ChartGlucose4Moms: Characterizing, by Trimester, Continuous Glucose Monitoring Measurements for determining effects on Maternal & Offspring Metabolic Sequelae

项目总结/摘要：在美国，妊娠糖尿病（GDM）的发病率正在上升， 特别是在少数种族和族裔中。妊娠期糖尿病与妊娠期大瘤的发生率较高相关 年龄（LGA）婴儿，剖腹产，严重的围产期并发症，并增加2型糖尿病的长期风险 糖尿病和发病率的母亲和婴儿。接受GDM治疗的女性不太可能 经历围产期并发症和分娩LGA婴儿比那些谁没有;因此，快速 GDM的检测可能对减少围产期并发症和出生结果的差异至关重要。 GDM通常在妊娠24-28周通过口服葡萄糖耐量试验（OGTT）诊断，但临床上， 重要的胰岛素抵抗和代谢功能障碍可能会因不及早检测而被遗漏。的代谢 妊娠早期不健康的子宫环境可能会对母亲产生长期的负面影响， 但是，如何以及何时测试妊娠期胰岛素抵抗和相关代谢功能障碍是 定义不好。需要更多的数据来了解葡萄糖水平和其他代谢指标如何在不同年龄段发生变化。 更好地评估妇女的代谢风险，以及这些风险如何与围产期和长期 成果。 使用连续葡萄糖监测（CGM）和代谢生物标志物测定，我们将详细描述 在怀孕过程中的代谢表型谱，并检查它们是如何与 围产期和产后结局。我们建议招募400名女性作为他们的第一个样本， 从Kaiser Permanente Northwest和Kaiser Permanente夏威夷的三个月，并进行CGM，OGTT， 并在妊娠12周、20周和28周时获得生物标志物， 与围产期结局相关。目标1和目标3将评估CGM变量的影响 (Aim 1）和OGTT和其他生物标志物（目的3）在每个时间点对LGA的风险，其他围产期 结果和产后糖尿病。目标2将评估CGM变量之间的关系， 通过OGTT诊断GDM，以及CGM变量与其他代谢 生物标志物。我们假设代谢紊乱只是更大的代谢紊乱的一个标志 可以通过这个联合体的工作来描述。表征更广泛的 代谢失调及其与不良围产期结局的相关性将导致筛查的改善 为孕妇提供更好的治疗方案和治疗，为母亲和婴儿带来更好的结果。

PROJECT SUMMARY/ABSTRACT: Gestational diabetes (GDM) rates are on the rise in the US, particularly among racial and ethnic minorities. GDM is associated with higher rates of large for gestational age (LGA) infants, C-section, and serious perinatal complications, and increased long-term risks of Type 2 diabetes and morbidity in both mothers and infants. Women who get treatment for GDM are less likely to experience perinatal complications and give birth to LGA infants than those who do not; therefore, rapid detection of GDM may be critical to reducing perinatal complications and disparities in birth outcomes. GDM is normally diagnosed by oral glucose tolerance testing (OGTT) at 24-28 weeks gestation, but clinically important insulin resistance and metabolic dysfunction may be missed by not testing earlier. A metabolically unhealthy uterine environment in early pregnancy may lead to long-term negative impacts on mother and child, but how and when to test for insulin resistance and associated metabolic dysfunction in pregnancy is poorly defined. More data are needed on how glucose levels and other metabolic measures change across pregnancy to better evaluate women's metabolic risks and how those risks relate to perinatal and long-term outcomes. Using continuous glucose monitoring (CGM) and metabolic biomarker assays, we will describe detailed metabolic phenotype profiles over the course of pregnancy and examine how they are associated with perinatal and postpartum outcomes. We propose to recruit a diverse sample of 400 women in their first trimester from Kaiser Permanente Northwest and Kaiser Permanente Hawaii and to perform CGM, OGTT, and obtain biomarkers at 12 weeks, 20 weeks, and 28 weeks of gestation to examine how these measures relate to each other and to perinatal outcomes. Aim 1 and Aim 3 will assess the effects of CGM variables (Aim 1) and OGTT and other biomarkers (Aim 3) at each time point on the risk of LGA, other perinatal outcomes, and postpartum diabetes. Aim 2 will assess the relationship between CGM variables and diagnosis of GDM by OGTT, as well as the relationship between CGM variables and other metabolic biomarkers. We hypothesize that dysglycemia is just one marker of a much larger metabolic dysregulation that can be characterized through the work of this consortium. Characterizing a broader spectrum of metabolic dysregulation and its association with adverse perinatal outcomes will lead to improved screening regimens and treatments for pregnant women and better outcomes for both mothers and babies.