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