Clinical trial NCT06401629: Outcomes After Unified Versus Standard GDM Diagnosis
Official title: The UPDATE-GDM Study: OUtcomes After NPRP anD ConventionAl CriTEria for GDM Diagnosis: A Pragmatic Randomised Trial
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: NA
Conditions: Gestational Diabetes
Diagnosis
Pregnancy
Keywords: Gestational Diabetes Mellitus
IADPSG
NPRP
Obesity
Dysglycemia
High-risk Pregnancy
Lead sponsor: Qatar University
Sponsor class: OTHER
Collaborators: name: Hamad Medical Corporation
First posted: 2024-05-07
Enrollment: 2650
Sex: FEMALE
Minimum age (years): 18
Maximum age (years): 45
Standard ages: ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: This study will be designed as a multicentre, two-arm, parallel, pragmatic, randomized controlled trial conducted at two participating hospitals in Qatar. This design allows for an assessment of interventions in real-world settings and offers practical insights into the clinical utility of different diagnostic criteria. All pregnancies will be randomly assigned to the NPRP or IADPSG approach (1:1 ratio) at their first prenatal visit using an electronically generated random assignment procedure; this assignment will be provided to the lab within CERNER at the time of reporting GDM screening results (typically done at 24-28 weeks' gestation). If screening was ordered more than once, the same assigned result type will be presented to providers each time.
Primary purpose: DIAGNOSTIC

Brief summary: Gestational diabetes mellitus (GDM) is a condition that can affect pregnant women during pregnancy and may cause complications for the mother and the baby. Therefore, early and accurate detection is necessary to provide the woman and the baby with better health outcomes. Currently, the most commonly used criteria to detect GDM is the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criterion. However, there is a suggestion that it results in over-diagnosis of GDM, and newer methods of diagnosis have been proposed. One such proposal is to have more than a binary outcome of assessment of dysglycemia in pregnancy. The investigator group created this criterion known as the National Priorities Research Program (NPRP) criterion. This clinical trial compares the IADPSG to the NPRP criteria in pregnant women in Qatar to determine if this newer method mitigates overdiagnosis and more accurately identifies women at risk of complications.

Detailed description: This research project explores a crucial aspect of maternal and fetal health: the diagnosis of gestational diabetes mellitus (GDM), a condition that poses risks to both pregnant women and the babies. Gestational diabetes is a condition that can develop during pregnancy, characterized by dysglycemia and associated risks of complications such as pre-eclampsia, cesarean delivery, and macrosomia. For the baby, it raises the risk of developing obesity, type 2 diabetes later in life, and metabolic syndrome. Therefore, early and accurate diagnosis is paramount to manage and mitigate these risks. The IADPSG (International Association of Diabetes and Pregnancy Study Groups) criteria, the current standard for GDM diagnosis, has been widely adopted due to its putative sensitivity in detecting GDM and potential for reducing GDM-related complications. However, this method is not without its limitations, including the risk of over- or under-diagnosis of GDM. This project will investigate the efficacy of an alternative diagnostic method, the National Priorities Research Program (NPRP) criteria, against the conventional IADPSG criteria, diagnosis usually being undertaken between the 24th and 28th weeks of pregnancy. The NPRP criteria are based on a unified assessment of the oral glucose tolerance test (GTT), which could offer a four-level classification of dysglycemia in pregnancy as opposed to the binary diagnosis by the IADPSG criteria, thus having the added benefit of glycemic risk stratification during pregnancy. By comparing the outcomes of pregnancies diagnosed using the NPRP criteria against those diagnosed using the IADPSG criteria, the investigators aim to assess whether the NPRP criteria can provide improved outcomes (Bashir et al. 2021) in terms of maternal and fetal health through better informed GDM-related decision-making. In addition, this study proposes the NPRP criteria as potentially able to mitigate over- and under-diagnosis of GDM. This study will employ a parallel-group, prospective, randomized, pragmatic, controlled trial design and the study investigators will work closely with a cohort of pregnant women throughout pregnancy, employing both diagnostic methods to evaluate their impact on the health of the mother and the baby. The evaluation will not only focus on the immediate outcomes during pregnancy but will also aim to follow up on longer-term metabolic health implications for both mother and child post-delivery after the trial is completed and if the participant consents to such additional follow-up. The significance of this research lies in its potential to transform the current practices in GDM diagnosis, by offering evidence on the effectiveness and benefits of the NPRP criteria, thus paving the way for a shift towards a more patient-centered approach to the diagnosis of gestational diabetes. Determining if the NPRP criteria can lead to better health outcomes for mothers and babies can have profound implications for maternal and child health. Improved diagnostic methods could lead to more timely interventions, reducing the prevalence of complications associated with gestational diabetes and improving the quality of life for countless families. Through this study, the investigators hope to make a significant contribution to the well-being of pregnant women and babies, ensuring a healthier start for the next generation.

Eligibility criteria: Inclusion Criteria:

* This will include broad eligibility criteria of age 18-45 years with or without risk factors at first antenatal care (ANC) visit who are willing to undergo testing at 24-28 weeks and able to provide informed consent.

Exclusion Criteria:

* a multiple pregnancy at the time of screening, pre-existing diabetes (T1DM, T2DM)
* any medical condition affecting glucose metabolism or the results of the GTT (e.g., Cushing's syndrome, bariatric surgery history)
* known history of major conditions that could interfere with the study or pregnancy outcomes (e.g., severe liver, renal or cardiovascular disorders, chronic infections).

Primary outcomes:
measure: large for gestational age (LGA)
timeFrame: Through pregnancy completion, an average of 9 months
Secondary outcomes:
measure: Average plasma glucose
timeFrame: Through pregnancy completion, an average of 9 months
measure: Glycemic targets unmet
timeFrame: Through pregnancy completion, an average of 9 months
measure: Adverse events related to treatment
timeFrame: Through pregnancy completion, an average of 9 months
measure: Total weight gain in pregnancy (kg)
timeFrame: Through pregnancy completion, an average of 9 months
measure: Birth weight (newborn's weight at birth)
timeFrame: Through pregnancy completion, an average of 9 months
measure: Hypoglycemia within 1 hour of birth
timeFrame: Through pregnancy completion, an average of 9 months
measure: Neonatal composite morbidity and mortality outcome
timeFrame: Through pregnancy completion, an average of 9 months
measure: Assisted labor/delivery (including cesarean)
timeFrame: Through pregnancy completion, an average of 9 months
measure: Preterm delivery
timeFrame: Through pregnancy completion, an average of 9 months
measure: Peripartum infection
timeFrame: Through pregnancy completion, an average of 9 months
measure: Pregnancy induced hypertension (PIH) or pre-eclampsia/ eclampsia
timeFrame: Through pregnancy completion, an average of 9 months
Other outcomes:
measure: Additional composite outcome
timeFrame: Through pregnancy completion, an average of 9 months
Locations:
Study officials:
affiliation: Qatar University
name: Suhail A. Doi, MBBS, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Doi SAR, Bashir M, Sheehan MT, Onitilo AA, Chivese T, Ibrahim IM, Beer SF, Furuya-Kanamori L, Abou-Samra AB, McIntyre HD. Unifying the diagnosis of gestational diabetes mellitus: Introducing the NPRP criteria. Prim Care Diabetes. 2022 Feb;16(1):96-101. doi: 10.1016/j.pcd.2021.08.006. Epub 2021 Aug 19.
citation: International Association of Diabetes and Pregnancy Study Groups Consensus Panel; Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva Ad, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJ, Omori Y, Schmidt MI. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010 Mar;33(3):676-82. doi: 10.2337/dc09-1848. No abstract available.
citation: Bashir M, Syed A, Furuya-Kanamori L, Musa OAH, Mohamed AM, Skarulis M, Thalib L, Konje JC, Abou-Samra AB, Doi SAR. Core outcomes in gestational diabetes for treatment trials: The Gestational Metabolic Group treatment set. Obes Sci Pract. 2021 Feb 3;7(3):251-259. doi: 10.1002/osp4.480. eCollection 2021 Jun.