Effect of Maternal Diabetes on Brain Development, as Measured by Neonatal Electroencephalogram (EEG)

Diabetes, Gestational Clinical Trial

Official title:

Effect of Maternal Diabetes on Brain Development, as Measured by Neonatal Electroencephalogram (EEG)

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02968628
• Other study ID #: RSRB00061973
• Status: Completed
• Start date: September 1, 2016
• Est. completion date: October 1, 2018

Study information

• Verified date: February 2020
• Source: University of Rochester
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

Alterations in the intrauterine environment can have profound effects on fetal development. Diabetes during gestation results in multiple deleterious short-term outcome differences, and is correlated with long-term developmental deficits. Multiple studies, in neonates through school-aged children, have demonstrated differences in language, attention and psychomotor development in offspring of diabetic pregnancies. Neonatal EEG is a promising and non-invasive tool for assessment of abnormal brain development or "dysmaturity" in this population. Multiple conventional EEG (cEEG) and amplitude-integrated EEG (aEEG) parameters change predictably with advancing gestational development and have been used to differentiate between at risk groups in neonatal studies.

The investigators hypothesize that neonatal EEG can identify brain dysmaturity in infants of diabetic mothers (IDMs) compared to gestational-age matched controls. The primary aim is documentation of brain dysmaturity in IDMs using cEEG. The secondary aim is establishment of aEEG as a more accessible tool to quantify the effects of maternal diabetes on neonatal brain development.

The investigators will conduct a pilot study comparing cEEG and aEEG parameters of cases to gestational-age matched controls. Cases will be IDM neonates of at least 35 weeks' gestation whose mothers were recommended treatment with either insulin or an oral glycemic agent. Video EEG recording will be planned for approximately 60 minutes and obtained between 24 hours and 5 days of life during birth hospitalization. Additional data will be extracted from maternal and neonatal medical records and a maternal questionnaire.

In addition to evaluating the measures of cEEG and aEEG, this project will establish a research cohort. A subsequent study involving developmental evaluations will allow for correlation of EEG results with long-term outcomes. The ability to identify those at risk at birth would provide the opportunity to intervene in order to mitigate outcome differences, particularly in language development. More significantly, we hope to establish neonatal CNS outcome measures for future diabetic pregnancy intervention studies. .

Recruitment information / eligibility

• Status: Completed
• Enrollment: 39
• Est. completion date: October 1, 2018
• Est. primary completion date: October 1, 2018
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: N/A to 120 Hours

Eligibility

Inclusion Criteria:

• >/= 35 weeks post-menstrual age at delivery

• Dating by, or consistent with, 1st trimester ultrasound

• Mother able to communicate in oral and written English

• Available maternal obstetric record and medication history

• Singleton gestation

• Delivery at URMC attended by obstetric staff

Exclusion Criteria:

Maternal Exclusion Criteria:

• Diagnosis by obstetrician of intrauterine growth restriction (IUGR)

• Documentation in medical record of daily maternal cigarette smoking during 2nd or 3rd trimester

• Chronic maternal sedative or opiate use (>weekly use)

• Recreational opiate use or addiction

• Cocaine or amphetamine use during pregnancy

• ETOH abuse or concern for abuse during pregnancy (>weekly use)

• Other maternal conditions that may compromise fetus

• Psychiatric medications beyond isolated SSRI use

• Anti-epileptic drugs (AEDs) during gestation

• Magnesium exposure within 3 days of delivery

Neonatal Exclusion Criteria:

• Blood gas pH of less than 7.1, if obtained (cord or any prior to EEG)

• Apgar less than 8 at 5 min

• CNS malformations, seizures, subgaleal or intracranial bleeds

• Cardiac anomalies except asymptomatic small-moderate VSD, ASD, or PDA

• Clinically significant malformations or chromosomal anomalies

• Small-for-gestational age (<10th % on Fenton growth curve)

• Respiratory distress ever requiring intubation or requiring CPAP support > 48 hours

• Hemodynamic instability requiring use of pressors or >2 bolus

• Culture positive sepsis

• Clinical concern for meningitis or encephalopathy

• Sedation medication or other conditions/medications affecting CNS function

• Clinically obtained total bilirubin more than 15 on day of EEG

• Scalp injury preventing placement of EEG leads

• Point-of-care testing (POCT) glucose <45 at time of EEG

Related Conditions & MeSH terms

• Diabetes in Pregnancy
• Diabetes Mellitus
• Diabetes, Gestational
• Infant, Newborn, Diseases
• Perinatal Disorders of Growth and Development
• Pregnancy in Diabetics

Intervention

Other:
• Video Electroencephalogram (EEG)
Single neonatal video EEG at 24 hrs to 5 days of life during birth hospitalization. Neonatal scalp leads, respiratory and nasal leads. Approximately 60 minute recording.
• Point-of Care Blood Sugar Testing
One-time heel-stick point-of-care blood sugar testing at time of EEG.
• Medical Record Data Extraction
Medical record data extraction from both maternal obstetric and neonatal medical record for variables known to impact EEG and neurodevelopmental outcomes.
• Maternal Questionnaire
One-time maternal questionnaire related to smoking practices, ETOH consumption, level of education, and body mass index.

Locations

Country	Name	City	State
United States	University of Rochester Medical Center	Rochester	New York

Sponsors (1)

Lead Sponsor	Collaborator
University of Rochester

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Maximum Interburst Interval on cEEG		Single EEG between 24 hours of life and 5 days of life
Primary	Lower Margin Amplitude on aEEG		Single EEG between 24 hours of life and 5 days of life
Secondary	Number of Delta Brushes on cEEG		Single EEG between 24 hours of life and 5 days of life
Secondary	Bandwidth on aEEG		Single EEG between 24 hours of life and 5 days of life