Gestational diabetes mellitus (GDM) is an illness some women suffer with during pregnancy. It means that whilst they are pregnant the sugar levels in their blood are raised and not properly controlled. Once these women have given birth, the problem usually disappears. Women who have had GDM during pregnancy have a higher risk of developing type 2 diabetes (T2DM), heart disease and stroke.
This study aims to use data collected by GP practices in the UK to investigate progression to T2DM in women who have had GDM in pregnancy. We will also investigate what characteristics increase the risk of developing T2DM in this group of women; such as ethnicity, weight and number of pregnancies, and whether the number of women progressing to T2DM from GDM is increasing over time. In addition we will compare women who had gestational diabetes in pregnancy, with those who did not, to see if they are more likely to go on to have other serious health issues such as a stroke, heart attack or cancer.
The information from this analysis will be used to develop a model that will look at long-term costs and clinical outcomes of women who have had GDM.
Gestational diabetes mellitus (GDM) is a serious complication of pregnancy that affected an estimated 11% of pregnancies in Europe in 2013.[1] Although the condition is usually resolved naturally after birth, women who have previously suffered from GDM have an increased risk of progressing to type 2 diabetes (T2DM) and cardiovascular disease (CVD) in the future.
This work seeks to assess both incidence and risk factors for T2DM, CVD and cancer, after a diagnosis of GDM, in a cohort of women included within the Clinical Practice Research Datalink (CPRD). CPRD data (linked to both HES and ONS) will be used to examine progression rates to T2DM, CVD and cancer. Data will be extracted between 2000 and 2018, on women diagnosed with GDM who have at least 5 years of follow-up. For each case of GDM identified, a time-matched control with no diagnosis of GDM during pregnancy will be selected. The controls will be selected to ensure the pregnancy occurred within a year of the matched case. Further, within the GDM cohort, risk factors for progression to T2DM, CVD and cancer following GDM will be investigated (such as age, ethnicity, and weight), as well as any changes to progression rates from GDM to T2DM, CVD and cancer over time
All of this information, as well as further published information on health care costs, will be used to create a Markov model to assess the long-term health outcomes and cost implications of GDM in a UK population. This project will allow for a greater understanding of current progression rates to T2DM and cardiovascular events in women who have been diagnosed with GDM. Increasing understanding, particularly in terms of risk factors, will enable appropriate interventions to be developed, and for them to be targeted where they are most needed.
Outcomes of interest are T2DM, CVD, and all-cause mortality.
Clare Gillies - Chief Investigator - University of Leicester
Clare Gillies - Corresponding Applicant - University of Leicester
Bee Tan - Collaborator - University of Leicester
Elpida Vounzoulaki - Collaborator - University of Leicester
Kamlesh Khunti - Collaborator - University of Leicester
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation