Obesity, Pregnancy Related, Sleep Disordered Breathing
Conditions
Brief summary
Sleep disordered breathing (SDB) insidiously worsens metabolic function, heightens insulin resistance (IR), and in pregnancy is thought to precipitate gestational diabetes, preterm birth, growth restriction, gestational hypertension, and preeclampsia. Despite the fact that sleep disturbances are common during pregnancy, SDB remains under-recognized, under-diagnosed, and poorly understood, particularly in pregnancies affected by obesity. Sixty percent of pregnancies are now affected by obesity, yet the relationship between SDB, patterns of glycemia, and insulin resistance (IR) in obese pregnant women is a neglected area with major therapeutic implications to improve maternal and infant health. Using a prospective design in which diet and gestational age are highly controlled, the investigators propose to measure SDB (apneas/hypopneas) in obese pregnant women using an ambulatory sleep monitoring system. In parallel, robust patterns of glycemia will be measured with a continuous glucose monitoring system (CGMS), followed by a 75g oral glucose tolerance test to measure insulin action. The investigators global hypothesis is that worse SDB in part accounts for higher 24-hour patterns of glycemia in obese normal glucose tolerant (NGT) pregnant women in their 3rd trimester. The Investigators will test the hypothesis that: 1) In obese NGT pregnant women at 32-34 weeks gestation on a controlled eucaloric diet, higher apnea hypopnea index (AHI) will be positively associated with 24-hour glycemia measured by a CGMS and that, 2) Higher AHI in obese NGT pregnant women at 32-34 weeks gestation on a eucaloric controlled diet will be associated with higher insulin resistance measured by a 75g oral glucose tolerance test (Matsuda Model). Early identification and treatment has the potential to decrease long-term maternal cardiovascular morbidity and mortality.
Interventions
None listed
Sponsors
Colorado Clinical & Translational Sciences Institute
University of Colorado, Denver
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
20 Years to 39 Years
Healthy volunteers
Yes
Inclusion criteria
* Pregnant women: 1. Between the ages of 20-39 yrs, 2. At 32-34 weeks gestation, 3. Who have a BMI of ≥30 to ≤40 kg/m2, 4. Who have a singleton pregnancy, and 5. Who have a normal glucose tolerance test on entrance to the study.
Exclusion criteria
* Pregnant Women: 1. Who have a diagnosis of diabetes (GDM, type 1 or type 2), 2. Who are using beta blockers/glucocorticoids. 3. Who have other children who are ≤2 yrs old (due to risk of disrupted sleep), 4. With diagnosed sleep disorders (e.g. OSA, insomnia, restless leg syndrome), 5. Who work night or rotating shifts, 6. Who report use of sleep medications will be excluded, 7. With diagnosed pulmonary or cardiovascular disease 8. Who do not speak English.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 24 hour glycemia measurement of the Pregnant Mother | Every 24 hours for 3 days | Glycemia will be measured by Continuous glucose monitoring |
| Evaluation of Insulin resistance of the Pregnant Mother | 2 hours after a 75 gram glucose load | Insulin resistance will be measured with an Oral Glucose Tolerance Test |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Infant Body Composition | At 2 weeks of life | Percent of Fat Mass |
| Stress Levels | 15 minutes before Sleep and 15 minutes after sleep | Cortisol Levels |
Countries
United States
Outcome results
None listed