Regulation Of Maternal Fuel Supply And Neonatal Adiposity

NCT ID: NCT00826904

Last Updated: 2019-11-05

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 59 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2007-10-31
• Study Completion Date: 2017-03-20

Brief Summary

The purpose of this study is to determine whether unrecognized maternal hyperglycemia and postprandial lipemia early or late in gestation predicts excess neonatal adiposity.

Detailed Description

Mounting epidemiologic evidence suggests that maternal obesity and Gestational Diabetes Mellitus (GDM) independently influence size at birth and disease susceptibility later in life. A major gap in the understanding of fetal programming is the knowledge of whether and how exposure to excess maternal fuels in the absence of frank hyperglycemia impacts fetal fat accretion. The investigators hypothesis is that neonatal adiposity results from unrecognized maternal hyperglycemia and excess lipid availability in gestation, in part caused by excessive lipolysis in the white adipose tissue of obese women, some of whom will be subsequently diagnosed as having GDM. In Aim 1 the investigators will test the hypothesis that in obese women, some of whom will later be diagnosed with GDM, increased lipolysis and unrecognized hyperglycemia and hypertriglyceridemia occur earlier in gestation than in lean women, resulting in increased plasma non-esterified fatty acids (NEFA), glycerol, triglycerides (TGs), and glucose available for fetal metabolism. In Aim 2 the investigators will test the hypothesis that fetal adiposity by ultrasound and neonatal adiposity by Dual-energy X-ray Absorptiometry (DXA) are strongly correlated with excess lipid and glucose availability in obese mothers early in gestation, regardless of GDM status, and that fasting biomarkers of neonatal insulin sensitivity will correlate with neonatal adiposity. In Aim 3 the investigators will test the hypothesis that the in-vitro suppression of lipolysis in white adipose tissue correlates with excess NEFA and TG availability in-vivo and is predictive of neonatal adiposity. The elucidation of specific derangements in both glucose and lipid metabolism and their timing in gestation in mothers who deliver infants with excess adiposity could challenge our current screening methods and entirely redirect our treatment to target the responsible maternal fuels. On a public health level, this research is instrumental to the investigators understanding of how an intrauterine environment may deliver excess glucose and/or lipids to the fetus and contribute to the genesis of the pediatric obesity epidemic. Such information may result in new treatment strategies in pregnant women to normalize fetal growth.

Conditions

Fetal Macrosomia; Gestational Diabetes

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Study Groups

Lean

Healthy, pregnant women with BMI of 20 - 26 kg/m2

No interventions assigned to this group

Obese

Healthy, obese pregnant women with BMI 30 - 38 kg/m2

No interventions assigned to this group

Eligibility Criteria

Inclusion Criteria

• Age 18 - 35 yr
• Pregnant (12-14 weeks gestation)
• Lean (BMI 20-26 kg/m2)
• Obese (BMI 30-38 kg/m2)

Exclusion Criteria

• Age < 18 or > 35 yr
• Pre-existing diabetes
• Chronic medical conditions:

1. hypertension,

2. hepatitis,

3. Human immunodeficiency Virus (HIV),

4. Thrombophilias,

5. History of:

1. thromboembolism,

2. renal disease,

3. neurologic diseases,

4. rheumatologic disorders,

5. gastrointestinal disease,

6. cardiac dysfunction, or

7. pulmonary disease

• Obstetric conditions:

1. history of stillbirth,

2. severe growth restriction,

3. severe preeclampsia, or

4. placental abruption

• Medications known to affect lipid or glucose metabolism:

1. Metformin,

2. glucocorticoids,

3. beta agonists or blockers, or

4. antihypertensives

• Use of recreational drugs, alcohol or tobacco.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 35 Years
• Eligible Sex: FEMALE
• Accepts Healthy Volunteers: Yes

Sponsors

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

NIH

Sponsor Role: collaborator

University of Colorado, Denver

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Linda A Barbour, MD, MSPH

Role: PRINCIPAL_INVESTIGATOR

University of Colorado, Denver

Locations

University of Colorado Denver

Aurora, Colorado, United States

Countries

United States

References

Barbour LA, Farabi SS, Friedman JE, Hirsch NM, Reece MS, Van Pelt RE, Hernandez TL. Postprandial Triglycerides Predict Newborn Fat More Strongly than Glucose in Women with Obesity in Early Pregnancy. Obesity (Silver Spring). 2018 Aug;26(8):1347-1356. doi: 10.1002/oby.22246. Epub 2018 Jun 22.

Reference Type: DERIVED

PMID: 29931812 (View on PubMed)

Other Identifiers

R56DK078645

Identifier Type: NIH

Identifier Source: secondary_id

View Link

07-0535

Identifier Type: -

Identifier Source: org_study_id