Intrapartum Glycemic Control in GDMA2

NCT ID: NCT05647798

Last Updated: 2024-06-04

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

TERMINATED

Clinical Phase

NA

Total Enrollment

2 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-05-22

Study Completion Date

2024-05-15

Brief Summary

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This is a randomized, parallel, controlled, non-inferiority trial to assess the impact of a tight versus a more liberalized intrapartum glycemic control in gestational diabetic mothers on neonatal glycemia. National guidelines for the management of intrapartum glucose in women with GDM are lacking. This is likely due to the scarcity of high-quality data on the topic.

Detailed Description

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Gestational diabetes mellitus (GDM) remains a common pregnancy complication, affecting 6-15% of pregnancies worldwide. The incidence of GDM is expected to continue its global upward trend in light of the growing obesity epidemic and delayed childbearing. GDM is associated with adverse short- and long-term maternal and offspring outcomes. Neonatal hypoglycemia, as a result of fetal hyperinsulinemia, occurs in up to 35% of pregnancies complicated by GDM with potential long-term neurodevelopmental sequelae. In that regard, significant emphasis has been placed on the prevention of neonatal hypoglycemia through optimal maternal glycemic control. Available data are conflicting as to the contribution of intrapartum glycemia to neonatal glycemia.

Moreover, national guidelines for the management of intrapartum glucose in women with GDM are lacking. This is likely due to a lack of high-quality data on the topic. As far as we are aware, only one single center randomized controlled trial has been published on the topic. That study's findings suggest that an approach to a more liberalized intrapartum glycemic management was not associated with a higher rate of neonatal hypoglycemia compared to a tight glycemic control regimen. We propose to replicate these findings in a different population at our institution. If this more relaxed approach to intrapartum glycemic management is confirmed to be safe to women and their babies, its clinical application has the potential to decrease the inconvenience of frequent finger pricks for our patients during labor and allow more efficient allocation of resources for the nursing staff on an already labor-intensive unit.

Conditions

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Pregnancy Gestational Diabetes Mellitus, Class A2 Neonatal Hypoglycemia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

OTHER

Blinding Strategy

NONE

Study Groups

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Usual care glycemic management arm

Blood glucose will be checked every 2 hours during labor and glucose target will be 75-110 mg/dl

Group Type ACTIVE_COMPARATOR

Blood sugar check every 2 hours

Intervention Type OTHER

Blood sugar check every 2 hours

More liberalized glycemic management arm

Blood glucose will be checked every 4 hours during labor and glucose target will be 70-126 mg/dl

Group Type ACTIVE_COMPARATOR

Blood sugar check every 4 hours

Intervention Type OTHER

Blood sugar check every 4 hours

Interventions

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Blood sugar check every 2 hours

Blood sugar check every 2 hours

Intervention Type OTHER

Blood sugar check every 4 hours

Blood sugar check every 4 hours

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Women 18 years or older
* Non-anomalous singleton gestation
* Gestational diabetes type A2 diagnosed at 24 weeks' gestation or beyond
* Planned vaginal delivery at term at Inova Fairfax Women's Hospital

Exclusion Criteria

* Women \< 18 years
* Fetus with major congenital malformations
* Twin or higher order gestation
* Pre-existing diabetes mellitus
* Exposure to antenatal or any systemic steroids 14 days or less prior to delivery
* Preterm delivery
* Scheduled cesarean birth
* Intrapartum cesarean birth prior to 4-5 cm of cervical dilatation
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Inova Health Care Services

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jean W Thermolice, MD

Role: PRINCIPAL_INVESTIGATOR

Inova Healthcare Services

Locations

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Inova Fairfax Medical campus

Falls Church, Virginia, United States

Site Status

Inova Health Care Services

Falls Church, Virginia, United States

Site Status

Countries

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United States

References

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McIntyre HD, Catalano P, Zhang C, Desoye G, Mathiesen ER, Damm P. Gestational diabetes mellitus. Nat Rev Dis Primers. 2019 Jul 11;5(1):47. doi: 10.1038/s41572-019-0098-8.

Reference Type BACKGROUND
PMID: 31296866 (View on PubMed)

Lean SC, Derricott H, Jones RL, Heazell AEP. Advanced maternal age and adverse pregnancy outcomes: A systematic review and meta-analysis. PLoS One. 2017 Oct 17;12(10):e0186287. doi: 10.1371/journal.pone.0186287. eCollection 2017.

Reference Type BACKGROUND
PMID: 29040334 (View on PubMed)

Schummers L, Hutcheon JA, Hacker MR, VanderWeele TJ, Williams PL, McElrath TF, Hernandez-Diaz S. Absolute risks of obstetric outcomes by maternal age at first birth: a population-based cohort. Epidemiology. 2018 May;29(3):379-387. doi: 10.1097/EDE.0000000000000818.

Reference Type BACKGROUND
PMID: 29517506 (View on PubMed)

Lavery JA, Friedman AM, Keyes KM, Wright JD, Ananth CV. Gestational diabetes in the United States: temporal changes in prevalence rates between 1979 and 2010. BJOG. 2017 Apr;124(5):804-813. doi: 10.1111/1471-0528.14236. Epub 2016 Aug 11.

Reference Type BACKGROUND
PMID: 27510598 (View on PubMed)

Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: Final Data for 2018. Natl Vital Stat Rep. 2019 Nov;68(13):1-47.

Reference Type BACKGROUND
PMID: 32501202 (View on PubMed)

ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol. 2018 Feb;131(2):e49-e64. doi: 10.1097/AOG.0000000000002501.

Reference Type BACKGROUND
PMID: 29370047 (View on PubMed)

Murray SR, Reynolds RM. Short- and long-term outcomes of gestational diabetes and its treatment on fetal development. Prenat Diagn. 2020 Aug;40(9):1085-1091. doi: 10.1002/pd.5768. Epub 2020 Jul 1.

Reference Type BACKGROUND
PMID: 32946125 (View on PubMed)

Voormolen DN, de Wit L, van Rijn BB, DeVries JH, Heringa MP, Franx A, Groenendaal F, Lamain-de Ruiter M. Neonatal Hypoglycemia Following Diet-Controlled and Insulin-Treated Gestational Diabetes Mellitus. Diabetes Care. 2018 Jul;41(7):1385-1390. doi: 10.2337/dc18-0048. Epub 2018 Apr 13.

Reference Type BACKGROUND
PMID: 29654142 (View on PubMed)

Dalgic N, Ergenekon E, Soysal S, Koc E, Atalay Y, Gucuyener K. Transient neonatal hypoglycemia--long-term effects on neurodevelopmental outcome. J Pediatr Endocrinol Metab. 2002 Mar;15(3):319-24. doi: 10.1515/jpem.2002.15.3.319.

Reference Type BACKGROUND
PMID: 11924935 (View on PubMed)

Tam EW, Haeusslein LA, Bonifacio SL, Glass HC, Rogers EE, Jeremy RJ, Barkovich AJ, Ferriero DM. Hypoglycemia is associated with increased risk for brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy. J Pediatr. 2012 Jul;161(1):88-93. doi: 10.1016/j.jpeds.2011.12.047. Epub 2012 Feb 4.

Reference Type BACKGROUND
PMID: 22306045 (View on PubMed)

Harris DL, Alsweiler JM, Ansell JM, Gamble GD, Thompson B, Wouldes TA, Yu TY, Harding JE; Children with Hypoglycaemia and their Later Development (CHYLD) Study Team. Outcome at 2 Years after Dextrose Gel Treatment for Neonatal Hypoglycemia: Follow-Up of a Randomized Trial. J Pediatr. 2016 Mar;170:54-9.e1-2. doi: 10.1016/j.jpeds.2015.10.066. Epub 2015 Nov 21.

Reference Type BACKGROUND
PMID: 26613985 (View on PubMed)

Shah R, Harding J, Brown J, McKinlay C. Neonatal Glycaemia and Neurodevelopmental Outcomes: A Systematic Review and Meta-Analysis. Neonatology. 2019;115(2):116-126. doi: 10.1159/000492859. Epub 2018 Nov 8.

Reference Type BACKGROUND
PMID: 30408811 (View on PubMed)

Yamamoto JM, Benham J, Mohammad K, Donovan LE, Wood S. Intrapartum glycaemic control and neonatal hypoglycaemia in pregnancies complicated by diabetes: a systematic review. Diabet Med. 2018 Feb;35(2):173-183. doi: 10.1111/dme.13546.

Reference Type BACKGROUND
PMID: 29117445 (View on PubMed)

Yamamoto JM, Donovan LE, Mohammad K, Wood SL. Severe neonatal hypoglycaemia and intrapartum glycaemic control in pregnancies complicated by type 1, type 2 and gestational diabetes. Diabet Med. 2020 Jan;37(1):138-146. doi: 10.1111/dme.14137. Epub 2019 Oct 11.

Reference Type BACKGROUND
PMID: 31529717 (View on PubMed)

Hamel MS, Kanno LM, Has P, Beninati MJ, Rouse DJ, Werner EF. Intrapartum Glucose Management in Women With Gestational Diabetes Mellitus: A Randomized Controlled Trial. Obstet Gynecol. 2019 Jun;133(6):1171-1177. doi: 10.1097/AOG.0000000000003257.

Reference Type BACKGROUND
PMID: 31135731 (View on PubMed)

Other Identifiers

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Protocol #20222678 U22-01-4642

Identifier Type: OTHER

Identifier Source: secondary_id

U22-01-4642

Identifier Type: -

Identifier Source: org_study_id

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