A Study of the Intervention of Time-restricted Eating in High-risk Populations of GDM

Effects of Time-restricted Eating on the Incidence of Gestational Diabetes Mellitus in High-risk Populations: a Randomized Controlled Study

This is a randomized controlled trial, aiming to investigate whether a time-restricted eating (TRE) can reduce the incidence of gestational diabetes mellitus (GDM) in high-risk pregnant women. Investigators intend to conduct a 3-month randomized controlled study to compare the effects of 10-hour TRE and habitual eating time on GDM .

Study Overview

• Status: Recruiting
• Conditions: Dietary Habits; Gestational Diabetes Mellitus; Lifestyle Intervention; Randomized Controlled Study
• Intervention / Treatment: Behavioral: Time-limited eating

Detailed Description

Investigators present a multicenter, open-label and parallel-group randomized study. Total 240 women in early pregnancy were randomly assigned to TRE group and SOC (standard of care) group according to the ratio of 1: 1. Participants assigned to the TRE group will be instructed to consume prescribed calories in a 10-hour eating window (from 8:30 am to 18:30 pm) each day and only noncaloric beverages were permitted outside of the eating window over 3 months (from 14-26 gestational weeks). Participants in the SOC group will be instructed to consume prescribed calories following habitual daily eating schedule over 3 months. All participants should follow moderate-intensity physical activity for about 30 minutes every day, and receive diet and exercise counseling during the study period. GDM was diagnosed by 75g oral glucose tolerance test (OGTT) test at about 26 gestational weeks.

• Study Type: Interventional
• Enrollment (Estimated): 240
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Ying Zhao, PhD; Phone Number: 13061860396; Email: zhaoying7662@163.com

Study Locations

• China
  • Shanghai Municipality
    • Shanghai, Shanghai Municipality, China, 200011
      • Recruiting
      • Obstetrics and Gynecology Hospital of Fudan University
      • Contact: Yu Xiong, phd; Phone Number: +862163455050; Email: xiongyu1535@163.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion criteria:

1. Aged 18-50 years;
2. The risk for GDM includes overweight or obesity (BMI ≥ 24 kg/m2 before pregnancy), first-degree relative with diabetes, history of cardiovascular disease, hypertension (≥130/80 mmHg or on therapy for hypertension), HDL cholesterol level < 1 mmol/L and/or a triglyceride level > 2.8 mmol/L, history of GDM, history of macrosomia delivery, individuals with polycystic ovary syndrome, repeated positive fasting urine glucose in the first trimester, or age>45 years according to Guideline of Diagnosis and Treatment of Hyperglycemia in Pregnancy (2022);
3. Less than 14 weeks of gestation;
4. Able to read and complete questionnaires in Chinese;
5. singleton pregnancy.

Exclusion criteria:

1. Pregestational diabetes (including diabetes diagnosed before conception; fasting blood glucose ≥ 7.0 mmol/L or HbA1c ≥ 6.5% in the first trimester; typical symptoms of hyperglycemia or hyperglycemic crisis with optional blood glucose ≥ 11.1 mmol/L);
2. Impaired glucose tolerance (including fasting blood glucose ≥ 5.6 mmol/L or two fasting blood glucose ≥ 5.1 mmol/L in the first trimester);
3. Current or recent use of drugs that affect glucose metabolism such as metformin, glucocorticoids and Orlistat;
4. Severe comorbidities (including cardiac diseases, kidney diseases, hepatopathy, autoimmune diseases, uncontrolled thyroid disease, previous or current malignant tumors, etc.);
5. Fetal malformations or chromosomal abnormalities;
6. Cervical insufficiency (including ultrasonic cervical length < 25 mm before 24 weeks of gestation, history of spontaneous preterm birth at 14-36 weeks of previous pregnancy, or cervical dilation in the past or current pregnancy);
7. Exercise contraindications (including continuous vaginal bleeding, threatened premature labor, placenta previa, premature rupture of membranes, severe anemia, etc.);
8. Drug abuse, which refers to the repetitive, heavy use of drugs with dependent characteristics such as narcotic, psychotropic substances, tobacco and alcohol;
9. Hyperemesis gravidarum, which refers to the severe and persistent nausea and vomiting, unable to eat or eat little that leads to dehydration, ketosis and even acidosis;
10. On a special or prescribed diet for other reasons;
11. Eating window<10 h.

Exit criteria：

1. Failure to comply with or assume the corresponding responsibilities and obligations of the informed agreement;
2. Pregnant women who terminate their pregnancy before completing GDM diagnosis and screening at 24-28 weeks of pregnancy will automatically withdraw from the group, such as severe fetal malformation, eclampsia, abortion, etc.
3. Major diseases, such as particularly serious obstetric medical events, malignant tumors, serious cardiovascular and cerebrovascular diseases, brain injuries, paralysis and other major diseases, can not continue to accept this intervention plan and follow-up, and withdraw from the study;
4. Accidental disability or death caused by non-intervention factors occurred during the study period, and he withdrew from the study;
5. Subjects are subjectively unwilling to continue to accept the intervention program, and sign the withdrawal agreement to withdraw from the group on a voluntary basis, and decide whether to continue to follow up the pregnancy process and outcome according to the specific contents of the withdrawal statement.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: TRE(Time-restricted eating group); Participants assigned to the TRE group will be instructed to consume prescribed calories in a 10-hour eating window (from 8:30 am to 18:30 pm) each day and only noncaloric beverages were permitted outside of the eating window over 3 months (from 14-26 gestational weeks).	Behavioral: Time-limited eating; All participants will be instructed to follow a diet of 1800-2200 kcal/d (45-50% of energy from carbohydrate, 15-20% from protein, 25-30% from fat) based primarily on Dietary Guidelines for Chinese Residents (2022), Dietary guidelines for pregnant women and Guideline of Diagnosis and Treatment of Hyperglycemia in Pregnancy (2022). Participants assigned to the TRE group will be instructed to consume prescribed calories in a 10-hour eating window (from 8:30 am to 18:30 pm) each day and only noncaloric beverages were permitted outside of the eating window over 3 months (from 14-26 gestational weeks). Participants in the SOC group will be instructed to consume prescribed calories following habitual daily eating schedule over 3 months.
No Intervention: SOC (standard of care group); Participants in the SOC group will be instructed to consume prescribed calories following habitual daily eating schedule over 3 months.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The incidence of GDM	Diagnosed by the 75g oral glucose tolerance test (OGTT).	26 gestational weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of newborns with macrosomia	Number of newborns with birth weight ≥4000g.	At delivery
Number of newborns with low birth weight	Number of newborns with birth weight <2500g.	At delivery
Number of newborns large for gestational age (LGA)	Number of newborns with weight lies above the 90th percentile for the gestational age.	At delivery
Number of newborns small for gestational age (SGA)	Number of newborns with weight lies below the 10th percentile for the gestational age.	At delivery
Incidence of shoulder dystocia	The incidence of the condition in which normal traction on the fetal head does not lead to the delivery of the shoulders.	At delivery
Number of newborns with birth injury	Number of newborns with an impairment of the neonate's body function or structure due to an adverse event that occurred at birth.	At delivery
Number of neonatus with neonatal intensive care unit (NICU) admission	Number of neonatus with neonatal intensive care unit (NICU) admission.	Within the first 28 days after delivery
Number of neonatus with neonatal respiratory distress	Number of neonatus with clinical symptoms including tachypnea, nasal flaring, grunting, retractions (subcostal, intercostal, supracostal, jugular), cyanosis, apnea, bradypnea, irregular breathing, inspiratory stridor, wheeze and hypoxia, etc.	Within the first 28 days after delivery
Number of neonatus with hypoglycemia	Number of neonatus with venous glucose levels <2.6mmol/L.	Within the first 48 hours after delivery
Number of neonatus with pathologic jaundice	Jaundice that arises from factors that alter the usual process involved in bilirubin metabolism in the liver that requires treatment.	Within the first 28 days after delivery
Number of neonatus with intraventricular hemorrhage (IVH) of II grade or above	Intraventricular hemorrhage (IVH) of II grade or above diagnosed by ultrasound.	Within the first 28 days after delivery
Number of neonatus with necrotizing enterocolitis (NEC)	Necrotizing enterocolitis (NEC) diagnosed by radiography or surgery.	Within the first 28 days after delivery
Number of neonatus managed with assisted ventilation >24 hours via endotracheal tube.	Number of neonatus managed with assisted ventilation >24 hours via endotracheal tube.	Within 72 hours of birth
Number of neonatus with sepsis.	Number of neonatus with septicemia ascertained by blood culture.	Within the first 28 days after delivery
The incidence of neonatal death.	The incidence of deaths among live births during the first 28 completed days of life.	Within the first 28 days after delivery
The level of maternal fasting plasma insulin	Maternal fasting plasma insulin level.	at 24-28 gestational weeks
The level of maternal HbA1c	Maternal venous glycosylated hemoglobin A1c (HbA1c) level.	at 24-28 gestational weeks
Insulin resistance calculated by homeostatic model assessment (HOMA-IR)	Insulin resistance calculated by homeostatic model assessment (HOMA-IR). HOMA-IR=fasting plasma glucose (FPG)× fasting plasma insulin (FINS)/22.5. The higher HOMA-IR value indicates higher severity of insulin resistance.	at 24-28 gestational weeks
Maternal lipid profile	Level of maternal venous low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides and total cholesterol.	at 24-28 gestational weeks
Maternal change in depression, quality of sleep and quality of life	Maternal change in depression, quality of sleep and quality of life measured by the Patient Health Questionnaire-9 (PHQ-9), Pittsburgh sleep quality index (PSQI) and 12-item Short-Form Health Survey Questionnaire (SF-12) according to pre-pregnancy status and 24-28 gestational weeks. The Patient Health Questionnaire-9 (PHQ-9): Scores range from 0 to 27, with higher scores indicating severer depression. The standard cut-off score for screening to identify possible major depression is 10 or above. Pittsburgh sleep quality index (PSQI): Scores range from 0 to 21, with higher scores indicating worse sleep quality. 12-item Short-Form Health Survey Questionnaire (SF-12): physical component score (PCS) range from 0 to 100, higher scores are better.	From pre-pregnancy to 24-28 gestational weeks
Gestational weight gain	Measured according to pre-pregnancy weight and weight at 24-28 gestational weeks.	From pre-pregnancy to 24-28 gestational weeks
Change in waist circumference	Measured according to pre-pregnancy waist circumference and waist circumference at 24-28 gestational weeks.	From pre-pregnancy to 24-28 gestational weeks
Incidence of maternal morbidities	Incidence of hypertensive disorders of pregnancy, hydramnios, placental abruption, preterm/prelabor rupture of membranes (P/PROM), preterm birth, chorioamnionitis, postpartum hemorrhage and still birth.	From 24-28 gestational weeks to delivery

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Adherence to the intervention	Adherence to the intervention measure by Chinese Dietary Guidelines Compliance Index for Pregnant Women (CDGCI-PW) and by counting the number of days in which participants consumed calories outside the time-window or exceeding the upper limit of the required energy intake. Chinese Dietary Guidelines Compliance Index for Pregnant Women (CDGCI-PW): Scores range from 0-100, with higher score indicating better adherence.	From 14-26 gestational weeks

Collaborators and Investigators

• Sponsor: Fudan University
• Collaborators: Shenzhen Maternity & Child Healthcare Hospital

Study record dates

Study Major Dates

• Study Start (Actual): April 17, 2024
• Primary Completion (Estimated): January 1, 2026
• Study Completion (Estimated): December 1, 2026

Study Registration Dates

• First Submitted: April 23, 2024
• First Submitted That Met QC Criteria: May 28, 2024
• First Posted (Actual): May 29, 2024

Study Record Updates

• Last Update Posted (Actual): November 21, 2025
• Last Update Submitted That Met QC Criteria: November 18, 2025
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Keywords: Metabolic Diseases; Gestational Diabetes Mellitus
• Additional Relevant MeSH Terms: Urogenital Diseases; Endocrine System Diseases; Female Urogenital Diseases and Pregnancy Complications; Pregnancy Complications; Glucose Metabolism Disorders; Diabetes Mellitus; Behavior; Nutritional and Metabolic Diseases; Behavior, Animal; Diabetes, Gestational; Metabolic Diseases; Feeding Behavior
• Other Study ID Numbers: FD153502

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No