Adverse Pregnancy Outcomes, Early Pregnancy, Fasting Plasma Glucose, Hemoglobin A1c Protein, Human, Lifestyle Intervention
Conditions
Brief summary
This is a multicentre, parallel-group, open-label, pragmatic, randomised-control trial of early lifestyle intervention versus routine prenatal care by random allocation (1:1) in women with early abnormal glucose metabolism (EAGM) to compare the incidence of large-gestational age and preterm birth between two groups. The investigators aim to assess the effectiveness of early lifestyle interventions and to provide evidence for the optimal standard management for Chinese women with EAGM.
Detailed description
Women with early abnormal glucose metabolism (EAGM) , which is defined as fasting plasma glucose (FPG) 5.1-6.9 mmol/L and/or hemoglobin A1c (HbA1c) 5.7%-6.4% at before 14 weeks of gestation, will be recruited and randomized in a 1:1 ratio into the intervention or control group. The intervention will consist of a lifestyle intervention that comprises advice on diet, exercise, weight management and self-monitoring of blood glucose (SMBG) with feedback from healthcare professionals on results and insulin treatment if indicated. The educational session is delivered as an initial session following randomization followed by five follow-up sessions which will occur approximately every four months, either face-to-face during routine prenatal visits or via telephone consultation. Routine prenatal care will also be applied to the intervention group. Women in the control group will only receive routine prenatal care. Both groups will receive an OGTT test at 24-28 weeks of gestation unless insulin is needed before the OGTT test for suboptimally controlled blood glucose levels. Whether to continue the intervention depends on the OGTT results as women diagnosed with GDM or overt diabetes will continue intervention plus routine prenatal care until delivery while those will normal OGTT result will pause interventions and follow the routine prenatal care only until delivery. The primary outcome of our trial will be a composite of neonatal outcome including large-for-gestational age and preterm birth.
Interventions
BEHAVIORALLifestyle intervention and self-monitoring of blood glucose
The intervention will consist of a lifestyle intervention that comprises advice on diet, exercise, weight management, and self-monitoring of blood glucose (SMBG) with feedback from healthcare professionals on results and insulin treatment if indicated.
Sponsors
First People's Hospital of Foshan
Jiangmen Maternity and Child Health Care Hospital
Panyu Maternal And Child Care Service Centre Of Guangzhou
The Affiliated Shunde Hospital of Jinan University
Shenzhen Second People's Hospital
Guangxi Hospital Division of The First Affiliated Hospital, Sun Yat-sen University
BoAi Hospital of Zhongshan
Yuebei People's Hospital
Qingyuan People's Hospital
The Sixth Affliated Hospital of Jinan University
Baoan Maternal And Child Health Care Hospital, Shenzhen, China
Jiangxi Maternal and Child Health Hospital
Guangxi provincial maternal and chidren's hospital
Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
Obstetrics and Gynecology Hospital of Zhejiang University
Xiangya Hospital of Central South University
Guangzhou Women's and Children's Hospital
First Affiliated Hospital, Sun Yat-Sen University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 55 Years
Healthy volunteers
No
Inclusion criteria
* Over 18 years of age. * Able to provide informed consent. * Confirmed viable pregnancy on a nuchal translucency scan done between 11+0 and 13+6 weeks. * Singleton pregnancies. * An abnormal glucose metabolism determined by a blood test performed before 14 weeks, defined as FPG 5.1-6.9mmol/L and/or HbA1c 5.7-6.4%.
Exclusion criteria
* Pregestational diabetes (diagnosed as diabetes mellitus before pregnancy, or FPG≥7.0mmol/L, or HbA1c≥6.5% at the first prenatal visit), impaired fasting glucose or impaired glucose tolerance diagnosed before pregnancy. * Plan for termination of pregnancy due to fetal anomaly identified at the first trimester scan. * Use of medications known to interfere with glucose metabolism (e.g. corticosteroids, antipsychotic drugs) at the time of randomisation. * Any other physical (serious medical conditions such as cancer, organ failure, epilepsy, paraplegia, disability) or psychological condition (e.g. learning difficulties, serious mental illness) that is likely to interfere with the conduct of the trial according to evaluation by the trial monitoring group. * Women currently with hyperemesis gravidarum leading to dehydration or requiring hospitalization. If persisting vomiting resolves, the patient may be reassessed for inclusion in the trial up to and including 14+6 weeks of gestation, providing all other inclusion and
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Composite neonatal outcome of large-gestational age and preterm birth | outcomes will be collected up to primary hospital discharge, or 28 days after the estimated date of delivery, whichever is sooner. |
Secondary
| Measure | Time frame |
|---|---|
| Gestational diabetes mellitus | outcomes will be collected up to primary hospital discharge, or 28 days after the estimated date of delivery, whichever is sooner. |
| Gestational hypertension | outcomes will be collected up to primary hospital discharge, or 28 days after the estimated date of delivery, whichever is sooner. |
| Preeclampsia | outcomes will be collected up to primary hospital discharge, or 28 days after the estimated date of delivery, whichever is sooner. |
| Eclampsia | outcomes will be collected up to primary hospital discharge, or 28 days after the estimated date of delivery, whichever is sooner. |
| Prescription of hypoglycaemic drug | outcomes will be collected up to primary hospital discharge, or 28 days after the estimated date of delivery, whichever is sooner. |
| Preeclampsia requiring delivery before 37 weeks | outcomes will be collected up to primary hospital discharge, or 28 days after the estimated date of delivery, whichever is sooner. |
| Total gestational weight gain | outcomes will be collected up to primary hospital discharge, or 28 days after the estimated date of delivery, whichever is sooner. |
| Mode of birth | outcomes will be collected up to primary hospital discharge, or 28 days after the estimated date of delivery, whichever is sooner. |
| Primary caesarean | outcomes will be collected up to primary hospital discharge, or 28 days after the estimated date of delivery, whichever is sooner. |
| Large-for-gestational age | outcomes will be collected up to primary hospital discharge, or 28 days after the estimated date of delivery, whichever is sooner. |
| Preterm birth at <37 weeks of gestation | outcomes will be collected up to primary hospital discharge, or 28 days after the estimated date of delivery, whichever is sooner. |
| Pregnancy-related hypertensive disorders | outcomes will be collected up to primary hospital discharge, or 28 days after the estimated date of delivery, whichever is sooner. |
| Small-for-gestational-age | outcomes will be collected up to primary hospital discharge, or 28 days after the estimated date of delivery, whichever is sooner. |
| Gestational age at birth, weeks and days | outcomes will be collected up to primary hospital discharge, or 28 days after the estimated date of delivery, whichever is sooner. |
| Neonatal hypoglycaemia | outcomes will be collected up to primary hospital discharge, or 28 days after the estimated date of delivery, whichever is sooner. |
| Admission to neonatal wards or intensive care unit | outcomes will be collected up to primary hospital discharge, or 28 days after the estimated date of delivery, whichever is sooner. |
| Fetal loss <24 weeks of gestation | outcomes will be collected up to primary hospital discharge, or 28 days after the estimated date of delivery, whichever is sooner. |
| Fetal loss ≥24 weeks of gestation | outcomes will be collected up to primary hospital discharge, or 28 days after the estimated date of delivery, whichever is sooner. |
| Termination of pregnancy | outcomes will be collected up to primary hospital discharge, or 28 days after the estimated date of delivery, whichever is sooner. |
| Neonatal death | outcomes will be collected up to primary hospital discharge, or 28 days after the estimated date of delivery, whichever is sooner. |
| Apgar score at 1min after birth | outcomes will be collected up to primary hospital discharge, or 28 days after the estimated date of delivery, whichever is sooner. |
| Apgar score at 5min after birth | outcomes will be collected up to primary hospital discharge, or 28 days after the estimated date of delivery, whichever is sooner. |
| Neonatal birthweight | outcomes will be collected up to primary hospital discharge, or 28 days after the estimated date of delivery, whichever is sooner. |
Countries
China
Contacts
Primary ContactHaitian Chen, Professor
Outcome results
None listed