Glycemic Profiles and Pregnancy Outcomes Study (GLOSS)

项目总结 妊娠期糖尿病(GDM)的患病率在过去20年中大幅增加。 考虑到妊娠期糖尿病与不良妊娠结局的关联，这种增加的患病率令人担忧 作为对妇女及其子女的长期不利后果。妊娠期糖尿病的诊断和治疗 临床上很重要，因为治疗可以减少至少部分-但不是全部-不利结果的频率。 妊娠期糖尿病治疗与减少不良反应之间关系不一致的一个潜在解释 孕妇、新生儿和儿童的结局是妊娠期糖尿病的诊断和治疗通常发生在第三 三个月，这可能太晚了，无法改善与母亲血糖异常有关的所有不良反应。 然而，努力在怀孕早期确定与临床相关的母亲血糖异常，如怀孕前三个月， 或者预测谁将随后患上妊娠期糖尿病，都没有成功。这种不成功的原因之一 对怀孕期间血糖水平的评估主要涉及禁食的单独测量 葡萄糖或仅在葡萄糖负荷后的几个葡萄糖水平。这些措施可能会提供有限的洞察 母亲的血糖状态在短期和长期都在变化。连续血糖监测(CGM) 提供评估血糖谱并获取与这些谱如何变化相关的信息的机会 纵向上是几小时、几天、几周和几个月。在这个提案中，我们将解决这样一个假设，即产妇 从怀孕早期开始的血糖信号将预测随后诊断的妊娠期糖尿病，并更好 与妊娠晚期诊断的妊娠期糖尿病相比，孕妇和新生儿的结局更有关联。要解决这个问题 假设，我们将使用来自CGM的数据来检查怀孕期间的血糖模式，并分析这些 模式，以确定它们与GDM后续发展的关联度有多大 作为不良的孕产妇和新生儿结局。 这项拟议的研究将确定没有糖尿病的妇女在怀孕期间血糖水平的演变。 糖尿病，并确定妊娠早期的血糖模式，以确定哪些妇女将进展为妊娠期糖尿病和/或 世卫组织将更有可能出现产妇和新生儿的不良后果。这些数据对帮助 确定未来的临床试验和干预措施，以减少短期和长期不良妊娠结局。

PROJECT SUMMARY The prevalence of gestational diabetes mellitus (GDM) has increased substantially over the past two decades. This increased prevalence is of concern given the association of GDM with adverse pregnancy outcomes as well as longer-term adverse outcomes for both women and their children. Identification and treatment of GDM are clinically important, as treatment can lessen the frequency of at least some — but not all — adverse outcomes. One potential explanation for the inconsistent relationship of GDM treatment to the reduction of adverse maternal, neonatal, and childhood outcomes is that GDM diagnosis and treatment typically occur in the third trimester, which may be too late to ameliorate all of the adverse effects associated with maternal dysglycemia. However, efforts to identify clinically relevant maternal dysglycemia earlier in gestation, such as the first trimester, or to predict who will subsequently develop GDM, have not been successful. One reason for this lack of success is that the evaluation of glucose levels during pregnancy has primarily involved singular measures of fasting glucose or only a few glucose levels following a glucose load. Such measures may provide limited insight into a maternal glycemic state that is in flux both in the short and long term. Continuous glucose monitoring (CGM) provides an opportunity to evaluate glucose profiles and gain information related to how these profiles change longitudinally over hours, days, weeks, and months. In this proposal, we will address the hypothesis that maternal glucose signatures, starting early in pregnancy, will predict the subsequent diagnosis of GDM and be better associated with maternal and newborn outcomes than the third-trimester diagnosis of GDM. To address this hypothesis, we will use data from CGM to examine glycemic patterns during pregnancy, and analyze these patterns to determine how strongly they are associated with the subsequent development of GDM as well as adverse maternal and neonatal outcomes. The proposed study will define the evolution of glucose levels during pregnancy in women without diabetes mellitus, and define patterns of glycemia in early pregnancy that identify women who will progress to GDM and/or who will be more likely to have maternal and neonatal adverse outcomes. These data are crucial to help determine future clinical trials and interventions to reduce short- and long-term adverse pregnancy outcomes.