Obesity in pregnancy increases the risk of gestational diabetes (GDM) and associated adverse outcomes. NICE guidelines recommend that all obese women have an oral glucose tolerance test at 24-28 weeks' gestation for detection of GDM. However, excessive fetal growth in obese women is evident before diagnosis of GDM, accompanied by an abnormal metabolome. The identification of obese women with an increased risk of GDM in early pregnancy would enable targeted intervention and is therefore essential to prevent GDM and improve clinical outcomes in obese women.
Our group have recently developed a novel early pregnancy GDM prediction tool. The tool, developed from clinical and biochemical variables, identifies obese pregnant women in early pregnancy at risk of developing GDM. The risk of GDM is doubled in the high risk group compared to unselected obese women.
This project will address the hypothesis that early pregnancy dietary advice and/or metformin, the two 'first line' treatments for women with established GDM, will prevent gestational diabetes by improving glucose tolerance and metabolic function in obese pregnant women identified as 'at risk' by this prediction tool.
1. To assess in obese pregnant women at high risk of GDM, the efficacy of a) dietary advice, b) metformin treatment plus dietary advice to improve maternal glycaemic control when compared with c) standard care
2. To determine in obese pregnant women at high risk of GDM, the impact of a) dietary advice, b) metformin treatment plus dietary advice on a targeted maternal metabolome (Nuclear Magnetic Resonance, NMR) when compared with c) standard care.
Skills training includes; maternal metabolic profiling, nutritional epidemiology, use of novel glucose monitoring methodologies to assess glycaemic status in obese pregnancy, large scale data analysis and curation, study design.
Please contact Dr Angela Flynn, Department of Women and Children's Health, King's College London for further details, [email protected].