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Am J Perinatol
DOI: 10.1055/a-2490-3118
Review Article

A Queen City Legacy: 45 Years of Research in Pregnant Women with Insulin-Dependent Diabetes Mellitus, The Diabetes in Pregnancy Program Project Grant

Jane C. Khoury   *
1   Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
2   Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
3   Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
,
Menachem Miodovnik   *
4   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Inova Health System, Fairfax, Virginia
,
Francis B. Mimouni
5   Department of Pediatrics and Research Institute, Leumit Health Services, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
,
Shelley Ehrlich
1   Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
2   Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
6   Department of Environmental and Public Health Sciences, University of Cincinnati, College of Medicine, Cincinnati, Ohio
,
Rhonda Szcznesiak
1   Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
2   Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
,
Barak Rosenn
7   Department of Obstetrics and Gynecology, Jersey City Medical Center, West New York, New Jersey
› Author Affiliations
Funding The studies described were supported in part by the Diabetes in Pregnancy Program Project Grant (HD11725) funded from 1978 to 1993 by the U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Child Health and Human Development, and in part by The TEAM Study funded from 2016 to 2022 by National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK109956).
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Abstract

The Diabetes in Pregnancy Program Project Grant (PPG) was a 15-year program focused on enhancing the care for women with insulin-dependent diabetes mellitus (IDDM) during pregnancy and improving the well-being of their offspring. Launched in July 1978 at the University of Cincinnati, the PPG pursued a multifaceted research agenda encompassing basic science, animal and placental studies, and maternal and neonatal clinical trials to understand the physiological and pathophysiological aspects of IDDM during pregnancy. A total of 402 singleton pregnancies in 259 women with IDDM were enrolled prior to 10 weeks gestation over the 15-year period. Of the 402 pregnancies, there were 295 live births, 1 stillbirth, 4 neonatal deaths, and 15 infants were born with major congenital malformations. Central to the program's methodology was the management of diabetes during pregnancy, involving intensive insulin therapy and meticulous monitoring using the cutting-edge technology of the time to achieve glycemic control. The extensive research of the PPG yielded profound insights into the effects of maternal diabetes on embryonic and fetal development and neonatal health. Through animal studies, notably using pregnant sheep, the program clarified the mechanisms of fetal hypoxia and metabolic disorders. Clinical trials underscored the significance of early glycemic control in mitigating the risks of spontaneous abortions, congenital malformations, and neonatal complications. The program also examined the influence of pregnancy on the progression of microvascular diseases, the role of maternal weight and weight gain in pregnancy outcomes, and the distinctive growth patterns of fetuses in IDDM pregnancies. Furthermore, the PPG probed the incidence and underlying mechanisms of hypoglycemia during pregnancy and the heightened risk of obstetric complications in IDDM patients. Our findings established a foundation of knowledge to aid clinicians, researchers, and health care providers in best practices and ensure a lasting impact on the care of pregnant women with pregestational diabetes.

Key Points

  • Prepregnancy management reduces maternal, fetal, and neonatal complications in IDDM.

  • Strict glycemic control improves many pregnancy outcomes in IDDM.

  • Fetal glycemic exposure may have lifelong effects.

Keywords

diabetes in pregnancy - Program Project Grant - insulin-dependent diabetes mellitus - glycemic control - maternal complications - neonatal complications

Ethical Approval

All studies were approved by the Investigational Review Board at the University of Cincinnati, and where applicable, by the Investigational Review Board at Cincinnati Children's Hospital Medical Center.


* These are co-first authors.




Publication History

Received: 24 July 2024

Accepted: 26 November 2024

Article published online:
24 December 2024

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