Impact of Early Gestational Diabetes Screening in High-Risk Populations

描述(申请人提供)：随着美国育龄妇女肥胖率的上升，肥胖对胎儿的健康发育构成越来越大的威胁。肥胖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。妊娠期糖尿病(GDM)与人群肥胖同步上升，很可能有很大比例的GDM妇女现在可以在怀孕前三个月(早期GDM)被识别--但这基本上是没有研究的。我们建议启动一项新的临床护理方案，在Kaiser Permanente的西北部和夏威夷地区首次产前访问时筛查所有高危肥胖孕妇的早期GDM，在那里，普遍的GDM筛查现在是怀孕24-28周(通常为GDM)的常规检查。我们假设，早期妊娠期糖尿病代表了一种更具侵袭性的表型，并且由于与肥胖相关，可能占当前妊娠期糖尿病相关不良结局的很大比例。在超过59,000名孕妇及其婴儿(总计118,000名)的高危多民族人口中，我们将评估与肥胖有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。与随机对照试验一样，我们的干预是假设驱动的，但由于其背景--在大型医疗保健组织的临床护理中--它可以测试整个人群，而不仅仅是通常参与随机对照试验的健康志愿者。长期目标是填补妊娠期糖尿病研究中的关键知识空白，特别是与人口肥胖症有关的知识空白，并减少与妊娠期糖尿病相关的不良孕产妇和围产儿结局。我们的具体目标是比较早期和普通妊娠期糖尿病的患病率，并比较这些群体在母婴结局方面的差异；确定测量的孕妇体重(怀孕期间的初始和增加)作为与妊娠期糖尿病相关的孕产妇和围产儿结局的独立预测因子的影响；以及确定早期妊娠期糖尿病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中将妊娠期糖尿病检测提前到前三个月是否会在系统水平上改善孕产妇和围产儿结局。研究人群将是两个Kaiser地区的整个高危孕妇人口，代表着一个多种族和社会经济多样化的队列。公共卫生相关性：项目简介该项目将在所有肥胖孕妇的首次产前检查中筛查所有肥胖孕妇及其婴儿(总计118,000人)中的早期糖尿病，以确定对高危妇女的早期妊娠期糖尿病诊断和治疗是否可以减少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.