Clinical trial NCT00826904: Regulation Of Maternal Fuel Supply And Neonatal Adiposity
Official title: Regulation Of Maternal Fuel Supply And Neonatal Adiposity
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Fetal Macrosomia
Gestational Diabetes
Keywords: Fetal programming
Fetal macrosomia
Fetal health
Gestational diabetes
Maternal health
Maternal obesity
Lead sponsor: University of Colorado, Denver
Sponsor class: OTHER
Collaborators: name: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
First posted: 2009-01-22
Enrollment: 59
Sex: FEMALE
Minimum age (years): 18
Maximum age (years): 35
Standard ages: ADULT
Accepts healthy volunteers: yes
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Lean (BMI 20-26 kg/m2)and Obese (BMI 30-38 kg/m2) pregnant women (age 18-35 yr) without chronic medical conditions or obstetric complications will be enrolled at 12-14 weeks gestation.

Brief summary: The purpose of this study is to determine whether unrecognized maternal hyperglycemia and postprandial lipemia early or late in gestation predicts excess neonatal adiposity.

Detailed description: Mounting epidemiologic evidence suggests that maternal obesity and Gestational Diabetes Mellitus (GDM) independently influence size at birth and disease susceptibility later in life. A major gap in the understanding of fetal programming is the knowledge of whether and how exposure to excess maternal fuels in the absence of frank hyperglycemia impacts fetal fat accretion. The investigators hypothesis is that neonatal adiposity results from unrecognized maternal hyperglycemia and excess lipid availability in gestation, in part caused by excessive lipolysis in the white adipose tissue of obese women, some of whom will be subsequently diagnosed as having GDM. In Aim 1 the investigators will test the hypothesis that in obese women, some of whom will later be diagnosed with GDM, increased lipolysis and unrecognized hyperglycemia and hypertriglyceridemia occur earlier in gestation than in lean women, resulting in increased plasma non-esterified fatty acids (NEFA), glycerol, triglycerides (TGs), and glucose available for fetal metabolism. In Aim 2 the investigators will test the hypothesis that fetal adiposity by ultrasound and neonatal adiposity by Dual-energy X-ray Absorptiometry (DXA) are strongly correlated with excess lipid and glucose availability in obese mothers early in gestation, regardless of GDM status, and that fasting biomarkers of neonatal insulin sensitivity will correlate with neonatal adiposity. In Aim 3 the investigators will test the hypothesis that the in-vitro suppression of lipolysis in white adipose tissue correlates with excess NEFA and TG availability in-vivo and is predictive of neonatal adiposity. The elucidation of specific derangements in both glucose and lipid metabolism and their timing in gestation in mothers who deliver infants with excess adiposity could challenge our current screening methods and entirely redirect our treatment to target the responsible maternal fuels. On a public health level, this research is instrumental to the investigators understanding of how an intrauterine environment may deliver excess glucose and/or lipids to the fetus and contribute to the genesis of the pediatric obesity epidemic. Such information may result in new treatment strategies in pregnant women to normalize fetal growth.

Eligibility criteria: Inclusion Criteria:

* Age 18 - 35 yr
* Pregnant (12-14 weeks gestation)
* Lean (BMI 20-26 kg/m2)
* Obese (BMI 30-38 kg/m2)

Exclusion Criteria:

* Age \< 18 or \> 35 yr
* Pre-existing diabetes
* Chronic medical conditions:

  1. hypertension,
  2. hepatitis,
  3. Human immunodeficiency Virus (HIV),
  4. Thrombophilias,
  5. History of:

     1. thromboembolism,
     2. renal disease,
     3. neurologic diseases,
     4. rheumatologic disorders,
     5. gastrointestinal disease,
     6. cardiac dysfunction, or
     7. pulmonary disease
* Obstetric conditions:

  1. history of stillbirth,
  2. severe growth restriction,
  3. severe preeclampsia, or
  4. placental abruption
* Medications known to affect lipid or glucose metabolism:

  1. Metformin,
  2. glucocorticoids,
  3. beta agonists or blockers, or
  4. antihypertensives
* Use of recreational drugs, alcohol or tobacco.

Primary outcomes:
measure: Change in neonatal adiposity by maternal Triglycerides, Glucose
timeFrame: 14-16, 26-28 weeks gestation
measure: Change in maternal postprandial lipemia
timeFrame: 26-28 weeks gestation
Secondary outcomes:
measure: Change in maternal postprandial lipemia
timeFrame: 14-16, 26-28 weeks gestation
measure: Change in maternal postprandial glycemia
timeFrame: 14-16, 26-28 weeks gestation
measure: Prediction of neonatal adiposity by placental and maternal adipose tissue lipoprotein lipase (LPL) activity
timeFrame: 26-28 weeks gestation
measure: Correlation of neonatal adiposity and fetal growth
timeFrame: 28-30 weeks gestation
measure: Correlation of neonatal adiposity and fetal growth
timeFrame: 36-37 weeks gestation
Other outcomes:
Locations:
city: Aurora
country: United States
facility: University of Colorado Denver
state: Colorado
Study officials:
affiliation: University of Colorado, Denver
name: Linda A Barbour, MD, MSPH
role: PRINCIPAL_INVESTIGATOR
References:
citation: Barbour LA, Farabi SS, Friedman JE, Hirsch NM, Reece MS, Van Pelt RE, Hernandez TL. Postprandial Triglycerides Predict Newborn Fat More Strongly than Glucose in Women with Obesity in Early Pregnancy. Obesity (Silver Spring). 2018 Aug;26(8):1347-1356. doi: 10.1002/oby.22246. Epub 2018 Jun 22.