TREATMENT FOR MILD GESTATIONAL DIABETES MELLITUS

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。妊娠期糖尿病被定义为不同严重程度的碳水化合物不耐受，在怀孕期间首次被发现。这一定义适用于无论使用胰岛素进行治疗或妊娠后病情持续的情况，也不排除未被识别的糖尿病可能在怀孕之前就已经存在的可能性。众所周知，既往糖尿病对围产期发病率和死亡率有很大影响。虽然母亲碳水化合物不耐受很可能反映了不良后果的连续风险，但尚不清楚在妊娠期识别和随后治疗轻度碳水化合物不耐受是否有益。为了确定轻度妊娠期糖尿病是否是围产儿不良结局的危险因素，以及在识别和治疗轻度疾病患者方面是否有用，建议对空腹血糖水平正常的妊娠期糖尿病患者进行随机临床试验。这项研究将对随机接受饮食治疗的患者和随机接受不饮食治疗的患者进行比较。在试验中，非糖尿病对照组的50克葡萄糖测试异常，但基于传统的三小时口服葡萄糖耐量测试没有妊娠期糖尿病，他们将与轻度妊娠期糖尿病患者进行混杂变量匹配。被随机分成不进行饮食治疗的患者与非糖尿病对照组没有区别。这将最大限度地减少产科或医疗干预的混杂影响。所有患者都将接受标准的3小时OGTT，分娩时获取脐带血，通过脚后跟获取婴儿血液，并进行新生儿人体测量。这些被随机接受饮食治疗的妇女还将每天进行四次血糖仪测试，直到分娩，并每周都会被看到。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Gestational diabetes mellitus is defined as carbohydrates intolerance of variable severity, which is first recognized during pregnancy. This definition applies regardless of insulin use for treatment or persistence of the condition after pregnancy, and does not exclude the possibility that unrecognized diabetes may have preceded the pregnancy. It is known that pre-existing diabetes substantially contributes to perinatal morbidity and mortality. While it is likely that maternal carbohydrate intolerance reflects a continuum of risk for adverse outcomes, it is not known whether there is a benefit to identification and subsequent treatment of mild carbohydrate intolerance during pregnancy. To determine whether mild gestational diabetes is a risk factor for adverse perinatal outcome and whether there is utility in identifying and treating patients with mild disease, a randomized clinical trial is proposed of patients with gestational diabetes who have normal fasting glucose level. The study will compare patients who have been randomized to diet therapy with patients who have been randomized to no diet therapy. A non-diabetic control group, who have an abnormal 50 gram glucose test but do not have gestational diabetes based on a traditional three hour oral glucose tolerance test, will be matched for confounding variables with the mild gestational diabetic patients in the trial. Patients who have been randomized to no dietary treatment will be indistinguished from the non-diabetic control group. This will minimize the confounding influence of obstetrical or medical intervention. All patients will undergo a standard 3-hour OGTT, umbilical cord blood obtained at delivery, infant blood obtained via heelstick and neonatal anthropometric measurements. Those women randomized to diet therapy will also perform glucometer testing four times daily until delivery and be seen weekly.