Impact of Early Gestational Diabetes Screening in High-Risk Populations

早期妊娠糖尿病筛查对高危人群的影响

• 批准号: 8288727
• 负责人: TERESA A HILLIER
• 金额: $ 49.11万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-01 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8288727
• 关键词: Accounting; Area; Birth; Brachial plexus structure; Cessation of life; Clinical Protocols; Clinical Trials; Communities; Data; Detection; Development; Diagnosis; Discipline of obstetrics; Dystocia; Epidemic; Ethnic Origin; Fasting; Female of child bearing age; Fetus; First Pregnancy Trimester; Future; Gestational Age; Gestational Diabetes; Glucose Intolerance; Gynecology; Hawaii; Health; High Risk Woman; Humeral Fractures; Hyperglycemia; Hypertension; Injury; Institutes; Insulin; Intervention; Knowledge; Literature; Manuscripts; Maternal and Child Health; Measures; Mothers; OGTT; Obesity; Outcome; Perinatal; Phenotype; Policies; Population; Population Study; Populations at Risk; Pregnancy; Pregnancy Trimesters; Pregnancy in Diabetics; Pregnant Women; Prevalence; Protocols documentation; Publishing Peer Reviews; Research; Risk; Risk Factors; Screening procedure; Sensitivity and Specificity; Series; Shoulder; System; Testing; Time; Visit; Weight; Weight Gain; Woman; adverse outcome; base; clinical care; cohort; cost; design; early onset; fasting glucose; glycemic control; healthy volunteer; high risk; improved; performance tests; prenatal; programs; public health relevance; socioeconomics; stillbirth; volunteer

DESCRIPTION (provided by applicant): With rising epidemic obesity in US women of childbearing age, obesity is an increasing threat to healthy development of the fetus. Obesity adversely impacts maternal and child health-and ultimately the health of our communities and nation. Gestational diabetes (GDM) during pregnancy is rising in parallel with population obesity, and there is likely a large proportion of women with GDM who can now be recognized in the 1st trimester of pregnancy (early GDM)-but this is essentially unstudied. We propose to initiate a new clinical care protocol to screen all high-risk obese pregnant women for early GDM at their first prenatal visit in the Northwest and Hawaii regions of Kaiser Permanente, where universal GDM screening is now routine at 24-28 weeks gestation (usual GDM). We hypothesize that early GDM represents a more aggressive phenotype, and because of associated obesity, may account for a large proportion of current GDM- associated adverse outcomes. Among a high-risk multi-ethnic population of over 59,000 pregnant women and their babies (118,000 total), we will evaluate maternal and perinatal GDM-associated outcomes as it relates to obesity, and the impact of the universal early GDM screening intervention on these outcomes from the perinatal period to birth. Like an RCT, our intervention is hypothesis driven, but because of its setting-in the clinical care of a large HMO-it can test the entire population, rather than only healthy volunteers who typically participate in an RCT. The long-term objectives are to fill in the critical knowledge gaps in GDM research, particularly as it pertains to population obesity, and to reduce GDM-associated adverse maternal and perinatal outcomes. Our specific aims are to compare early versus usual GDM both in prevalence of diagnosis and compare how these groups differ in outcomes for mother and baby; to determine the impact of measured maternal weight (both initial and gain during pregnancy) as an independent predictor of GDM-associated maternal and perinatal outcomes; and to determine the sensitivity and specificity of screening tests for early GDM. In addition, we will evaluate whether advancing GDM detection to the first trimester in high-risk obese women will improve maternal and perinatal outcomes at the system-level. The study population will be the entire at-risk population of pregnant women in two Kaiser regions, representing a multi-ethnic and socio-economically diverse cohort. PUBLIC HEALTH RELEVANCE: PROJECT NARRATIVE This project will screen for early diabetes in pregnancy in all obese pregnant women at their first prenatal visit, among a study population of over 59,000 pregnant women and their babies (118,000 total) in a large diverse HMO, to determine if early gestational diabetes diagnosis and treatment of high- risk women reduces complications for the baby and the mother.

描述（由申请人提供）：随着美国育龄妇女肥胖流行病的增加，肥胖对胎儿健康发育的威胁越来越大。肥胖会对孕产妇和儿童健康产生不利影响，并最终影响我们社区和国家的健康。怀孕期间妊娠糖尿病 (GDM) 的发病率与人口肥胖症同时增加，并且可能有很大一部分患有 GDM 的女性现在可以在怀孕的第一个三个月（早期 GDM）中被识别出来 - 但这基本上尚未得到研究。我们建议启动一项新的临床护理方案，在 Kaiser Permanente 西北和夏威夷地区的所有高风险肥胖孕妇首次产前检查时筛查早期 GDM，其中普遍 GDM 筛查现已成为妊娠 24-28 周（通常 GDM）的常规检查。我们假设早期 GDM 代表了一种更具攻击性的表型，并且由于相关的肥胖，可能占当前 GDM 相关不良后果的很大一部分。在超过 59,000 名孕妇及其婴儿（总计 118,000 名）的高风险多种族人群中，我们将评估与肥胖相关的孕产妇和围产期 GDM 相关结局，以及普遍的早期 GDM 筛查干预对这些从围产期到出生的结局的影响。与随机对照试验一样，我们的干预是假设驱动的，但由于其设置在大型 HMO 的临床护理中，它可以测试整个人群，而不仅仅是通常参加随机对照试验的健康志愿者。长期目标是填补 GDM 研究中的关键知识空白，特别是与人口肥胖相关的知识空白，并减少与 GDM 相关的不良孕产妇和围产期结局。我们的具体目标是比较早期 GDM 与普通 GDM 的诊断患病率，并比较这些群体在母亲和婴儿结局方面的差异；确定测量的孕产妇体重（包括初始体重和怀孕期间体重增加）作为 GDM 相关孕产妇和围产期结局的独立预测因素的影响；并确定早期 GDM 筛查试验的敏感性和特异性。此外，我们将评估将高危肥胖女性的 GDM 检测提前至妊娠早期是否会在系统层面改善孕产妇和围产期结局。研究人群将是两个凯撒地区的所有高危孕妇人群，代表多种族和社会经济多样化的群体。公共健康相关性：项目叙述 该项目将在大型多元化 HMO 中对超过 59,000 名孕妇及其婴儿（总共 118,000 名）进行研究，对所有肥胖孕妇在第一次产前检查时筛查妊娠期早期糖尿病，以确定对高危妇女进行早期妊娠糖尿病诊断和治疗是否可以减少婴儿和母亲的并发症。

项目成果

Impact of earlier gestational diabetes screening for pregnant people with obesity on maternal and perinatal outcomes.

• DOI: 10.1515/jpm-2021-0581
• 发表时间: 2022-10-26
• 期刊: Journal of perinatal medicine
• 影响因子: 2.4

Impact of Maternal Glucose and Gestational Weight Gain on Child Obesity over the First Decade of Life in Normal Birth Weight Infants.

• DOI: 10.1007/s10995-016-1955-7
• 发表时间: 2016-08
• 期刊: MATERNAL AND CHILD HEALTH JOURNAL
• 影响因子: 2.3
• 作者: Hillier, Teresa A.;Pedula, Kathryn L.;Vesco, Kimberly K.;Oshiro, Caryn E. S.;Ogasawara, Keith K.
• 通讯作者: Ogasawara, Keith K.