Fetal and Early Postnatal Influences on Child Metabolic Health After Gestational Diabetes

妊娠糖尿病后胎儿和产后早期对儿童代谢健康的影响

基本信息

批准号：
10399625
负责人：
Erica Pauline Gunderson
金额：
$ 68.2万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-05-06 至 2025-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10399625
关键词：
Accounting Adolescence Adverse effects Affect Age Animal Experiments Anthropometry Behavior Birth Birth Weight Body mass index Breast Feeding Breastfed infant Child Child Health Childhood diabetes Clinical Data Data Development Diabetes Mellitus Diagnosis Diet Discipline of obstetrics Disease Electronic Health Record Epidemiology Exposure to Fibrinogen Food Fruit Funding Future Gestational Age Gestational Diabetes Glucose Glucose Intolerance Goals Growth Health Health Status Health behavior Height Homeostasis Human Hyperglycemia Infant Insulin Integrated Health Care Systems Intervention Juice Knowledge Life Life Style Link Lipids Measures Metabolic Modification Mothers Neonatal Non-Insulin-Dependent Diabetes Mellitus OGTT Obesity Outcome Outcome Study Pattern Persons Prediabetes syndrome Pregnancy Pregnant Women Prospective Studies Prospective cohort Protocols documentation Puberty Research Severities Sleep Standardization Surveys Telephone Temperament Time Update Visit Weight Woman Youth adverse pregnancy outcome cohort falls feeding fetal follow-up gestational weight gain glucose tolerance high risk high risk population improved in utero insight maternal diabetes maternal obesity member neonatal outcome newborn adiposity nutrition obesity in children obesity prevention obesity risk offspring perinatal outcomes postnatal postnatal period prenatal prenatal exposure primary outcome prospective recruit sleep behavior sociodemographics sugar sweetened beverage

项目摘要

Gestational diabetes mellitus (GDM), defined as glucose intolerance first recognized during pregnancy, is a heterogeneous condition and the most common obstetric disorder affecting ~240,000 or ~8% of U.S. pregnant women per year. Fetal exposure to GDM is linked with adverse perinatal outcomes, and higher adiposity, obesity, dysglycemia, and type 2 diabetes during childhood and adolescence. Much less is known about the impact of early postnatal factors [breastfeeding, infant diet including sugar-sweetened beverages (SSB), juice, behaviors, sleep habits] on future adiposity and metabolic health of children exposed to GDM in utero, because previous studies have rarely prospectively assessed any early postnatal factors, except current breastfeeding (BF) at birth or age 3 months (Y/N). Thus, it is unknown whether these modifiable early postnatal factors exert persistent effects on future child adiposity and metabolic health independent of fetal exposure to GDM severity and maternal obesity. This represents a major gap for human studies because animal experiments found that manipulation of postnatal nutrition can ameliorate the adverse effects of fetal exposure to maternal diabetes. The Study of Women, Infant Feeding and Type 2 Diabetes after GDM (SWIFT) is a prospective cohort of 1,035 women with GDM [R01HD050625] recruited during pregnancy (within a single integrated healthcare system) and longitudinally assessed at 3 in-person research visits from 6-9 weeks post-delivery (baseline 2008-2011) and annually up to 2 y post-baseline. Each research visit included 2-h 75 g research OGTTs and assessments of maternal anthropometry, lifestyle behaviors, socio-demographics, and health status under standardized protocols. Monthly mailed surveys, phone calls, and 3 in-person study visits prospectively assessed early postnatal factors [breastfeeding duration and intensity, infant diet including sugar-sweetened beverages (SSB), fruit juice, sleep habits and temperament]. The study also obtained GDM severity measures (3-h 100 g OGTT, GDM treatment, gestational age at diagnosis), perinatal outcomes, and additional clinical data (mother/child weight, height, diabetes diagnoses, health outcomes) from electronic health records (EHR). SWIFT research data have been supplemented by EHR data since its inception and updated annually during follow up since baseline with excellent cohort retention through 2 y post-baseline and beyond (78% are KP members in 2019). The proposed SWIFT Child Study efficiently leverages the currently funded [R01DK118409] 4th in-person research visit at 10 y post-baseline in SWIFT women (Fall 2019-2022). This represents a time-sensitive opportunity to conduct concurrent research visits in their children at age ~10 y (prior or proximate to puberty) with continued prospective follow up from fetal life through the early postnatal period and beyond. The SWIFT Child Study will be one of the first to measure GDM severity under treatment in relation to child metabolic health, and the first prospective study to rigorously assess the lasting independent influences of key early postnatal factors on growth, adiposity, and metabolic health in youth exposed to maternal GDM in utero.

妊娠糖尿病（GDM）被定义为在怀孕期间首次识别的葡萄糖不耐症，是一种异质性病，是影响约240,000或约8％的美国孕妇的最常见的产科疾病。胎儿对GDM的暴露与不良的围产期结局以及在儿童期和青春期期间更高的肥胖，肥胖，性糖性和2型糖尿病有关。关于早期产后因素的影响[母乳喂养，包括加糖饮料的婴儿饮食（SSB），果汁，行为，睡眠习惯]对未来的肥胖和子宫内GDM儿童的代谢健康的影响知之甚少。因此，尚不清楚这些可修改的早期产后因素是否对未来的儿童肥胖和代谢健康产生持久影响，而不是胎儿暴露于GDM严重程度和孕产妇肥胖。这代表了人类研究的主要差距，因为动物实验发现对产后营养的操纵可以改善胎儿暴露于孕产妇糖尿病的不利影响。 GDM（SWIFT）后对妇女，婴儿喂养和2型糖尿病的研究是一项预期的队列，该研究在怀孕期间招募了1,035名GDM [R01HD050625]的女性（在单个综合医疗系统中）招募（在单个综合医疗系统中），并在3-9周后对3-9周的3-9周进行了纵向研究，并在3-9周进行了仔细评估，并以3-9周的速度进行了2008-11111111111111111111111111111111111111111111111期为2011年。每次研究访问包括2-H 75 G研究OGTT和对母体人体测量法，生活方式行为，社会人口统计学和在标准方案下的健康状况的评估。每月邮寄的调查，电话和3次面对面的研究访问前瞻性评估了早期的产后因素[母乳喂养持续时间和强度，包括糖味饮料（SSB），包括糖粉饮料（SSB），果汁，睡眠习惯和气质的婴儿饮食]。该研究还获得了GDM严重程度度量（3-H 100 G OGTT，GDM治疗，诊断时的胎龄），围产期结局以及电子健康记录（EHR）的其他临床数据（母/儿童体重，身高，糖尿病，糖尿病诊断，健康结果）。自成立以来，Swift研究数据已通过EHR数据补充，自基线以来每年进行随访，并在基线以来，并在基线后及以后进行了出色的队列保留率（2019年，KP成员是KP成员78％）。拟议中的Swift儿童研究有效利用了当前资助的[R01DK118409]在Swift妇女后10 Y的第4次亲自研究访问（2019 - 2022年秋季）。这代表了一个时间敏感的机会，可以在约10岁（先前或接近青春期）进行同时进行研究探访，从胎儿生活到产后早期及以后的前瞻性随访。 Swift儿童研究将是第一个与儿童代谢健康有关的治疗中GDM严重程度的研究之一，也是第一个前瞻性研究，以严格评估关键早期早期早期因素对UTERO中孕妇GDM的年轻人的生长，肥胖和代谢健康的持久独立影响。