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Carbohydrate Counting and DASH Intervention and Pregnancy Outcomes Among Women With Gestational Diabetes

21 november 2018 uppdaterad av: Sabika Salem Allehdan, University of Jordan

Studying the Effectiveness of Carbohydrate Counting and Dietary Approach to Stop Hypertension Dietary Intervention on Glycemic Control and Maternal and Newborn Health Outcomes Among Jordanian Pregnant Women With Gestational Diabetes

Study is an interventional clinical trial. Pregnant women (aged 25-40 years) diagnosed with GDM (by a 75-g oral glucose tolerance test at 24-28 weeks' gestation) will be recruited conveniently from Obstetrics and Gynecology clinic at the Jordan University Hospital and National Center for Diabetes, Endocrinology and Genetics, Amman, Jordan. A sample of 180 pregnant women with GDM (60 women who do not use insulin and hypoglycemia medications, 60 women who are treated with metformin, 60 women who are treated with insulin), who will meet the inclusion criteria and will be agreed to participate will be centrally randomized to follow carbohydrate counting dietary intervention, carbohydrate counting and DASH dietary intervention, and control dietary intervention.

Studieöversikt

Status

Okänd

Betingelser

Intervention / Behandling

Detaljerad beskrivning

The main objective of this study is to compare the effect of carbohydrate counting, carbohydrate counting and DASH diet dietary interventions and a general dietary intervention on glycemic control, maternal and neonatal outcomes among Jordanian pregnant women with GDM. Eligibility criteria to be enrolled in the study will be being Jordanian pregnant women with GDM at 24 -28 gestational weeks, aged between 25 to 40 with no-personal history of type 1 or 2 diabetes, or impaired fasting glucose, or chronic diseases and singleton gestation. DASH diet; and the third group will follow the diet prescribed by the hospital for GDM. The duration of intervention will extend from 24-28 gestational weeks until delivery, which will be usually 12-14 weeks later. The glycemic controls outcomes are testing fasting blood glucose, HbA1C, insulin and fructosamine at baseline and at end of intervention for three dietary interventions. While maternal outcomes are total maternal weight gain (kg), need for emergency caesarean section, the presence or absence of pregnancy-induced hypertension and preeclampsia. The new born birth weight, length and head circumference, the presence or absence of hypoglycemia and shoulder dystocia are the newborn outcomes.

Studietyp

Interventionell

Inskrivning (Förväntat)

180

Fas

  • Inte tillämpbar

Kontakter och platser

Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.

Studieorter

Deltagandekriterier

Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.

Urvalskriterier

Åldrar som är berättigade till studier

25 år till 40 år (Vuxen)

Tar emot friska volontärer

Nej

Kön som är behöriga för studier

Kvinna

Beskrivning

Inclusion Criteria:

  • Jordanian pregnant women with GDM at 24 -28 gestational weeks.
  • Aged 25-40 with no-personal history of type 1 or 2 diabetes, or impaired fasting glucose (Koivusalo et al., 2016).
  • Singleton gestation (Louie et al., 2011).
  • Absence of chronic diseases such as hypertension, hepatic and kidney disease and cancer, and psychiatric disorder (Ma et al., 2014).
  • Absence of the use of medication that influences glucose metabolism, such as continuous therapy with oral corticosteroids (Koivusalo et al., 2016)
  • Pregnant women who do not have special dietary requirements (Louie et al., 2011).

Nonsmoker or nonalcoholic drinker during pregnancy (Louie et al., 2011) Well educated and well cooperative, more than 10 years of formal schooling (Ma et al., 2014).

Exclusion Criteria:

  • Non- Jordanian pregnant women or Jordanian pregnant women with GDM at <24 or >28 gestational weeks.
  • Aged > 40 years with multiple gestation and suspected over-diabetes (Koivusalo et al., 2016).
  • Multiple gestations (Louie et al., 2011).
  • Presence of chronic diseases, severe psychiatric disorder. Women with the risk factors for placental insufficiency, or history of preeclampsia (Ma et al., 2014; Koivusalo et al., 2016).
  • Presence of the use of medication that influences glucose metabolism, such as continuous therapy with oral corticosteroids (Koivusalo et al., 2016)
  • Pregnant women who have special dietary requirements (Louie et al., 2011).
  • Who smoked or consumed alcohol during pregnancy (Louie et al., 2011)
  • Less than 10 years of formal schooling or previous intensive nutrition education or intervention for diabetes (Ma et al., 2014).

Studieplan

Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.

Hur är studien utformad?

Designdetaljer

  • Primärt syfte: Behandling
  • Tilldelning: Randomiserad
  • Interventionsmodell: Parallellt uppdrag
  • Maskning: Enda

Vapen och interventioner

Deltagargrupp / Arm
Intervention / Behandling
Experimentell: Dietary intervention CHO counting
Carbohydrate counting diet will be prepared according to Kulkarni, (2005). Tailored diet plans according to patient's food preference, physical activity level and appropriate insulin: Carbohydrates ratio will be prescribed for each participants. Diets were based on each participants's recommended intakes of energy, protein (15-25%), fat (30-40%) and carbohydrate (40-50%) (Thomas and Gutierrez, 2005; Kleinwechter et al., 2014). Energy requirement will be determined in the participants' pre-pregnancy weight with adding the extra requirement (450 kcal) due to pregnancy. The carbohydrate counts will be distributed into three main meals and 3 snacks.
Beteende: Dietary Intervention
Adjusting the quantity and quality of food intake to improve glycemic control, maternal and newborn health outcomes of women with gestational diabetes.
Andra namn:
  • diet therpy
Experimentell: Dietary intervention CHO Counting & DASH
The recommended intakes of energy, protein (15-25%), fat (30-40%) and carbohydrate (40-50%) will be similar to that in carbohydrate counting diet which mentioned above. DASH diet food choices will be inserted in the diet of the participants assigned for the combined diet of DASH and carbohydrate counting. The emphasis will be more on the fruits and vegetables group (>8 servings/day), whole grains (at least half of the amount of the total servings of cereals; 6-8 servings/day), fat free dairy products (2-3 servings/day), lean meat and plant proteins (0-2 servings/day) and nuts (5-7 servings/week). From the fat group olive oil will represent the main type of fat (20-25% of total fat %). Adequate intake of sodium (2000mg) will be applied into participants' diet.
Beteende: Dietary Intervention
Adjusting the quantity and quality of food intake to improve glycemic control, maternal and newborn health outcomes of women with gestational diabetes.
Andra namn:
  • diet therpy
Inget ingripande: General Dietary guidlines
the general dietary advice and diet that will be prescribed by hospital for participants

Vad mäter studien?

Primära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Fasting blood glucose
Tidsram: one year
Fasting blood glucose in mg/dL at 24 -28 weeks of gestation (baseline) and at 36-37) weeks of gestation(endline) of intervention.
one year

Sekundära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Hemoglobin A1c level
Tidsram: one year
Hemoglobin A1c% at both baseline and endline of intervention
one year
Fasting insulin level
Tidsram: one year
Fasting insulin level in µIU/mL at both baseline and endline of intervention.
one year
Fructosamine level
Tidsram: one year
fructosamine in µmol/L at both baseline and endline of intervention.
one year
Total maternal weight gain
Tidsram: one year
Total maternal weight gain during pregnancy in kilograms
one year
Weekly weight gain
Tidsram: one year
weight in kilogram will be measured weekly for all participants
one year
Insulin Therapy
Tidsram: one year
Number of participants who need insulin therapy to normalize blood sugar.
one year
Emergency caesarean section
Tidsram: one year
Number of participants who need for emergency caesarean section versus vaginal delivery.
one year
Pregnancy-induced hypertension
Tidsram: one year
Number of participants with existence of hypertension (defined as a blood pressure of at least 140/90 mmHg on two occasions).
one year
Newborn weight
Tidsram: one year
The newborn weight in grams
one year
Newborn Length
Tidsram: one year
The new born length in centimeters.
one year
Newborn head circumference
Tidsram: one year
The newborn head circumference in centimeters.
one year
Hypoglycemic
Tidsram: one year
Number of newborn babies who will suffer from hypoglycemia
one year
Shoulder dystocia
Tidsram: one year
Number of newborn babies with shoulder dystocia.
one year

Samarbetspartners och utredare

Det är här du hittar personer och organisationer som är involverade i denna studie.

Sponsor

University of Jordan

Utredare

  • Studierektor: Reema F Tayyem, PhD, University of Jordan

Publikationer och användbara länkar

Den som ansvarar för att lägga in information om studien tillhandahåller frivilligt dessa publikationer. Dessa kan handla om allt som har med studien att göra.

Allmänna publikationer

Studieavstämningsdatum

Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.

Studera stora datum

Studiestart (Faktisk)

20 augusti 2017

Primärt slutförande (Förväntat)

20 augusti 2019

Avslutad studie (Förväntat)

20 oktober 2019

Studieregistreringsdatum

Först inskickad

31 juli 2017

Först inskickad som uppfyllde QC-kriterierna

6 augusti 2017

Första postat (Faktisk)

9 augusti 2017

Uppdateringar av studier

Senaste uppdatering publicerad (Faktisk)

26 november 2018

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

21 november 2018

Senast verifierad

1 november 2018

Mer information

Termer relaterade till denna studie

Ytterligare relevanta MeSH-villkor

Andra studie-ID-nummer

  • 2 (Annan identifierare: Instituto Cardiovascular de Buenos Aires)

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