The major focus has been to examine the utility of glycosylated blood protein concentrations (measured by affinity chromatography) in the assessment of normal pregnancy and pregnancy complicated by diabetes. Gestational biabets, a frequent complication of pregnancy with an incidence of 1.6-3.0%, is associated with increased fetal and maternal morbidity and fetal mortality. In contrast to earlier work suggesting that gestational diabetes occurs only in the third trimester, our work indicated GlyHb (glycosylated hemoglobin concentration) elevation can be detected as early as 15 weeks gestation in those women who ultimately develop gestational diabetes. Additionally, our studies indicate that GlyHb elevation by 15 weeks is predictive of macrosomia in the infants of both women with normal glucose tolerance in pregnancy and women with gestational diabets. GlyHb remains elevated throughout gestation in women with gestational diabets receiving conventional dietary on insulin therapy, and fetal outcome in compromised. As an extension of these studies, a board based clinical investigatin of pregnancy complicated by elevation of glycosylated blood protein concentrations in proposed. Such an investigation is feasible because, in contrast to earlier methodologies, GlyHb and GSP (glycosylated serum protein concentration) offer quantitative assessment of blood glucose regulation in pregnancy.
The specific aims of this proposal are to (1) test the hypothesis that intensified therapy for glucose intolerance in pregnancy based on the maintenance of normal GlyHb will result in improved perinatl outcome, (2) determine whether women with GlyHb elevation but normal glucose tolerance in pregnancy can be distinguished for women with gestational diabets by historical, clinical, or biochemical parameters, (3) elaluae longitudinally physical growth, intellectual development, and pancreatic beta cell function in the children of women with mild glucose intolerance in pregnancy, (4) monitor the development of diabetes in women withGlyHb elevation in pregnancy to determine whether euglycemia, as determined by normal GlyHb, maintained throughout gestation results in a decreased risk or severity of glucose intolerance in late pregnancy or in later life, and (5) determine whether the glycosylation of fetal proteins is increased prior to 20 week gestation when maternal GlyHb is elevated.
