A Randomized Controlled Trial of Diabetes Screening Immediately Postpartum (DIP) and Follow Up PP CARE

Официальное название

A Randomized Controlled Trial of Diabetes Screening Immediately Postpartum (DIP) - Follow up Study: Patient Perspectives on Postpartum Interventions to Improve Future Maternal CARdiovascular hEalth After Gestational Diabetes (PP CARE)

Обзор

DIP : To conduct a pragmatic, non-blinded randomized controlled trial (pRCT) of immediate in-patient postpartum OGTT prior to delivery discharge (intervention) versus 4-12 week outpatient postpartum OGTT (current standard care) to improve the frequency of post-partum diabetes screening among individuals with a pregnancy complicated by GDM. Follow up PP CARE: To engage with individuals with a history of GDM through a patient-centered mixed-methods survey and qualitative assessment to evaluate the barriers to and facilitators of Cardiovascular health (CVH) counseling and risk-reduction postpartum at the patient and healthcare system levels inclusive of Social determinants of health (SDOH) and structural factors, as well as patient preferences and perspectives on CVH and wellness interventions

Подробное описание

DIP: Individuals with gestational diabetes (GDM) during pregnancy have up to a 10-fold increased risk of developing of T2DM. Postpartum screening facilitates detection of impaired glucose tolerance and diabetes mellitus with the possibility for subsequent preventive and treatment interventions. The American College of Obstetricians and Gynecologists (ACOG) and the American Diabetes Association (ADA) recommend screening individuals with GDM postpartum with a 75-g, 2-hour oral glucose tolerance test (OGTT) that includes a fasting blood glu-cose.4,6 This is historically performed at 4-12 weeks so that it will coincide with the timing of the typical postpartum visit. However, the rate of postpartum screening with the recommended method are low, as many individuals do not seek timely postpartum care-only a quarter to one half of individuals undergo diabetes screening in the first year postpartum. Multiple structural barriers exist for patients and healthcare providers to effectively complete postpartum diabetes screening via the current recommended method. An immediate postpartum OGTT has been proposed as an alternative to the current standard practice which is generally performed between 4-12 week postpartum OGTT at the routine postpartum visit. An immediate OGTT has comparable performance characteristics for detection of impaired glucose tolerance and diabetes compared with a 4-12 week postpartum OGTT.

Follow up PP CARE: Postpartum adverse CVH is a critical public health problem and contributes to persistent and inequitable maternal health. Adverse cardiovascular health outcomes after delivery, including hypertension, dyslipidemia, diabetes, and obesity, are frequent and a major source of maternal morbidity and mortality. Ultimately, these conditions increase the risk of long-term cardiovascular disease which affects 60 million women in the United States (US). It represents the leading cause of death, contributing to 1 in 5 deaths in women in the US. Despite these epidemiologic associations, relatively less research exists on prevention, recognition and treatment of adverse CVH in high-risk postpartum women before the occurrence of clinical disease. Further, adverse CVH is more common among individuals who experience an adverse pregnancy outcome (APO), as well as adverse social determinants of health (SDOH), including self-identified minoritized race or ethnicity as a proxy for racism, low socioeconomic status, housing and food insecurity, and limited access to healthcare.

Вмешательства

• Диагностический тест Immediate inpatient postpartum OGTT
  The intervention includes immediate inpatient postpartum 2-hour oral glucose tolerance test (OGTT) prior to delivery discharge
• Диагностический тест Standard of care 4-12 week postpartum OGTT
  Standard of care is 4-12 week outpatient postpartum OGTT

Первичные конечные точки

• Rate of postpartum diabetes mellitus screening [Срок оценки: From delivery to up to 12 weeks postpartum]
• Patient reported outcome of postpartum Cardiovascular health (CVH) counseling received within the first 12 months after delivery [Срок оценки: Within the first 12 months after delivery]
• Patient perspectives, preferences and barriers to engagement with respective to postpartum interventions to improve CVH. [Срок оценки: Between 12 and 24 months postpartum]

Вторичные конечные точки (5)

• Risk perception and lifestyle modification [Срок оценки: From delivery to up to 12 weeks postpartum]
• Rates of primary care provider (PCP) visits within 1 year of delivery [Срок оценки: Within 1 year postpartum]
• Risk Perception Survey for Developing Diabetes [Срок оценки: From delivery to up to 12 weeks postpartum]
• Diabetes Treatment Satisfaction Questionnaire [Срок оценки: From delivery to up to 12 weeks postpartum]
• Prediabetes or type 2 diabetes [Срок оценки: Within 1 year postpartum]

Критерии участия

DIP - Inclusion Criteria:

• Immediately postpartum individuals during their delivery hospital admission
• ≥ 18 years old with the ability to give informed consent.
• Diagnosed with GDM during pregnancy by:

• Elevated one-hour 50-gram glucose challenge test any time during pregnancy AND provider documentation of gestational diabetes (NOT pregestational diabetes) diagnosis OR
• Two elevated values on a 3-hour 100-gram glucose tolerance test any time in pregnancy AND provider documentation of gestational diabetes (NOT pregestational diabetes) diagnosis
• English or Spanish speaking
• Receiving prenatal and postpartum care at OSU

DIP- Exclusion Criteria:

• Individuals who cannot tolerate a 2-hour oral glucose tolerance test (OGTT) (i.e. history of gastric bypass)
• Not English or Spanish speaking

PP CARE Inclusion criteria: Enrolled DIP participants who are English speaking will be eligible for PP CARE follow up if they are between 12 and 24 months postpartum.

PP CARE Exclusion criteria: Spanish speaking DIP participants will be excluded because the study team does not include anyone who is Spanish speaking.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Открытое

Основная цель

Профилактика

Центры проведения

США · 1 центр

• The Ohio State University Wexner Medical Center OB/GYN Maternal and Fetal Medicine — Columbus

Публикации

• Field C, Grobman WA, Mast D, Wu J, Vickers S, Csizmadia V, Bartholomew A, Chen A, Mullangi V, Gabbe S, Buschur E, Werner E, Landon MB, Venkatesh KK. Diabetes Testing Immediately Postpartum After Gestational Diabetes Mellitus: A Randomized Controlled Trial. Obstet Gynecol. 2026 May 1;147(5):735-744. doi: 10.1097/AOG.0000000000006236. Epub 2026 Mar 12. PMID 41842598

Идентификаторы

NCT: NCT05909046 · 2023H0189

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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