"Intrauterine environment have its imprint on the baby's overall structure and physiology, and they ultimately become more prone to have diabetes, blood pressure, obesity, and cardiovascular disease in their adult life," said Dr. Sunil Gupta in a conversation with Dr. P.C. Manoria at the World Congress Cardio Kidney Metabolic (WC CKM) Medicine 2026. Here are the top 5 takeaways from the conversation: 1 Barker Hypothesis: Metabolic diseases originate in utero, making pregnancy the critical window for primordial prevention. 2 Universal Screening: 1 in 4 Indian women have hyperglycemia in pregnancy; first-trimester 75g OGTT screening is vital. 3 Strict Targets: Aim for fasting under 90 mg/dL, postprandial under 120 mg/dL, and HbA1c under 6.0% to protect the fetus. 4 Treatment: Insulin is the gold standard (no placental crossing). Metformin is secondary, provided placental health is normal. 5 Preconception Care: 90% of pregnancies are unplanned; counseling is essential to manage hyperglycemia before conception. Dr. Sunil Gupta is a globally renowned Diabetologist and the President-elect of the Research Society for the Study of Diabetes in India (RSSDI). He is a leading advocate for gestational diabetes awareness and has pioneered the "Fitness for Pregnancy" concept in India to combat the intergenerational cycle of diabetes. Dr. Gupta is widely recognized for his clinical expertise and his role in shaping national guidelines for the screening and management of hyperglycemia during pregnancy. Dr. Professor P.C. Manoria is the Executive President for the World Congress Cardio Kidney Metabolic (WC CKM) Medicine. He is a distinguished cardiologist based in Mumbai and is a prominent figure in the integration of cardio-renal-metabolic care. Dr. Manoria has led numerous international medical congresses aimed at addressing the epidemic proportions of non-communicable diseases in South Asia.