Hyperglycemia and Pregnancy Outcome(HAPO) Follow Up Study

描述（由申请人提供）：患有既存糖尿病（DM）或妊娠期糖尿病（GDM）的母亲的后代患儿童肥胖症的风险增加。妊娠期糖尿病也与2型糖尿病的母体风险增加有关。目前尚不清楚的是儿童肥胖和代谢紊乱或母体葡萄糖代谢紊乱的风险，沿着母体葡萄糖水平连续到DM诊断水平。高血压和不良妊娠结局（HAPO）随访研究将从参与HAPO研究的女性及其后代队列中招募，以解决这些问题。其假设是妊娠期高血糖症，比显性糖尿病严重，与8-12年后不良儿童和母亲结局的风险增加独立相关。HAPO是一项观察性研究，使用通用方案和数据收集工具、统一的人员培训和中心实验室，在一个大型、多国、种族多样的妊娠晚期女性队列中检查了葡萄糖耐量。HAPO的假设是，妊娠期高血糖症，比显性糖尿病严重，与母亲和新生儿不良结局的风险增加独立相关。其结果导致一个共识小组制定新的国际妊娠期糖尿病研究组协会（IADPSG）诊断GDM的标准。在HAPO中，母亲血糖水平较高与出生体重、脐带血C肽和婴儿肥胖>第90百分位数的频率增加独立相关。在糖尿病母亲的后代中，这些结果是儿童肥胖和代谢紊乱的风险因素，但这些关联的性质和与低于糖尿病诊断的母亲葡萄糖水平增加相关的风险程度，包括基于新的IADPSG标准的GDM母亲，尚不清楚。HAPO随访研究是解决这些重要问题的独特定位。其总体目标是获得肥胖、葡萄糖、胰岛素敏感性和分泌、脂质， 在15个HAPO现场中心中的10个中，在多个种族/种族组的7，000对HAPO母子（8-12岁）中进行炎症和血压（BP）研究。主要目的和假设是：主要目的1：确定妊娠期间母体葡萄糖水平与后代肥胖指标的相关性。假设1：母亲的葡萄糖水平，包括那些新归类为GDM，是积极的和独立的措施，肥胖的后代（肥胖，超重，脂肪百分比）。主要目的2：确定妊娠期间母体葡萄糖水平与8-12年后母体代谢紊乱的关系。假设二：母体葡萄糖水平，包括那些新归类为GDM的，与后期母体葡萄糖代谢紊乱（糖尿病、空腹血糖受损、糖耐量受损）风险呈正相关且独立相关。第二个目的是检查怀孕期间母体葡萄糖水平与子代的胰岛素敏感性和分泌、脂质、血压和炎症以及母亲心血管风险的测量之间的关系。

DESCRIPTION (provided by applicant): Offspring of mothers with pre-existing diabetes mellitus (DM) or gestational DM (GDM) have an increased risk of childhood obesity. GDM is also associated with an increased maternal risk of type 2 DM. What is not known is the risk of childhood obesity and metabolic disorders or maternal disorders of glucose metabolism along the continuum of maternal glucose to levels diagnostic of DM. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Follow-up Study will recruit from the cohort of women and their offspring who participated in the HAPO Study to address these questions. Its hypothesis is hyperglycemia in pregnancy, less severe than overt DM, is independently associated with increased risk of adverse childhood and maternal outcomes 8-12 years later. HAPO, an observational study, examined glucose tolerance in a large, multi-national, racially diverse cohort of women in the 3rd trimester of gestation using a common protocol and data collection instruments, uniform training of personnel and a central laboratory. HAPO's hypothesis was hyperglycemia in pregnancy, less severe than overt diabetes, is independently associated with increased risk of adverse maternal and neonatal outcomes. Its results led a consensus panel to formulate new International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria for the diagnosis of GDM. In HAPO, higher levels of maternal glucose were independently associated with increased frequency of birthweight, cord serum C- peptide, and infant adiposity >90th percentile. In the offspring of diabetic mothers, these outcomes are risk factors for childhood obesity and metabolic disorders, but the nature of these associations and magnitude of risk associated with increasing levels of maternal glucose below those diagnostic of diabetes, including mothers with GDM based upon the new IADPSG criteria, are not known. A HAPO Follow-Up Study is uniquely positioned to address these important questions. Its General Aim is to obtain measures of adiposity, glucose, insulin sensitivity and secretion, lipids, inflammation and blood pressure (BP) in 7,000 HAPO mother-offspring (aged 8-12) pairs of multiple ethnic/race groups in 10 of the 15 HAPO field centers. The primary aims and hypotheses are: Primary Aim 1: To determine associations of maternal glucose levels during pregnancy with measures of adiposity in offspring. Hypothesis 1: Maternal glucose levels, including those newly classified as GDM, are positively and independently associated with measures of adiposity in offspring (obesity, overweight, percent fat). Primary Aim 2: Determine associations of maternal glucose levels during pregnancy and maternal metabolic disorders 8-12 years later. Hypothesis 2: Maternal glucose levels, including those newly classified as GDM, are positively and independently associated with later maternal risk of disorders of glucose metabolism (diabetes, impaired fasting glucose, impaired glucose tolerance). Secondary aims will examine associations of maternal glucose levels during pregnancy with glycemia and insulin sensitivity and secretion, lipids, BP and inflammation in the offspring and measures of cardiovascular risk in the mothers.