Impact of Early Gestational Diabetes Screening in High-Risk Populations

描述（由申请人提供）：随着美国育龄妇女肥胖症的流行，肥胖对胎儿健康发育的威胁越来越大。肥胖对孕产妇和儿童的健康产生负面影响，并最终影响我们社区和国家的健康。妊娠期糖尿病（GDM）与人口肥胖同时上升，现在可能有很大一部分患有妊娠期糖尿病的妇女在妊娠的前三个月（早期GDM）就可以被诊断出来，但这基本上没有研究。我们建议在Kaiser Permanente的西北和夏威夷地区启动一项新的临床护理方案，在所有高危肥胖孕妇的第一次产前检查中筛查早期GDM，在那里，GDM筛查目前在妊娠24-28周（通常的GDM）是常规的。我们假设早期GDM代表一种更具侵略性的表型，并且由于相关的肥胖，可能占当前GDM相关不良结果的很大比例。在超过59,000名高危多民族孕妇及其婴儿（共118,000人）中，我们将评估与肥胖相关的孕产妇和围产期GDM相关结果，以及从围产期到出生的普遍早期GDM筛查干预对这些结果的影响。像随机对照试验一样，我们的干预是假设驱动的，但由于它的设置-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，特别是与人口肥胖有关的空白，并减少GDM相关的孕产妇和围产期不良后果。我们的具体目的是比较早期和常规GDM的诊断患病率，并比较这些组在母亲和婴儿的结局方面的差异；确定测量的母亲体重（包括怀孕初期和怀孕期间的体重增加）作为gdm相关的母亲和围产期结局的独立预测因子的影响；并确定早期GDM筛查试验的敏感性和特异性。此外，我们将评估在高危肥胖妇女妊娠早期检测GDM是否会在系统水平上改善孕产妇和围产期结局。研究人群将是两个凯撒地区的孕妇的全部高危人群，代表了一个多种族和社会经济多样化的队列。该项目将在所有肥胖孕妇的第一次产前检查中筛查妊娠早期糖尿病，在一个大型多样化HMO的59,000多名孕妇及其婴儿（总共118,000人）的研究人群中，确定早期妊娠糖尿病的诊断和治疗是否减少了婴儿和母亲的并发症。

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.