Study of Pregnancy And Neonatal Health (SPAN) (SPAN)
Gestational Diabetes Mellitus
About this trial
This is an interventional treatment trial for Gestational Diabetes Mellitus focused on measuring Gestational Diabetes Mellitus, Delivery Timing
Eligibility Criteria
INCLUSION CRITERIA:
Aim 3 (GDM randomized trial, TIME) inclusion criteria:
Women inclusion criteria:
- Age ≥ 18 Years
Verified diagnosis of Gestational Diabetes Mellitus (GDM) with abnormal glucose levels*** or meeting other criteria for poor control, specifically any one of the following: Estimated fetal weight ≥90th percentile (LGA), Polyhydramnios, and or Demonstrate noncompliance or nonadherence as defined clinically, including missing visits, not keeping accurate log, etc.
***One or more elevated fasting blood glucoses OR three or more elevated post-prandial blood glucoses after receiving education about appropriate diet and lifestyle modification (e.g. physical activity)
- Accurate gestational age as verified by ultrasound
- Singleton gestation
- English or Spanish speaker
- Plans to deliver at the study site hospital
- Ability to provide informed consent to be randomized to initiation of delivery
EXCLUSION CRITERIA:
Aim 3 (GDM randomized trial, TIME) exclusion criteria:
Pre-gestational diabetes*
*will be defined as diabetes diagnosis before pregnancy OR before 13 weeks of gestation with a documented fasting plasma glucose ≥ 126 mg/dL, random plasma glucose ≥ 200 mg/dL, 2 hour post glucose ≥ 200 mg/dL during an oral glucose tolerance test (75 g glucose load), or hemoglobin A1c ≥ 6.5%.110.
- Previous stillbirth defined as fetal demise ≥ 20 weeks of gestation
- Self-reported history of alcohol dependency disorder and/or other drug/substance dependency in the past year
- Teratogen exposure (e.g. cyclophosphamide, valproic acid, warfarin)
- Known infectious diseases associated with neonatal morbidity (e.g. malaria, cytomegalovirus, rubella, toxoplasmosis, syphilis or Zika virus)
- Genetic disorders, aneuploidy and known major fetal anomalies
- Fetal demise
- Pregnancies with concurrent conditions and other indications for earlier delivery will also be excluded.
- Participation in another interventional study that influences management of labor and delivery or perinatal morbidity or mortality
Sites / Locations
- University of Alabama at BirminghamRecruiting
- Ochsner BaptistRecruiting
- University of North Carolina - Chapel HillRecruiting
- Duke University Perinatal Research CenterRecruiting
- University of PennsylvaniaRecruiting
- Intermountain HealthcareRecruiting
- University of UtahRecruiting
- INOVA Fairfax HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Arm 5
Arm 6
Arm 7
Experimental
Experimental
Experimental
Experimental
Experimental
Experimental
Experimental
Intervention Arm 1
Intervention Arm 2
Intervention Arm 3
Intervention Arm 4
Intervention Arm 5
Intervention Arm 6
Intervention Arm 7
Intervention Arm 1 Experimental Initiation of Delivery by induction or planned cesarean at 37 weeks 0-2 days.
Intervention Arm 2 Experimental Initiation of Delivery by induction or planned cesarean at 37 weeks 3-5 days.
Initiation of Delivery by induction or planned cesarean at 37 weeks 6 days to 38 weeks and 1 day.
Intervention Arm 4 Experimental Initiation of Delivery by induction or planned cesarean at 38 weeks 2-4 days.
Initiation of Delivery by induction or planned cesarean at 38 weeks 5 days to 39 weeks and 0 days.
Intervention Arm 6 Experimental Initiation of Delivery by induction or planned cesarean at 39 weeks 1-3 days.
Intervention Arm 7 Experimental Initiation of Delivery by induction or planned cesarean at 39 weeks 4-6 days.