Diabetes Mellitus, Intrahepatic Cholestasis of Pregnancy, Metabolic Disease
Conditions
Keywords
type 1 diabetes, type 2 diabetes, gestational diabetes, intrahepatic cholestasis of pregnancy, metabolic disease in pregnancy, brown adipose tissue, white adipose tissue, cardiac function, ECG, liver function, thermal imaging
Brief summary
There is limited knowledge about the extent of the impact of maternal metabolic diseases (MD) and/or alterations in maternal serum lipid content upon neonatal lipid distribution and phenotypes. This observational feasibility study aims to investigate the effect of maternal MD on fat distribution, lipid content and metabolic phenotype of different neonatal tissues. We will explore whether differences in tissue fat distribution and lipid content are observed in the neonates of women with MD during pregnancy, compared to those who have a healthy, uncomplicated pregnancy and if there are changes in how the different tissues work (e.g. cardiac function). If there is evidence to show that there are alterations during pregnancy in children of women with MD, this will help inform potential interventions to ensure optimal child health.
Interventions
DIAGNOSTIC_TESTThermal imaging
Use of a thermal imaging cameral to measure brown and white adipose tissue function
DIAGNOSTIC_TESTEchocardiogram
Echocardiographic imaging of the fetal heart to assess ventricular function
DIAGNOSTIC_TESTECG
ECG of the fetus and the neonate to look at the cardiac electrical activity
DIAGNOSTIC_TESTMRI scan
MRI scan of the neonate to assess adipose tissue, liver architecture and cardiac structure and function
DIAGNOSTIC_TESTSerum blood markers
Serum sample taken from mother before birth and umbilical cord or neonatal blood spot at birth to assess glucose levels / lipid levels and lipidomics and cardiac function (using NTproBNP) as a marker
Sponsors
King's College London
Guy's and St Thomas' NHS Foundation Trust
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
16 Years to 45 Years
Inclusion criteria
1. Pregnant women aged between 16 and 45 years old. 2. Women with GDM diagnosed at 26+0 to 30+6 weeks' gestation in accordance with the NICE guidelines Or 3. Pregnant women with pre-existing type 1 or type 2 diabetes mellitus Or 4. Women diagnosed with ICP at any stage of pregnancy 5. Fluent in English or presence of an interpreter or translation service (i.e. telephone translation services) at all visits. 6. Singleton pregnancy. 7. Willing and able to give written informed consent and comply with requirements of the study protocol 8. Planned antenatal, intrapartum and postpartum care at the participating centre (i.e. not planning to move before delivery)
Exclusion criteria
1\. Known fetal congenital abnormality on ultrasound requiring fetal medicine input (excluding congenital heart disease). 1. Known fetal congenital abnormality on ultrasound requiring fetal medicine input (excluding congenital heart disease). 2. Significant pre-pregnancy co-morbidities that increase risk in pregnancy, for example renal failure, severe liver disease, transplantation, cardiac failure, psychiatric conditions requiring in-patient admission (within previous year) in the opinion of the responsible clinician or the CI. 3. Significant co-morbidity in the current pregnancy, nephropathy (estimated GFR \<60ml/min), other physical or psychological conditions likely to interfere with the conduct of the study and/or interpretation of the study results in the opinion of the responsible clinician or the CI. (This does not include diabetes mellitus). 4. History of bariatric surgery. 5. Hypertension requiring treatment pre-pregnancy / in pregnancy. 6. Prescribed other medications that affect insulin sensitivity prior to OGTT for women diagnosed with GDM (oral antihyperglycemic agents, antipsychotic drugs, supraphysiological doses of steroids). 7. For the baby after birth: Not meeting the safety criteria to undergo MRI scan (e.g. metal implants, non MRI compatible devices, metal fragments in the body). \[ The mother will not have an MRI scan\].
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Assessment of the distribution of adipose tissue | 30 months | To perform imaging and biochemical studies to determine whether maternal metabolic disease alters the distribution of adipose tissue (SAT, VAT, BAT) of the fetuses and neonates of women with MD during pregnancy compared to neonates of women who had a healthy pregnancy. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Assessment of skeletal muscle, heart and liver | 30 months | To perform imaging and biochemical studies to determine whether maternal metabolic disease alters the distribution and phenotypes of skeletal muscle, heart and liver of the fetuses and neonates of women with MD during pregnancy compared to those of women who had a healthy pregnancy. |
| Assessment of the function of adipose tissue | 30 months | To evaluate novel MRI-based techniques to measure the function of adipose tissue (SAT, VAT, BAT) in the neonates. |
| Assessment of cardiac function and rhythm | 30 months | To perform echocardiography and fetal/ neonatal ECG studies to understand the impact of maternal MD on the fetal heart. |
| Thermal assessment | 30 months | To use thermal imaging to determine the temperature of regions of interest, e.g. BAT, of pregnant women with MD and their neonates. |
Outcome results
None listed