Cohort Profile: The Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) Study

Type 2 diabetes (T2DM) contributes significantly to the mortality gap between Indigenous and non-Indigenous Australians, with the onset of diabetes occurring at a younger age among Indigenous Australians.1 We respectfully acknowledge the two Indigenous populations of Australia, the Aboriginal and Torres Strait Islander peoples, who are referred to as Indigenous people in this paper. Thus T2DM is increasingly reported in Indigenous children and youth, and also prior to pregnancy among Indigenous women. Indigenous women are 10 times more likely to have T2DM in pregnancy and 1.5 times more likely to have gestational diabetes (GDM) than non Indigenous women.2 The intergenerational impact of T2DM on Indigenous communities is of great concern, as offspring of an intrauterine environment exposed to hyperglycaemia in pregnancy (HIP) are at significantly higher risk of obesity and diabetes later in life. For example,among Pima Indian peoples, children born after their mother was diagnosed with HIP were reported to have significantly higher body mass index (BMI) and 4-fold higher diabetes risk than their siblings born prior to diagnosis. 3 Prevention strategies implemented during early life are likely to be the most effective in addressing this epidemic among Indigenous Australians. In this context, HIP (which includes both GDM and pre-existing type 2 diabetes in pregnancy) may identify a group among Indigenous mothers and children who will specifically benefit from targeted early intervention, to reduce future risk and burden of chronic disease in this high-risk population.