Fetal and Early Postnatal Influences on Child Metabolic Health After Gestational Diabetes

妊娠糖尿病后胎儿和产后早期对儿童代谢健康的影响

• 批准号: 10159898
• 负责人: Erica Pauline Gunderson
• 金额: $ 67.31万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-06 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10159898
• 关键词: Accounting; Adolescence; Adverse effects; Affect; Age; Animal Experiments; Anthropometry; Behavior; Birth; Birth Weight; Body mass index; Breast Feeding; Breastfed infant; Child; Child Health; Childhood diabetes; Clinical Data; Data; Development; Diabetes Mellitus; Diagnosis; Diet; Discipline of obstetrics; Disease; Electronic Health Record; Epidemiology; Exposure to; Fibrinogen; Food; Fruit; Funding; Future; Gestational Age; Gestational Diabetes; Glucose; Glucose Intolerance; Goals; Growth; Health; Health Status; Health behavior; Height; Homeostasis; Human; Hyperglycemia; Infant; Insulin; Integrated Health Care Systems; Intervention; Juice; Knowledge; Life; Life Style; Link; Lipids; Measures; Metabolic; Modification; Mothers; Neonatal; Non-Insulin-Dependent Diabetes Mellitus; OGTT; Obesity; Outcome; Outcome Study; Pattern; Persons; Prediabetes syndrome; Pregnancy; Pregnant Women; Prospective Studies; Prospective cohort; Protocols documentation; Puberty; Research; Severities; Sleep; Standardization; Surveys; Telephone; Temperament; Time; Update; Visit; Weight; Woman; Youth; adverse pregnancy outcome; cohort; falls; feeding; fetal; follow-up; gestational weight gain; glucose tolerance; high risk; high risk population; improved; in utero; insight; maternal diabetes; maternal obesity; member; neonatal outcome; newborn adiposity; nutrition; obesity in children; obesity prevention; obesity risk; offspring; perinatal outcomes; postnatal; postnatal period; prenatal; prenatal exposure; primary outcome; prospective; recruit; sleep behavior; sociodemographics; sugar; sweetened beverage

Gestational diabetes mellitus (GDM), defined as glucose intolerance first recognized during pregnancy, is a heterogeneous condition and the most common obstetric disorder affecting ~240,000 or ~8% of U.S. pregnant women per year. Fetal exposure to GDM is linked with adverse perinatal outcomes, and higher adiposity, obesity, dysglycemia, and type 2 diabetes during childhood and adolescence. Much less is known about the impact of early postnatal factors [breastfeeding, infant diet including sugar-sweetened beverages (SSB), juice, behaviors, sleep habits] on future adiposity and metabolic health of children exposed to GDM in utero, because previous studies have rarely prospectively assessed any early postnatal factors, except current breastfeeding (BF) at birth or age 3 months (Y/N). Thus, it is unknown whether these modifiable early postnatal factors exert persistent effects on future child adiposity and metabolic health independent of fetal exposure to GDM severity and maternal obesity. This represents a major gap for human studies because animal experiments found that manipulation of postnatal nutrition can ameliorate the adverse effects of fetal exposure to maternal diabetes. The Study of Women, Infant Feeding and Type 2 Diabetes after GDM (SWIFT) is a prospective cohort of 1,035 women with GDM [R01HD050625] recruited during pregnancy (within a single integrated healthcare system) and longitudinally assessed at 3 in-person research visits from 6-9 weeks post-delivery (baseline 2008-2011) and annually up to 2 y post-baseline. Each research visit included 2-h 75 g research OGTTs and assessments of maternal anthropometry, lifestyle behaviors, socio-demographics, and health status under standardized protocols. Monthly mailed surveys, phone calls, and 3 in-person study visits prospectively assessed early postnatal factors [breastfeeding duration and intensity, infant diet including sugar-sweetened beverages (SSB), fruit juice, sleep habits and temperament]. The study also obtained GDM severity measures (3-h 100 g OGTT, GDM treatment, gestational age at diagnosis), perinatal outcomes, and additional clinical data (mother/child weight, height, diabetes diagnoses, health outcomes) from electronic health records (EHR). SWIFT research data have been supplemented by EHR data since its inception and updated annually during follow up since baseline with excellent cohort retention through 2 y post-baseline and beyond (78% are KP members in 2019). The proposed SWIFT Child Study efficiently leverages the currently funded [R01DK118409] 4th in-person research visit at 10 y post-baseline in SWIFT women (Fall 2019-2022). This represents a time-sensitive opportunity to conduct concurrent research visits in their children at age ~10 y (prior or proximate to puberty) with continued prospective follow up from fetal life through the early postnatal period and beyond. The SWIFT Child Study will be one of the first to measure GDM severity under treatment in relation to child metabolic health, and the first prospective study to rigorously assess the lasting independent influences of key early postnatal factors on growth, adiposity, and metabolic health in youth exposed to maternal GDM in utero.

妊娠期糖尿病 (GDM) 被定义为在怀孕期间首次发现的葡萄糖不耐受，是一种异质性疾病，也是最常见的产科疾病，每年影响约 240,000 名或约 8% 的美国孕妇。胎儿接触 GDM 与不良围产期结局以及儿童期和青春期期间肥胖、肥胖、血糖异常和 2 型糖尿病的发生率较高有关。关于早期产后因素 [母乳喂养、婴儿饮食，包括含糖饮料 (SSB)、果汁、行为、睡眠习惯] 对子宫内接触 GDM 的儿童未来肥胖和代谢健康的影响知之甚少，因为之前的研究很少前瞻性地评估任何早期产后因素，除了出生时或 3 个月大时的母乳喂养 (BF) (Y/N)。因此，尚不清楚这些可改变的早期产后因素是否会对未来儿童肥胖和代谢健康产生持续影响，而与胎儿暴露于 GDM 严重程度和母亲肥胖无关。这代表了人类研究的一个重大差距，因为动物实验发现，控制产后营养可以减轻胎儿接触母亲糖尿病的不利影响。 GDM 后妇女、婴儿喂养和 2 型糖尿病研究 (SWIFT) 是一个由 1,035 名 GDM 妇女 [R01HD050625] 组成的前瞻性队列，在怀孕期间（在单一综合医疗保健系统内）招募，并在产后 6-9 周（基线 2008-2011）和每年基线后 2 年期间进行 3 次现场研究访问进行纵向评估。每次研究访问均包括 2 小时 75 g 研究 OGTT 以及根据标准化方案对孕产妇人体测量、生活方式行为、社会人口统计和健康状况进行的评估。每月邮寄调查、电话和 3 次现场研究访问前瞻性评估早期产后因素 [母乳喂养持续时间和强度、婴儿饮食，包括含糖饮料 (SSB)、果汁、睡眠习惯和气质]。该研究还从电子健康记录 (EHR) 中获取了 GDM 严重程度指标（3 小时 100 g OGTT、GDM 治疗、诊断时孕龄）、围产期结局以及其他临床数据（母亲/儿童体重、身高、糖尿病诊断、健康结果）。自成立以来，SWIFT 研究数据就得到了 EHR 数据的补充，并在基线后的随访期间每年进行更新，在基线后 2 年内及之后的队列保留率非常出色（2019 年 78% 是 KP 成员）。拟议的 SWIFT 儿童研究有效地利用了目前资助的 [R01DK118409] 对 SWIFT 女性基线后 10 年进行的第四次现场研究访问（2019-2022 年秋季）。这是一个对时间敏感的机会，可以对大约 10 岁（青春期之前或接近青春期）的孩子进行同时研究访问，并从胎儿生命到产后早期及以后持续进行前瞻性随访。 SWIFT 儿童研究将是第一个衡量治疗中与儿童代谢健康相关的 GDM 严重程度的前瞻性研究，也是第一个严格评估关键产后早期因素对子宫内暴露于母亲 GDM 的青少年生长、肥胖和代谢健康的持久独立影响的前瞻性研究。