Funders:
  • NHMRC Clinical Trials and Cohort Studies 
Aims: 

Aim 1a: To identify and quantify differences in cardiometabolic risk markers (BMI, weight, waist circumference, HbA1c, and blood pressure) among offspring exposed and not exposed to hyperglycaemia in-utero and identify modifiable factors early in life (in pregnancy, Wave 1 and Wave 2) for cardiometabolic risk. 
Aim 1b: To describe the cumulative incidence and predictors of prediabetes, diabetes, CVD and CKD, among women who had GDM or T2D during their PANDORA pregnancy. 
Aim 2: Implement and evaluate a culturally appropriate health education package on intergenerational diabetes for First Nations people at risk of or with T2D and health professionals 

Summary: 

Type 2 diabetes disproportionately affect First Nations people, affecting each generation at an earlier age. Why we are seeing aggressive diabetes and the role of diabetes in pregnancy (both gestational diabetes and pre-existing type 2 diabetes) and early life factors is not well understood. The PANDORA study, established in 2011, is a longitudinal birth cohort of First Nations and non-First Nations participants, comprising 1,139 women and their children in the Northern Territory. With 28% of Aboriginal women in the cohort with pre-existing type 2 diabetes, this is the highest proportion of any cohort globally and well placed better understand intergenerational diabetes. A key strength of this study is detailed clinical data collection at birth (Baseline), age 2-4 years (Wave 1) and age 6-12 years (Wave 2). This proposal is for Wave 3- the next wave of this important cohort- at the critical period of 12-18 years postpartum. By conducting clinical assessments with women and their offspring, we will determine the incidence of type 2 diabetes and its complications and examine cardiometabolic risk trajectories in women and their offspring exposed to diabetes in pregnancy compared to those not exposed. We will also implement, evaluate and adapt a comprehensive health education package, that was co-designed with First Nations people, that tells the story of intergenerational diabetes. 

Implications for policy and practice:

The PANDORA study is the largest birth cohort of offspring exposed to diabetes in pregnancy born to mothers with Aboriginal ancestry. PANDORA is in a unique position to offer unparalleled comprehensive longitudinal data to rigorously better understand and explore the impact of gestational diabetes and type 2 diabetes in pregnancy and early life. Investing in the ongoing follow-up of the PANDORA cohort will provide an invaluable resource for future research into intergenerational diabetes beyond the scope of the current funding application. Wave 3 will be crucial for identifying early origins of youth-onset type 2 diabetes, enabling early identification of high risk children and efficient health resource allocation. This research program will identify long-term T2D and cardiometabolic risks in women and inform targeted policies to reduce this risk. This is of critical significance for the high-risk First Nations population nationally and internationally as type 2 diabetes in pregnancy rises. Additionally, Aim 2, addressing reciprocity in research, will develop a strengths-based health education package for national dissemination, empowering First Nations people to access preventative care.

Our research has found:  
  • First Nations women with pre-existing type 2 diabetes in pregnancy and more advsere birth outcomes compared to women wh did not have pre-existing type 2 diabetes
  • 22% of First Nations mothers with gestational diabetes developed type 2 diabetes within 2.5 years postpartum, compared to 5% of non-First Nations mothers.
  • Children of First Nations mothers with pre-existing type 2 diabetes or gestational diabetes showed altered growth at ages 1.5 to 6 years, with gestational diabetes exposure associated with lower weight and -Preliminary findings indicate that by ages 5.5 to 12 years, children of mothers with pre-existing type 2 diabetes or gestational diabetes had higher BMIs compared to those exposed to no diabetes.
Chief investigator:
Project managers:

 

Project dates:

January 2026 - December 2030

Information for study participants/ get involved with this project:

Starting in early 2026, our research team will be back travelling around the NT (and inter-state) seeing our PANDORA participants.
Contact us for more information
Email: pandora@menzies.edu.au
Phone: 08 8946 8497

  1. Titmuss A, Barzi F, Barr E, Webster V, Wood A, et al, Association between maternal hyperglycaemia in pregnancy and offspring anthropometry in early childhood: the PANDORA Wave 1 study. Int J Obes. 2023 Nov; 47(11): 1120-1131
  2. Wood A, Kasireddy V, Chitturi S, Walsh J. Insulinoma presenting with postprandial hypoglycaemia in a  pregnant woman with MEN-1. JCEM Case Reports, 1 (1), January 2023, luac015,
  3. Stapleton C, Watkins E, Hare M, Timms F, Wood A, Titmuss. The prevalence of diabetes distress and its association with glycaemia in young people living with insulin-requiring-diabetes in a regional centre in Australia J Paediatr Child Health 2022 Dec;58(12):2273-2279.
  4. Wood A, et al. Postpartum uptake of diabetes screening tests in women with gestational diabetes: the PANDORA study. Diabetic Medicine. 2023 Mar;40(3): e14999
  5. Titmuss A, Longmore D, Barzi F, Barr E, Webster V, Wood A, et al, Association between hyperglycaemia in pregnancy and growth of offspring in early childhood: The PANDORA study.  Pediatric Obesity. 2022 May 29;e12932. 
  6. Titmuss A D’Aprano A, Barzi F, Brown ADH, Wood A, et al. Hyperglycemia in pregnancy and developmental outcomes in children at 18-60 months of age: the PANDORA Wave 1 study. J Dev Orig Health Dis 2022 Apr 4;1-11.
  7. Wood A, Boyle JA, Barr ELM, Barzi F, et al. Type 2 diabetes after a pregnancy with gestational diabetes among First Nations women in Australia: the PANDORA study. Diabetes Research and Clinical Practice. 2021;181:109092.
  8. Ng E, Shaw JE, Wood A, Maple-Brown LJ, Hare MJL. Glucagon-like peptide-1 receptor agonist (GLP1-RA) therapy in type 2 diabetes. Accepted for publication in Australian Journal of General Practice, Nov 2021
  9. Wood A, Graham S, Boyle J, Marcusson B, Anderson S, Connors, McIntyre H, Maple-Brown LJ, Kirkham R, – A phenomenological study. Incorporating Aboriginal women’s voices in improving care and reducing risk for women with diabetes in pregnancy. BMC Pregnancy and Childbirth 2021;21(1):624.
  10. Wood A, MacKay D, Fitzsimmons D, Derkenne R, Kirkham R, Boyle J, Connors C, Whitbread C, Welsh A, Brown A, Shaw J, Maple-Brown L, Primary health care for Aboriginal Australian women in remote communities after a pregnancy with hyperglycaemia. International Journal Environmental Research and Public Health 2019; 17 (3).

PANDORA - Diabetes across the Lifecourse