Early Intervention for Gestational Diabetes
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Gestational diabetes (GDM) represents a significant and growing source nationwide of morbidity and mortality for both mothers and infants. Between 5 and 10% of pregnancies are complicated by GDM. Infants exposed in utero to hyperglycemia from GDM have an increased risk of neonatal complications as well as an increased prevalence of a number of chronic diseases, including type 2 diabetes and schizophrenia. Recent research shows that treatment with metformin begun as soon as hyperglycemia is detected in pregnancy is safe and effective. Additional studies demonstrated that metformin is able to decrease the incidence of type 2 diabetes among individuals at risk for this disease. Based upon these findings, the investigators propose to test the hypothesis that metformin therapy for women at risk for gestational diabetes, started prior to conception and before the onset of hyperglycemia, both decreases the incidence of and improves the maternal and neonatal outcomes from GDM.
The investigators intend to conduct a prospective, randomized, double-blind placebo controlled range-finding study to measure the effects of early metabolic intervention with metformin in women at risk for GDM before the commencement of pregnancy or prior to completion of the first trimester. The target sample size for this pilot study is 100 women. The effect size observed will provide preliminary data for a subsequent study which will be sufficiently powered to detect small or moderate effects from early metabolic intervention in women at risk for GDM.
The specific aims of the proposed research consist of the following:
- Determine whether treating women at risk for GDM with metformin prior to conception and/or completion of the 1st trimester decreases the incidence of GDM at 26 weeks' gestation.
- Evaluate the effects on maternal and fetal pregnancy outcomes of pre-conception metabolic intervention with metformin in women at risk for GDM.
Use these pilot study results to:
- identify specific demographic characteristics associated with an intervention effect
- calculate effect size for specific outcomes
- provide range-finding data for a subsequent study design
Metformin therapy for women at risk for gestational diabetes, started prior to conception and before the onset of hyperglycemia, both decreases the incidence of and improves the maternal and neonatal outcomes from GDM.
Condition | Intervention |
---|---|
Gestational Diabetes Mellitus |
Drug: Metformin Drug: Placebo |
Study Type: | Interventional |
Study Design: | Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Caregiver, Investigator) Primary Purpose: Prevention |
Official Title: | Early Medical Intervention in Women at Risk for Gestational Diabetes |
- Effect of metformin versus placebo on the development of GDM [ Time Frame: Pre-conception to delivery (at 8 week intervals) ] [ Designated as safety issue: No ]
- Effects on maternal and fetal pregnancy outcomes of pre-conception metabolic intervention with metformin. [ Time Frame: Pre-conception until discharge from hospital after delivery (at 4 week intervals) ] [ Designated as safety issue: No ]
Estimated Enrollment: | 100 |
Study Start Date: | April 2010 |
Estimated Study Completion Date: | April 2012 |
Estimated Primary Completion Date: | April 2012 (Final data collection date for primary outcome measure) |
Arms | Assigned Interventions |
---|---|
Placebo Comparator: Metformin Placebo |
Drug: Placebo
Administration of Metformin or placebo prior to conception to prevent the onset of GDM.
|
Active Comparator: Metformin |
Drug: Metformin
Administration of Metformin or placebo prior to conception to prevent the onset of GDM.
|
Ages Eligible for Study: | 18 Years to 45 Years |
Genders Eligible for Study: | Female |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Women delivered >37 weeks gestation in the Intermountain Healthcare Urban Central Region within the last 18 months to ascertain those at risk for GDM in their next pregnancy because of:
- A history of gestational diabetes in their immediately prior pregnancy
- A family history (i.e. type 2 diabetes in a first or second degree relative) of type 2 diabetes
- Delivery of an infant > 4000 gms.
- B.M.I. > 30 six months postpartum
- Hemoglobin A1C > 6.1% six months postpartum
Exclusion Criteria:
Pre-conception exclusion criteria will include any of the following:
- History of >1 miscarriage or fetal demise
- No contraindication to metformin (prior metformin intolerance, metabolic acidosis, GI disease)
- Hypertension (BP >135/85)
- No other endocrine, metabolic, renal, or autommune medical disorders
- Prior preterm birth
- Prior delivery complicated by shoulder dystocia
- Prior delivery complicated by neonatal palsy
- Multifetal pregnancy, including first-trimester embryonic demise of one or more
- Uterine malformations
- Illicit drug or alcohol abuse during current pregnancy
- Intent to deliver elsewhere
- Non-availability for prospective specimen/data collection
Contact: Camille Broadwater-Hollified, M.P.H. | 801-507-7864 | camille.hollifield@imail.org |
Contact: Ware Branch, M.D. | 801-507-7400 ext 7443 | ware.branch@imail.org |
United States, Utah | |
Intermountain Medical Center | Recruiting |
Murray, Utah, United States, 84107 | |
Principal Investigator: Ware Branch, M.D. | |
Sub-Investigator: Joel Ehrenkranz, M.D. |
Principal Investigator: | Ware Branch, M.D. | Intermountain Health Care, Inc. |
No publications provided
Responsible Party: | Ware Branch, Corporate Med. Director, Women and Newborns, Intermountain Health Care, Inc. |
ClinicalTrials.gov Identifier: | NCT01171456 History of Changes |
Other Study ID Numbers: | 1017118 |
Study First Received: | July 13, 2010 |
Last Updated: | April 17, 2012 |
Health Authority: | United States: Institutional Review Board |
Keywords provided by Intermountain Health Care, Inc.:
GDM Gestational Diabetes Diabetes Pregnancy |
Additional relevant MeSH terms:
Diabetes Mellitus Diabetes, Gestational Glucose Metabolism Disorders Metabolic Diseases Endocrine System Diseases |
Pregnancy Complications Metformin Hypoglycemic Agents Physiological Effects of Drugs Pharmacologic Actions |
ClinicalTrials.gov processed this record on October 17, 2012