Comparing Glycemic Profiles in Pregnancy and Maternal and Child Health Outcomes

在美国，每年有400万妇女在怀孕24-28周时接受50克葡萄糖耐量测试 各州。这项针对妊娠期糖尿病(GDM)的通用筛查旨在改善健康，减少 通过允许减少与妊娠期糖尿病相关的已知并发症的治疗，来降低成本。然而，由于 目前对妊娠期糖尿病患者所生子女进行筛查、诊断和治疗的风险仍然要高得多。 与非妊娠期糖尿病妇女的后代相比，儿童肥胖的风险更大。这些是女性所生的女婴 患有妊娠期糖尿病的人更有可能成为肥胖的成年人，因为妊娠期糖尿病的风险取决于母亲的身体 质量指数，这些妇女将更有可能在怀孕时患上妊娠期糖尿病。这 GDM导致子孙后代日益肥胖的循环只能用更好的 了解妊娠期母体血糖的变化，以便选择合适的时间和类型 与妊娠并发症最相关的血糖异常，包括儿童肥胖，可能是 已确认身份。此应用程序的总体目标是利用布朗大学/妇幼医院的 相当大的妊娠研究基础设施，早期产前护理比率高，接生量大，以及 妊娠期糖尿病成功临床研究的跟踪记录，以确保这项协作性队列研究 对孕期母体血糖的调查是成功的。布朗大学/妇幼医院将 在怀孕的前三个月至少招收400名妇女(占2000名登记总人数)，并跟踪她们和 他们的后代，直到孩子两岁。虽然最终目标将由方向盘决定 各参与中心委员会，提出了以下具体目标：1)利用连续葡萄糖 在妊娠期间的5个时间点监测(CGM)(第一个三个月、第二个三个月早期、24-28个月 周、妊娠晚期和产后)，以更好地了解临界值和时间段 血糖异常与怀孕、新生儿或儿童早期并发症有关，包括 肥胖和体重指数z-Score&gt；在2岁时为第85个百分位数；2)创建 将用于比较传统血糖测试的5个时间点的孕妇血清(空腹， 糖化血红蛋白和葡萄糖挑战)CGM结果以确定最佳筛查阳性 3)使用决策建模来评估任何改变对美国医疗保健的成本和影响 妊娠期糖尿病检测的时机或方式。如果成功，这个项目将产生更多的 全面了解妊娠期血糖变化，确定关键措施和孕周 与发病率最相关的窗口，并确定临床上识别的最佳筛查试验 严重的血糖紊乱。这将允许重新设计怀孕期间的血糖测试，以实现 更健康的下一代和财政节省。

Four million women undergo a 50 gram glucose tolerance test at 24-28 weeks gestation annually in the United States. This universal screen for gestational diabetes mellitus (GDM) is intended to improve health and reduce costs by allowing for treatments that will reduce the known complications associated with GDM. However, as currently screened for, diagnosed, and treated, offspring born to women with GDM are still at much higher risk for childhood obesity compared to the offspring of women without GDM. These female children born to women with GDM are more likely to become obese adults and because GDM risk is dependent on maternal body mass index, these women will be more likely to have GDM themselves when they become pregnant. This cycle of GDM leading to increasingly obese future generations can only be broken with a better understanding of the maternal glycemic profile during gestation so that the timing and types of dysglycemia most associated with pregnancy complications, including childhood obesity, can be identified. The overall objective of this application is to leverage Brown University/Women & Infants Hospital's considerable pregnancy research infrastructure, high rates of early prenatal care, large delivery volume, and track record of successful clinical research in diabetes in pregnancy to ensure this collaborative cohort study investigating maternal glycemia in pregnancy is a success. Brown University/Women & Infants Hospital will enroll at least 400 women (of the 2000 total enrollment) in the first trimester of pregnancy and follow them and their offspring until the children are two years of age. While the final aims will be determined by a steering committee of all participating centers, the following specific aims are proposed: 1) Utilize continuous glucose monitoring (CGM) at 5 time points during gestation (first trimester, early second trimester, 24-28 weeks, third trimester, and post-partum) to better understand critical values and time periods when dysglycemia is associated with pregnancy, and neonatal or early childhood complications, including adiposity and body mass index z-score >85th percentile at 2 years of life; 2) create a biobank of maternal serum at the 5 time points that will be used to compare traditional glucose tests (fasting, glycosylated hemoglobin, and glucose challenge) to CGM results to determine optimal screen-positive cut-offs; 3) use decision modeling to assess the costs and effects to US health care of any changes to the timing or modality of GDM testing in pregnancy. If successful, this project will result in a more complete understanding of glycemic changes over gestation, identify critical measures and gestational age windows most associated with morbidity, and determine the optimal screening test to identify clinically significant dysglycemia. This will allow glucose testing in pregnancy to be re-designed to achieve both a healthier next generation and fiscal savings.