Approximately 9-19% of pregnant women have a positive glucose challenge test when screened for diabetes but a normal diagnostic oral glucose tolerance test (OGTT). Women with a positive glucose challenge test and normal OGTT do not obtain usual diabetes care, diet counseling and plasma glucose monitoring. The proposed study determines the impact of a positive glucose challenge test and normal OGTT on maternal-fetal outcomes in young, low income minority pregnant women in Camden. Potential links with abnormal metabolism will be examined as well. Based on the information collected from prior prospective cohort studies (n=2789) and using blood specimens collected and stored at entry to prenatal care (<20 weeks) and in the 3rd trimester (24-28 weeks), we propose to (1) determine the influence of a positive glucose challenge test and normal OGTT on adverse pregnancy outcome, using data from the whole cohort and (2) determine if fundamental metabolic abnormalities are present comparing cases from the cohort (n=200) to controls (n=600) who are randomly selected from among women with a negative glucose challenge test. Metabolic abnormalities include: (i) Insulin resistance and secretion; (ii) Fasting plasma free fatty acid (FFA) level , FFA composition and dietary fat and fatty acid intake; (iii) Circulating levels of adiponectin, TNF-a, C-reactive protein. This study will be the first to examine in detail the effects of a positive glucose challenge test and normal OGTT on maternal-fetal outcomes along with potential mechanisms in a young, low income minority women. Prenatal care during pregnancy is critical and one of the few times when these women obtain preventive health care. Should this application demonstrate that women with positive glucose challenge test and normal OGTT have increased adverse maternal-fetal outcomes or detectable abnormalities in metabolism, fuel substrates and inflammatory biomarkers comparing with negative glucose challenge test women, there would have important public health implications for reducing adverse maternal-fetal outcomes in vulnerable women. Low income ethnic minorities usually receive only intermittent medical care apart from pregnancy. If such women are at risk for type 2 diabetes, preventive intervention that takes place in the context of prenatal care would provide an opportunity to prevent or delay the development of type 2 diabetes and its precursor, gestational diabetes mellitus. ? ? ? ?
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