definitions
Vikram NK, Pandey RM, Misra A, Sharma R, Devi JR, Khanna N. Non-obese
(body mass index <25 kg/m2
) Asian Indians with normal waist circumference
have high cardiovascular risk. Nutrition. 2003;19:503–9

12. How SA is different from west ??
• Abdominal obesity is quite prevalent in South Asians,
with females outnumbering males.
Misra A, Khurana L. Obesity and the Metabolic Syndrome in developing
countries. J Clin Endocrinol Metab. 2008;93:S9–30

13. Causative factors in south asians
• physically less active
• Increasing usage of computers and mechanization in
workplaces and at household work is leading to a sedentary
lifestyle.
• Leisure-time activities have also shifted from outdoor games
to indoor entertainment like television and computer games.
• Importantly, girls and women have been found to be more
sedentary than men.
Misra A, Vikram NK. Insulin resistance syndrome (metabolic syndrome) and obesity in
Asian Indians. Evidence and implications. Nutrition. 2004;20:482–91

14. Causative factors in south asians
• Energy dense imbalanced foods (high calories, carbohydrates, saturated
fats, and low fiber) are being consumed increasingly in the Indian
subcontinent.
• Asian Indians consume higher carbohydrates as compared with Europeans,
and this may lead to hyperinsulinemia, postprandial hyperglycemia, high
serum TG, and low HDL levels associated with insulin resistance.
• South Asians also have significantly lower intakes of -3 polyunsaturatedω
fatty acids (PUFAs), monounsaturated fatty acids (MUFAs), and higher
intakes of -6 PUFAs than British Caucasians.ω
Wasir JS, Misra A. The metabolic syndrome in Asian Indians: The impact of nutritional and
socio-economic transition in India. Metab Syndr Relat Disord. 2004;2:14–23.
Burden ML, Samanta A, Spalding D, Burden AC. A comparison of the glycaemic and
insulinaemic effects of an Asian and a European meal. Pract Diabetes Int. 1994;11:208–11
.
Sevak L, McKeigue PM, Marmot MG. Relationship of hyperinsulinemia to dietary intake in
south Asian and European men. Am J Clin Nutr. 1994;59:1069–74

15. Causative factors in south asians
• Rapid demographic, nutritional, and economic
changes are occurring in South Asians.
• The life expectancy and the percentage of elderly
population have increased.
• Most importantly, globalization of diets and
consumption of non traditional fast foods have
occurred at a rapid pace in urban areas.

16. The present definitions of the MS bear analogy to the folklore of the six blind
men and the elephant whereby each correctly describes only a part of the whole

17. Definition
• However, so far several definitions have been proposed by
• World Health Organi-zation (WHO),
• the International Disease Federation (IDF),
• the National Cholesterol Education Program (NCEP), and
• American Heart Association (AHA)
• National Heart, Lung and Blood Institute (NHLBI))
• “Adult Treatment Panel III (ATP III)”- has been widely used as a common
definition in literature
Grundy, S.M., Brewer Jr., H.B., Cleeman, J.I., et al. (2004) Definition of Metabolic Syndrome:
Report of the National Heart, Lung and Blood Institute/American Heart Association Conference on
Scientific Issues Related to Definition. Circulation, 109, 433-438.

18. Adult treatment Panel -ATP III Criteria
• presence of three or more of the five criteria
• high waist circumference (WC > 102 cm in men and WC > 88 cm in
women),
• high blood pressure (BP > 130/80 mm/Hg),
• high triglyceride (TG > 150 mm/dl),
• high glucose (FBG > 110 mg/dl, and
• low HDL (HDL < 40 mg/dl in men and HDL < 50 mg/dl in women)
– Reaven, G.M. (1988) Banting Lecture 1988. Role of Insulin Resistance in Human Disease.
Diabetes, 37, 1595-1607
• On the other hand, abdominal obesity, defined by high WC is a
compulsory criterion on two or more of the other four criteria in IDF
definition
– Hajian-Tilaki, K. (2015) Metabolic Syndrome and Its Associated Risk Factors in Iranian Adults: A
Systematic Review. Caspian Journal of Internal Medicine, 6, 51-61.

19. Difficulty in pregnancy
• The SM setting in pregnancy is controversial because the
criteria for detection of SM overlap to the physiologic
changes of pregnancy.
• During pregnancy, a woman experiences a set of periodic
transformations that disappear after delivery, among many
quoted phenomena: insulin resistance, increased anabolism in
the first half of pregnancy, increased adiposity, hyperlipidemia,
prothrombotic state
Bartha, J.L., Bugatto, F.G., Macías, R.F., González, N.L., Delgado, R.C. and Vivancos, B.H.
(2008) Metabolic Syn-drome in Normal and Complicated Pregnancies. European Journal of
Obstetrics & Gynecology and Reproductive Bi-ology, 137, 178-184

20. SM criteria in pregnancy
• There are various diagnosing criteria for metabolic
syndrome, but just Bartha and Chatzi presented
modifications to diagnosis of the metabolic syndrome
in obstetric people.
• Bartha introduced changes to the criteria of WHO
and NCEP-ATP III, while Chatzi did it in the criteria
of the NCEP ATP III and the NHLBI/AHA

21. NCEP-ATP III adaptation of MS settings to pregnancy
Clinical NCEP—ATP III for defining SM
Proposal for Adaptation of MS definition of the NCEP—ATP III to preg-
nancy [15]
Any of the following 3 Any of the following 3
Visceral obesity, defined as waist circumference ˃ 88
cm
Visceral obesity , defined as waist circumference ˃ 2 SD for
gestational
(in women) age in the 1st
half of pregnancy or pre-pregnancy BMI ˃ 30 kg/m2
Plasma triglycerides ≥ 150 mg/dl Plasma triglycerides ≥ 2 SD for gestational age
˂HDL cholesterol 50 mg/dl (in women) HDL cholesterol ˂ 2 SD for gestational age
Blood Pressure ≥ 130/≥ 85 mm/Hg Blood Pressure ≥ 130/≥ 85 mm/Hg
Fasting glucose ≥ 110 mg/dL Fasting glucose ≥ 110 mg/dL
Bartha, J.L., Bugatto, F.G., Macías, R.F., González, N.L., Delgado, R.C. and Vivancos, B.H.
(2008) Metabolic Syn-drome in Normal and Complicated Pregnancies.
European Journal of Obstetrics & Gynecology and Reproductive Bi-ology, 137, 178-184

22. WHO adaptation of MS settings to pregnancy
WHO clinical criteria for defining SM Proposal for Adaptation to Pregnancy SM definition of WHO [15]
Resistance to insulin by one of the following Resistance to insulin by one of the following
Type 2 Diabetes Type 2 Diabetes
Impaired fasting glucose Impaired fasting glucose ≥ 105 mg/dL
Impaired Glucose Tolerance -
Insulin resistance defined euglycemic hyper- Insulin resistance defined using the euglycemic hyperinsulinemic clamp or other
insulinemic clamp using the sensitivity measuring method insulin, adjusted for gestational age
More any two of the following More any two of the following
Antihypertensive and/or high blood pressure Antihypertensive and/or high blood pressure (systolic or diastolic ≥ 140 ≥ 90
mm/Hg )
(systolic or diastolic ≥ 140 ≥ 90 mm/Hg)
Plasma triglycerides ≥ 150 mg/dl Triglicerídeos plasmáticos ≥ 2 DP para a idade gestacional
˂HDL cholesterol 39 mg/dl (in women) Cholesterol HDL ˂ 2 DP for gestational age
˃BMI 30 kg/m2
and/or the waist/hip ˃ 0.85 2
(in women)
IMC pre-pregnancy ˃ 30 Kg/m and/or waist/hip ratio ˃ 0.85
Urinary albumin excretion rate ≥ 20 g/min or
-
albumin creatinine ratio ≥ 30 mg/g

23. MS diagnosis in pregnancy
metabolic syndrome is diagnosed if 3 or more of the following
risk factors are present:
• pre-pregnancy body mass index > 30 kg/m2
;
• level of triglyceride ≥ 150 mg /dL;
• cholesterol level HDL < 50 mg/dl;
• fasting plasma glucose level ≥ 100 mg/dL, and
• blood pressure level ≥ 130/85 mm Hg
Chatzi, L., et el (2009) Metabolic Syndrome in Early Pregnancy and Risk of Preterm Birth.
American Journal of Epidemiology, 170, 829-836.
Chatzi, L et el (2009) The Metabolic Syndrome in Early Pregnancy &
Risk of Gestational Diabetes Mellitus. Dibetes & Metabolism, 35, 490-494.

24. Prevalence of SM in pregnancy
• There are few studies on metabolic syndrome in
pregnancy.
• In pregnant women with GDM it was reported a
prevalence of 10%
• In pregnant adolescents, the prevalence is 3% - 5%
BO, S., Menato, G., et al. (2004) Mild Gestational Hyperglycemia,
the Metabolic Syndrome and Adverse Neonatal Outcomes. Acta Obstetricia et Gynecologica Scandinavica, 83, 335- 340
Noussitou, P., Monbaron, D.,et al (2005) Gestational Diabetes Mellitus and
the Risk of Metabolic Syndrome: A Population-Based Study in Lausanne, Switzerland. Diabetes & Metabolism, 31, 361-369.

25. Prevalence of SM in puerperium
• Women with gestational hypertension have increased risk for
developing insulin resistance postpartum, thus increasing
likelihood of developing the metabolic syndrome.
• Drebes et al. 2009 detected a prevalence of MS in puerparas
who had been diagnosed pre-eclampasia of 13.9%, Al-Nasiry
2014 found it to be 7.6% .
Drebes, C., Hentschke, M., Cioffi, L., Furlanetti, T., da Costa, B.E.P., de Figueiredo, C.E.P. and
Gadonski, G. (2014) Hypertensive Disease Pregnancy and Metabolic Syndrome
Al-Nasiry, S., Ghossein-Doha, et el (2014) Metabolic Syndrome after Pregnancies Complicated by
Pre-Eclampsia or Small for Gestational Age: A Re-trospective Cohort. BJOG:
An International Journal of Obstetrics & Gynaecology, 47, 54-55.

26. Association of PIH with metabolic syndrome and increased
risk of cardiovascular disease in women: A systemic review
2016
• The prevalence and odds for developing MS after a
preeclamptic pregnancy are high suggesting that MS
may be involved in the pathogenesis of CVD
following preeclampsia.
• This will provide evidence on the potential health
benefits of a modifiable CVD risk screening program
for women with a history of preeclampsia.
Niger J Clin Pract. 2016 Jul-Aug;19(4):431-5.

27. Relation with Pregnancy wt gain
• women who have not lost the weight gained during
pregnancy up to twelve months after the birth of the
baby or put up on weight at this stage, are at serious
health risks
Retnakaran, R., Qi, Y., Sermer, M., Connelly, P.W., Zinman, B. and Hanley, A.J.G. (2008)
Isolated Hyperglycemia at 1 Hour on Oral Glucose Tolerance Test in Pregnancy
Resembles Gestational Diabetes Mellitus in Predicting Postpar-tum Metabolic Dysfunction.

28. Pre pregnancy obesity
• Metabolic alteration in pre-pregnancy is a determinant
complication factor in pregnancy, post-pregnancy, in life after
birth and adverse perinatal outcomes.
• Pre pregnancy obesity has been demonstrated to be an
independent risk factor for: macrosomia, delivery by cesarean
section, pregnancy induced hypertension, congenital
malformation and increased risk of IUFD
Bartha, J.L., et al (2007) Ultrasound Evaluation of Visceral Fat and
Metabolic Ris Factors during Early Pregnancy. Obesity, 15, 2233-2239.

29. • the long-term effects of inter pregnancy or pre
pregnancy lifestyle interventions on subsequent
GDM remain unknown.
• Future adequately powered and well-controlled clinical trials
are needed to determine the effects of lifestyle interventions
to prevent GDM and identify pathways to effectively reach
reproductive-aged women across all levels of society, before,
during, and after pregnancy.
Am J Perinatol. 2016 Aug 3
Role of pre / inter preg intervention on GDM
Windows of Opportunity for Lifestyle Interventions to
Prevent Gestational Diabetes Mellitus.

30. The risk of metabolic syndrome after gestational diabetes
mellitus - a hospital-based cohort study
• 120 women with a history of GDM and 120 women with a
history of normal glucose metabolism during pregnancy, all
aged between 25 and 46 were enrolled
• CONCLUSIONS:
• The risk of MetS was 2.4-fold higher after GDM than after
normal pregnancy. Cardiovascular risk factors were more
common in participants with high BMI than in those with
previous GDM. Multivariate analysis supported the main
findings. Weight control is important in preventing MetS after
delivery.
Diabetol Metab Syndr. 2015 May 12;7:43

31. Parity, duration of lactation and prevalence of maternal
metabolic syndrome: a cross-sectional study
• Our data did not support protective roles of
lactation in development of metabolic syndrome,
since in our study longer lactation durations as well
as higher number of parities were seen among
participants with metabolic syndrome.
Eur J Obstet Gynecol Reprod Biol. 2016 Jun;201:70-4.

32. Preterm Delivery and Metabolic Syndrome in Women
Followed From Prepregnancy Through 25 Years Later
• Women with a history of preterm birth have
increased risk of incident metabolic syndrome
compared with those with term births, independent
of the prepregnancy metabolic status and pregnancy
complications.
Obstet Gynecol. 2016 Jun;127(6):1127-34.

33. The effect of combined inositol supplementation on maternal metabolic
profile in pregnancies complicated by metabolic syndrome and obesity
• Combined inositol treatment during pregnancy
improves blood pressure, glucose levels at the
glucose tolerance test, and leptin levels in pregnant
women with metabolic-like syndrome phenotype but
not in obese pregnant women.
• In addition, inositol treatment was associated with
lower gestational weight gain in the obese but not in
the metabolic-like syndrome pregnant women.
Am J Obstet Gynecol. 2016 Oct;215(4):503.e1-8

34. Metabolic risk factors clustering and adverse pregnancy
outcomes: a prospective cohort study
• prospective cohort study
• Pre-pregnancy Overweight/obesity, and pregnancy high triglycerides, low
high density lipoprotein-cholesterol, hyperglycemia, raised blood pressure
were defined as metabolic risk factors.
• Adverse pregnancy outcomes were defined as preterm delivery,
small/large for gestational age, preeclampsia, gestational diabetes mellitus,
neonatal asphyxia and fetal demise. Stratified analyses were conducted on
a total of 5535 women according to classification in each metabolic risk
factor
• The numbers of metabolic risk factors and adverse pregnancy outcomes
were positively correlated (P trend <0.001).
• Pregnant women with a cluster of metabolic risk factors are more likely
to have adverse pregnancy outcomes than the others.
Diabetes Metab Res Rev. 2016 Apr 2

35. Nutraceuticals as Lipid-Lowering Treatment in Pregnancy and Their
Effects on the Metabolic Syndrome
• Maternal nutrition and lifestyle before and during pregnancy
influence both mother and offspring's health and can be
correlated with the metabolic syndrome in later life
• A low nutritional intake in early pregnancy may represent a
risk for adverse effects during pregnancy as well as on birth
outcome.
• Further prospective and intervention studies are needed to
establish it. Healthy lifestyle and dietary advice with
appropriate supplements usage should be considered.
Curr Pharm Biotechnol. 2016;17(7):614-23.

36. Pregnancy-Associated Hypertension in Glucose-Intolerant
Pregnancy and Subsequent Metabolic Syndrome
• observational cohort study on 825 women
• CONCLUSION:
• Women with varying degrees of glucose intolerance
who experienced pregnancy-associated hypertension
and then delivered preterm had a higher frequency
of subsequent hypertension, high triglycerides, and
metabolic syndrome 5-10 years later.
Obstet Gynecol. 2016 Apr;127(4):771-9

37. Nature and Nurture in the Early-Life Origins of
Metabolic Syndrome
• The combination of genetic background together with food excess and
lack of exercise has become the cornerstone of metabolic disorders
associated to lifestyle.
• Thus, having in mind the impact of the metabolic syndrome on the
worldwide public health, the present review affords the relative roles and
the interrelationships of nature (genetic predisposition to metabolic
syndrome) and nurture (lifestyle and environmental effects causing
epigenetic changes), on the establishment of the metabolic disorders in
women; disorders that may evolve to metabolic syndrome prior or during
pregnancy and may be transmitted to their descendants.
Curr Pharm Biotechnol. 2016;17(7):573-86.

38. The combination of maternal and offspring high-fat diets causes marked
oxidative stress and development of metabolic syndrome in mouse offspring
• Maternal overnutrition (e.g., high-fat (HF) diet) during
pregnancy and lactation is believed to cause oxidative stress
and increase the risk of metabolic syndrome in offspring. In
the present study, we investigated the effects of both
maternal and offspring HF diets on metabolic syndrome risk
and oxidative stress profiles in mice
• results suggest that the combination of maternal and offspring
overnutrition causes marked oxidative stress in offspring,
which accelerates metabolic syndrome.
Life Sci. 2016 Apr 15;151:70-5.

39. Chronic exposure to air pollution particles increases the risk of obesity and
metabolic syndrome: findings from a natural experiment in Beijing
• Epidemiologic evidence suggests that air pollution is a risk
factor for childhood obesity.
• However, no data have directly supported a link between air
pollution and non-diet-induced weight increases
• In a rodent model, we found that breathing Beijing's highly
polluted air resulted in weight gain and cardiorespiratory and
metabolic dysfunction.
• Chronic exposure to air pollution particles increases the risk
of obesity and metabolic syndrome
FASEB J. 2016 Jun;30(6):2115-22

40. Maternal adverse effects
• Maternal dietary conditions and changes in the intra uterine
environment are directly related to the outcome of
pregnancy.
• preterm birth, IUGR and newborn with LBW have a higher
risk of developing cardiovascular disease and insulin resistance
in the future.
• Previous studies have reported associations between pre-
pregnancy obesity, chronic hypertension, dyslipidemia, and
inflammation in early pregnancy to higher risks of preterm
birth and intrauterine growth restriction
Chatzi, L., Plana, E., et al (2009) Metabolic Syndrome in Early Pregnancy and Risk of
Preterm Birth. American Journal of Epidemiology, 170, 829-836

41. Perinatal sequlae
• Concerning the adverse perinatal outcomes, the
LGA and SGA neonates have augmented chances of
developing metabolic syndrome later
Hou, R.L., Jin, W.Y., et al (2014) Cord blood C-Peptide, Insulin, HbA1c, and Lipids Levels in
Small- and Large-for-Gestational-Age Newborns. Medical Science Monitor, 20, 2097-2105.

42. MS programming in intrauterine life
• Pregnant women who developed GDM or HGL
usually were found to be born with lower weight and
shorter legs, showing the fetal programming of MS
still in their intrauterine life

43. Prevention of complications of SM in pregnancy
• Once diagnosed Metabolic Syndrome in Pregnancy
(MSG) or elements of it, it’s possible to provide
rapid intervention to prevent complications in
pregnancy and adverse perinatal outcomes
Liu, J., Laditka, J.N., Mayer-Davis, E.J. and Pate, E.R. (2008) Does Physical Activity during Pregnancy
Reduce the Risk Gestacional Diabetes among Previously Inactive Women? Birth, 35, 188-195.

44. Prevention is better than cure !!
• In order to prevent MetS, a multipronged approach
is essential, which should include
• behavior modification,
• dietary modifications,
• increase in physical activities,
• prevention of smoking and alcohol excess.
Prabhakaran D, Reddy KS. The metabolic syndrome: Looking
beyond the debates. Clin Pharmacol Ther. 2011;90:19–21

45. Prevention in pregnancy
• Regarding the obstetric and neonatal complications related to MS in
pregnancy, gestational diabetes, hiperisulinemia, presence of acute
co- morbidities or chronic complications are directly related to
morbidity and maternal and fetal mortality.
• For this association is urgent to pay more attention in the
treatment and diet to prevent diseases that cause disorders in the
lives of mother/fetus and society.
• 50% to 70% of diabetic pregnant women improve their glycemic
rates with dietary improvement
Maganha, C.A., Vanni, D.G.B.S., Bernardini, M.A. and Zugaib, M. (2003) Treatment of
Gestational Diabetes Mellitus. Journal of the Brazilian Medical Association, 49, 330-334.

46. School
• Schools offer an ideal medium for lifestyle interventions
because the obesogenic lifestyle behaviors are less well
developed in children and are therefore amenable to change.
• Moreover, it is important to identify the adolescents at risk
for T2DM and CHD at an early age and use appropriate
prevention strategies while the pathological processes are still
reversible.
Bhatia V. IAP National Task Force for Childhood Prevention of Adult Diseases: Insulin
resistance and type 2 diabetes mellitus in childhood. Indian Pediatr. 2004;41:443–57.
Singhal N, Misra A, Shah P, Gulati S, Bhatt S, Sharma S, et al. Impact of intensive school-
based nutrition education and lifestyle interventions on insulin resistance, β-cell function,
disposition index, and subclinical inflammation among Asian Indian adolescents: A
controlled intervention study. Metab Syndr Relat Disord. 2011;9:143–50

47. Prevention-obstetric
• Target prepubertal and adolescent girl as they are
the future mother’s
• Catch them young

48. Lifestyle modification-role of parents and teachers

49. Vicious cycle
Obesity
Metabolic Syndrome

50. Drugs for obesity in children ??
• According to the current international guidelines,
none of the pharmacological agents are approved for
use for prevention of obesity or MetS in children

51. Summary
• The metabolic syndrome is a common metabolic disorder that results
from the increasing prevalence of obesity.
• The disorder is defined in various ways, but in the near future a new
definition(s) will be applicable worldwide.
• The pathophysiology seems to be largely attributable to insulin resistance
with excessive flux of fatty acids implicated.
• A proinflammatory state probably contributes to the syndrome.
• The increased risk for type 2 diabetes and cardiovascular disease demands
therapeutic attention for those at high risk.
• The fundamental approach is weight reduction and increased physical
activity; however, drug treatment could be appropriate for diabetes and
cardiovascular disease risk reduction.

52. Role of obstetrician
• OPD-adolescent PCOS and other adolescent pts
• Unique opportunity to counsel their mothers as well
• Community-school health programmes
• Pregnant lady-high index of suspicion from 1st
visit-
goal is to prevent not only in this pregnancy but in
future pregnancies as well and also prevent MS in her
later life (women’s dr)

53. Take Home Message
• MS –focus on prevention
• MS-early diagnosis to prevent complications in
current pregnancy
• MS- remain vigilant for its sequel

54. Dr. Laxmi Shrikhande
Shrikhande IVF & Surrogacy Center
Ph-96234 59766 / shrikhandedrlaxmi@gmail.com