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

项目摘要/摘要：妊娠期糖尿病(GDM)的发病率在美国呈上升趋势， 特别是在种族和族裔少数群体中。妊娠期糖尿病与较高的妊娠期巨大率相关 年龄(LGA)婴儿、剖腹产和严重的围产期并发症，以及2型的长期风险增加 母亲和婴儿的糖尿病和发病率。接受妊娠期糖尿病治疗的女性不太可能 经历过围产期并发症并生下LGA婴儿的人比没有经历过的人；因此，迅速 妊娠期糖尿病的检测可能是减少围产期并发症和出生结局差异的关键。 妊娠期糖尿病通常在妊娠24-28周时通过口服葡萄糖耐量试验(OGTT)确诊，但在临床上 如果不及早检测，可能会漏掉重要的胰岛素抵抗和代谢功能障碍。在新陈代谢方面 妊娠早期不良子宫环境可能对母婴造成长期负面影响 孩子，但如何以及何时测试怀孕期间的胰岛素抵抗和相关代谢功能障碍是 定义不明确。需要更多关于葡萄糖水平和其他新陈代谢指标如何变化的数据 以更好地评估妇女的代谢风险以及这些风险与围产期和长期妊娠的关系 结果。 使用连续血糖监测(CGM)和代谢生物标志物分析，我们将详细描述 妊娠过程中的代谢表型特征，并研究它们与 围产期和产后结局。我们建议招募400名女性作为第一个样本 来自Kaiser Permanente Northwest和Kaiser Permanente Hawaii的三个月，并执行CGM、OGTT、 并在怀孕12周、20周和28周时获取生物标记物，以检查这些指标是如何 相互关联，并与围产期结局有关。目标1和目标3将评估CGM变量的影响 (目标1)和OGTT和其他生物标志物(目标3)在每个时间点关于LGA、其他围产儿风险的 结果，以及产后糖尿病。目标2将评估CGM变量和 糖耐量试验诊断妊娠期糖尿病及其与其他代谢指标的关系 生物标志物。我们假设血糖异常只是更大的代谢失调的一个标志。 这可以通过这个财团的工作来表现出来。表现出更广泛的 代谢失调及其与不良围产儿结局的关联将导致改进筛查 为孕妇提供养生和治疗，为母亲和婴儿提供更好的结果。

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.