GDM is characterized by decreased insulin sensitivity, decreased insulin secretion, or a combination of both. Women with GDM are at significant risk for overt T2DM later in life, and postpartum insulin sensitivity and secretion in women with GDM has not been quantified, limiting our ability to optimize screening for overt T2DM. In addition, compliance with currently recommended postpartum T2DM screening by OGTT is poor. Quantification of postpartum insulin sensitivity and secretion in women at high risk for T2DM will inform strategies to improve diagnostic strategies. Continuous glucose monitoring (CGM) is a new technology that may be useful to identify women with persistent hyperglycemia. Understanding maternal glycemia and physiology that drives glycemia in the postpartum period is limited. Completion of this study will define postpartum maternal glycemia, quantify insulin secretion versus insulin sensitivity defects, and demonstrate the feasiblity of using continuous glucose monitoring to identify women most at risk for overt T2DM.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
40
All women enrolled in this study will have a 2-hour 75-g oral glucose tolerance test performed immediately postpartum (within 4 days of delivery), at 4-6 weeks postpartum, and at 6 months postpartum. Enrolled women will also wear a continuous glucose monitor for 10 days at each of these time periods. Both women and their infants will have skin fold thickness measured at each of these 3 study visits to estimate body fat composition. Additionally umbilical cord blood and placental biopsies will be collected at delivery and stored for future research.
University of Alabama at Birmingham
Birmingham, Alabama, United States
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina, United States
Pancreatic beta cell function
Insulin secretion will be estimated using the Stomvall index and insulin sensitivity using the Matsuda index.
Time frame: 4-6 weeks after delivery
Maternal glycemia measured by CGM
% time in range
Time frame: 10 day wear period starting at 0-4 days, 4-6 weeks, and 6 months after delivery
Maternal hyperglycemia measured by CGM
% time above range
Time frame: 10 day wear period starting at 0-4 days, 4-6 weeks, and 6 months after delivery
Maternal glucose variability
Coefficient of variation (glucose standard deviation/mean glucose)
Time frame: 10 day wear period starting at 0-4 days, 4-6 weeks, and 6 months after delivery
Pancreatic beta cell function
Insulin secretion will be estimated using the Stomvall index and insulin sensitivity using the Matsuda index.
Time frame: 0-4 days and 6 months after delivery
Maternal and infant body fat composition
Percentage body fat calculated from skin fold thickness measurements of upper mid-arm, triceps, subscapular, and flank along with height and weight for the mother and length, birthweight and head circumference for the infant.
Time frame: 0-4 days, 4-6 weeks, and 6 months after delivery
Maternal diabetes mellitus
Fasting blood glucose \>= 126mg/dL or 2-hour blood glucose \>=200 mg/dL after 75g oral glucose load.
Time frame: 4-6 weeks and 6 months after delivery
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