Late Gestational Diabetes Mellitus Diagnosis in Obese Women

NCT ID: NCT05510518

Last Updated: 2022-08-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

150 participants

Study Classification

OBSERVATIONAL

Study Start Date

2022-08-31

Study Completion Date

2025-02-28

Brief Summary

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In the current work, we aim to perform a prospective study that will investigate the relationship between maternal obesity (BMI \>30 kg/m2) and morbid obesity (BMI \>35 kg/m2) with a late GDM diagnosis (\>32 weeks), with an emphasis on obstetric and neonatal outcomes.

Detailed Description

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Methods

Study design:

A prospective study that will evaluate the rate of diagnosis of late GDM and clinical effect of performing a repeat OGTT beyond week 32 in women with obesity (BMI \>30 kg/m2) and morbid obesity (BMI \>35 kg/m2) for whom loading sugar was normal in the second trimester. The study will be carried out in the Mother and Fetus Unit at the Galilee Medical Center in Nahariya, Israel.

Study population:

Target population: women hospitalized in the Mother and Fetus Unit for various reasons, e.g., premature labor, amniotic fluid leakage, reduced fetal movements, following a car accident, etc.

Inclusion criteria:

1. Women with normal OGTT at weeks 24-28
2. Women with BMI \>30 kg/m2

Exclusion criteria:

1. Twins
2. Fetal abnormalities
3. Women who received steroids within the preceding week We will invite women who meet the enrollment criteria to participate in the study, and perform an OGTT.

Research objectives:

1. Primary endpoints:

The percentage of obese women with late GDM diagnosis will be divided into two groups according to BMI:
* BMI 30-35 kg/m2
* BMI \>35 kg/m2
2. Secondary endpoints:

* Differences in the following obstetric outcomes between women diagnosed or not diagnosed with GDM: percentage of macrosomia, delivery method, shoulder dystocia, grade 3-4 tear
* Differences in the following newborn outcomes between women diagnosed or not diagnosed with GDM: hypoglycemia, jaundice, need for phototherapy, polycythemia, hospitalization in neonatal intensive care, Apgar score, and newborn pH

Research procedure, interpretation of results, and patient follow-up:

* The OGTT involves assessing fasting blood glucose, drinking a solution comprising 100 g of glucose, and three glucose tests at one, two, and three hours following glucose load.
* Interpretation of the OGTT result is performed according to Carpenter-Coustan criteria \[6\]
* Women who are not diagnosed with GDM will be discharged for continued follow-up for regular prenatal care and the reason for her hospitalization.
* Per standard of care (regardless of research involvement) women diagnosed with GDM will receive counseling by a dietitian and other key department staff and undergo a complete glucose curve (seven tests per day: fasting, before each of three meals, and two hours after each meal).
* If more than 30% of glucose tests are abnormal, the patient will receive standard drug treatment.
* Follow-up is usually performed for 1-2 days in the hospital ward, after which women are discharged to ambulatory follow-up at the Mother and Fetus Clinic of the medical center.

Statistical analysis:

The sample size was calculated using the chi square formula for comparing two groups.

In a previous study in which repeat OGTT was performed beyond week 32 after initially normal results at week 24-28, the diagnosis rate of GDM for the total sample was 10%. An effect size of 20% was considered significant between obese and morbidly obese women with alpha=0.05, power 80%. The calculated sample size was 124 (at least 62 obese and 62 morbidly obese women).

Conditions

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Gestational Diabetes Mellitus in Pregnancy Macrosomia, Fetal Dystocia, Shoulder Neonatal Jaundice Polycythemia Hypoglycemia Neonatal Obesity Obesity, Morbid

Study Design

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Observational Model Type

CASE_ONLY

Study Time Perspective

PROSPECTIVE

Study Groups

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BMI >30 kg/m2

Singleton pregnant women with normal OGTT at 24-28 weeks of gestation and BMI \>30 kg/m2

oral glucose tolerance test (OGTT)

Intervention Type DIAGNOSTIC_TEST

• The OGTT involves assessing fasting blood glucose, drinking a solution comprising 100 g of glucose, and three glucose tests at one, two, and three hours following glucose load.

BMI >35 kg/m2

Singleton pregnant women with normal OGTT at 24-28 weeks of gestation and BMI \>35 kg/m2

oral glucose tolerance test (OGTT)

Intervention Type DIAGNOSTIC_TEST

• The OGTT involves assessing fasting blood glucose, drinking a solution comprising 100 g of glucose, and three glucose tests at one, two, and three hours following glucose load.

Interventions

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oral glucose tolerance test (OGTT)

• The OGTT involves assessing fasting blood glucose, drinking a solution comprising 100 g of glucose, and three glucose tests at one, two, and three hours following glucose load.

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

1. Women with normal OGTT at weeks 24-28
2. Women with BMI \>30 kg/m2

Exclusion Criteria

1. Multiple pregnancy
2. Fetal defects
3. Women who received steroids within the preceding week
Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Western Galilee Hospital-Nahariya

OTHER_GOV

Sponsor Role lead

Responsible Party

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Dr. Maya Wolf

Director of the Maternal and Fetal Medicine Unit

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Galil Medical Center

Nahariya, , Israel

Site Status

Countries

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Israel

Central Contacts

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Maya Wolf, MD

Role: CONTACT

+972-2-9107186

Osnat Sharon, CRC

Role: CONTACT

+972-52-3980209

References

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Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017-2018. NCHS Data Brief. 2020 Feb;(360):1-8.

Reference Type BACKGROUND
PMID: 32487284 (View on PubMed)

Arabin B, Stupin JH. Overweight and Obesity before, during and after Pregnancy: Part 2: Evidence-based Risk Factors and Interventions. Geburtshilfe Frauenheilkd. 2014 Jul;74(7):646-655. doi: 10.1055/s-0034-1368462.

Reference Type BACKGROUND
PMID: 25100879 (View on PubMed)

Abu Shqara R, Or S, Wiener Y, Lowenstein L, Frank Wolf M. Clinical implications of the 100-g oral glucose tolerance test in the third trimester. Arch Gynecol Obstet. 2023 Feb;307(2):421-429. doi: 10.1007/s00404-022-06520-5. Epub 2022 Mar 28.

Reference Type BACKGROUND
PMID: 35344083 (View on PubMed)

Zilberberg E, Mazaki S, Zilberman N, Mazkereth R, Weisz B, Sivan E, et al. Should late third trimester oral glucose tolerance test be offered for patients with suspected macrosomia or polyhydramnios? Evidence in support of the clinical importance of this policy. Am J Obstet Gynecol. 2012;206(1):S122.

Reference Type BACKGROUND

Kandauda C, Wanasinghe W. Repeat OGTT at 34 - 36 weeks to detect the late occurrence of GDM: A descriptive cross-sectional study conducted at the professorial unit, teaching hospital Peradeniya, Sri Lanka. Adv Reproduct Sci. 2020;8:157-65.

Reference Type BACKGROUND

Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol. 1982 Dec 1;144(7):768-73. doi: 10.1016/0002-9378(82)90349-0.

Reference Type BACKGROUND
PMID: 7148898 (View on PubMed)

Harrison RK, Cruz M, Wong A, Davitt C, Palatnik A. The timing of initiation of pharmacotherapy for women with gestational diabetes mellitus. BMC Pregnancy Childbirth. 2020 Dec 11;20(1):773. doi: 10.1186/s12884-020-03449-y.

Reference Type BACKGROUND
PMID: 33308193 (View on PubMed)

Other Identifiers

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0115-22-NHR

Identifier Type: -

Identifier Source: org_study_id

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