Magnetic Resonance Imaging and Thermal Imaging of Adiposity in Neonates of Women With Metabolic Diseases

• Conditions: Intrahepatic Cholestasis of Pregnancy; Diabetes Mellitus; Metabolic Disease
• Interventions: Diagnostic Test: Thermal imaging; Diagnostic Test: Echocardiogram; Diagnostic Test: ECG; Diagnostic Test: MRI scan; Diagnostic Test: Serum blood markers

• Registration Number: NCT04890886
• Lead Sponsor: Guy's and St Thomas' NHS Foundation Trust

Brief Summary

There is limited knowledge about the extent of the impact of maternal metabolic diseases (MD) and/or alterations in maternal serum lipid content upon neonatal lipid distribution and phenotypes. This observational feasibility study aims to investigate the effect of maternal MD on fat distribution, lipid content and metabolic phenotype of different neonatal tissues. We will explore whether differences in tissue fat distribution and lipid content are observed in the neonates of women with MD during pregnancy, compared to those who have a healthy, uncomplicated pregnancy and if there are changes in how the different tissues work (e.g. cardiac function). If there is evidence to show that there are alterations during pregnancy in children of women with MD, this will help inform potential interventions to ensure optimal child health.

Detailed Description

Not available

Study Timeline

• Status Verified: 2021-05
• Study First Submitted: 2021-05-13
• Study First Submitted QC: 2021-05-13
• Last Update Submitted: 2021-05-13
• Study First Posted: 2021-05-18
• Last Update Posted: 2021-05-18
• Study Start: 2021-06-01
• Primary Completion: 2023-12-01
• Study Completion: 2023-12-01

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: Female
• Target Recruitment: 80

Inclusion Criteria

1. Pregnant women aged between 16 and 45 years old.
2. Women with GDM diagnosed at 26+0 to 30+6 weeks' gestation in accordance with the NICE guidelines Or
3. Pregnant women with pre-existing type 1 or type 2 diabetes mellitus Or
4. Women diagnosed with ICP at any stage of pregnancy
5. Fluent in English or presence of an interpreter or translation service (i.e. telephone translation services) at all visits.
6. Singleton pregnancy.
7. Willing and able to give written informed consent and comply with requirements of the study protocol
8. Planned antenatal, intrapartum and postpartum care at the participating centre (i.e. not planning to move before delivery)

Exclusion Criteria

1. Known fetal congenital abnormality on ultrasound requiring fetal medicine input (excluding congenital heart disease).

2. Known fetal congenital abnormality on ultrasound requiring fetal medicine input (excluding congenital heart disease).

3. Significant pre-pregnancy co-morbidities that increase risk in pregnancy, for example renal failure, severe liver disease, transplantation, cardiac failure, psychiatric conditions requiring in-patient admission (within previous year) in the opinion of the responsible clinician or the CI.

4. Significant co-morbidity in the current pregnancy, nephropathy (estimated GFR <60ml/min), other physical or psychological conditions likely to interfere with the conduct of the study and/or interpretation of the study results in the opinion of the responsible clinician or the CI. (This does not include diabetes mellitus).

5. History of bariatric surgery.

6. Hypertension requiring treatment pre-pregnancy / in pregnancy.

7. Prescribed other medications that affect insulin sensitivity prior to OGTT for women diagnosed with GDM (oral antihyperglycemic agents, antipsychotic drugs, supraphysiological doses of steroids).

8. For the baby after birth: Not meeting the safety criteria to undergo MRI scan (e.g. metal implants, non MRI compatible devices, metal fragments in the body). [ The mother will not have an MRI scan].

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Control	Echocardiogram	Women without metabolic disease in pregnancy
Control	MRI scan	Women without metabolic disease in pregnancy
Pre-existing Type 1 Diabetes and Type 2 Diabetes	Thermal imaging	Women with type 1 diabetes and type 2 diabetes diagnosed prior to pregnancy
Pre-existing Type 1 Diabetes and Type 2 Diabetes	Echocardiogram	Women with type 1 diabetes and type 2 diabetes diagnosed prior to pregnancy
Pre-existing Type 1 Diabetes and Type 2 Diabetes	ECG	Women with type 1 diabetes and type 2 diabetes diagnosed prior to pregnancy
Pre-existing Type 1 Diabetes and Type 2 Diabetes	MRI scan	Women with type 1 diabetes and type 2 diabetes diagnosed prior to pregnancy
Pre-existing Type 1 Diabetes and Type 2 Diabetes	Serum blood markers	Women with type 1 diabetes and type 2 diabetes diagnosed prior to pregnancy
Gestational Diabetes	Thermal imaging	Women with gestational diabetes diagnosed in pregnancy by the oral glucose tolerance test
Gestational Diabetes	Echocardiogram	Women with gestational diabetes diagnosed in pregnancy by the oral glucose tolerance test
Gestational Diabetes	ECG	Women with gestational diabetes diagnosed in pregnancy by the oral glucose tolerance test
Gestational Diabetes	MRI scan	Women with gestational diabetes diagnosed in pregnancy by the oral glucose tolerance test
Gestational Diabetes	Serum blood markers	Women with gestational diabetes diagnosed in pregnancy by the oral glucose tolerance test
Intrahepatic cholestasis of pregnancy	Thermal imaging	Women with intrahepatic cholestasis of pregnancy
Intrahepatic cholestasis of pregnancy	Echocardiogram	Women with intrahepatic cholestasis of pregnancy
Intrahepatic cholestasis of pregnancy	MRI scan	Women with intrahepatic cholestasis of pregnancy
Control	ECG	Women without metabolic disease in pregnancy
Intrahepatic cholestasis of pregnancy	ECG	Women with intrahepatic cholestasis of pregnancy
Control	Serum blood markers	Women without metabolic disease in pregnancy
Intrahepatic cholestasis of pregnancy	Serum blood markers	Women with intrahepatic cholestasis of pregnancy
Control	Thermal imaging	Women without metabolic disease in pregnancy

Primary Outcome Measures

Name	Time	Method
Assessment of the distribution of adipose tissue	30 months	To perform imaging and biochemical studies to determine whether maternal metabolic disease alters the distribution of adipose tissue (SAT, VAT, BAT) of the fetuses and neonates of women with MD during pregnancy compared to neonates of women who had a healthy pregnancy.

Secondary Outcome Measures

Name	Time	Method
Assessment of the function of adipose tissue	30 months	To evaluate novel MRI-based techniques to measure the function of adipose tissue (SAT, VAT, BAT) in the neonates.
Assessment of cardiac function and rhythm	30 months	To perform echocardiography and fetal/ neonatal ECG studies to understand the impact of maternal MD on the fetal heart.
Assessment of skeletal muscle, heart and liver	30 months	To perform imaging and biochemical studies to determine whether maternal metabolic disease alters the distribution and phenotypes of skeletal muscle, heart and liver of the fetuses and neonates of women with MD during pregnancy compared to those of women who had a healthy pregnancy.
Thermal assessment	30 months	To use thermal imaging to determine the temperature of regions of interest, e.g. BAT, of pregnant women with MD and their neonates.