Transforming gestational diabetes management in Scotland to optimise outcomes for mothers and children
Principle Investigator (lead Institution) – Professor Rebecca Reynolds (University of Edinburgh)
Collaborating institutions – University of Glasgow
Funding amount – £999, 997
Lay Summary
Gestational diabetes (GDM), or high blood sugar (glucose) levels first detected in pregnancy, is the most common complication during pregnancy. Rates of GDM are increasing due to factors such as maternal obesity and advanced age. GDM poses significant risks to both mothers and babies, including adverse outcomes during childbirth and future health problems such as obesity, type 2 diabetes, and heart disease. Many women[1] with GDM come from minority ethnic backgrounds and deprived areas, which are additional risk factors for poor pregnancy outcomes. This research programme aims to improve the management of GDM, aligning with the Scottish Government Women’s Health Plan and addressing health inequalities.
The COVID-19 pandemic disrupted GDM care pathways, as pregnant women were considered a vulnerable group. A new National Guideline was implemented to reduce hospital attendance and minimize viral exposure during pregnancy. This included changes to GDM screening, diagnosis, and virtual review of blood sugar levels. Our review of 9000 GDM cases in the UK showed that outcomes for women managed with the new guideline during the pandemic were similar to those managed according to previous guidelines. This suggests we should re-examine GDM management pathways and consider new innovative approaches.
There are several reasons why this research is important and timely. Some health boards in Scotland are struggling to reintroduce GDM screening and diagnostic tests, and a significant number of those at risk fail to attend for screening, leading to untreated diabetes in pregnancy and associated complications. The lack of GDM screening for all pregnant women also means missed opportunities to provide essential diet and lifestyle advice to those who are overweight. Screening for type 2 diabetes after pregnancy is alarmingly low, despite the increased risk following GDM, which hinders heart disease risk assessment and prevention. New diagnostic approaches for glucose testing at home may be better for post-partum follow-up. Scotland’s excellent data systems and digital platforms can be used to record and monitor GDM cases, allowing for reporting of short- and long-term outcomes.
Our proposed research aims to improve clinical pathways for GDM screening and diagnosis, leading to consistent and effective care for pregnant women in Scotland. This will contribute to improved heart health for mothers and their children, addressing long-term complications associated with GDM. Our proposed research programme consists of inter-linked work packages, including a Scotland-wide GDM
audit to find out how many women have GDM and to improve data collection and care quality, pilot studies to test screening, education, self-management and follow-up interventions, and engagement with patients and stakeholders to ensure their voices and experiences are included in maternity care design and delivery. We offer a comprehensive, rigorous, and nuanced understanding of the best management of GDM. Our proposed work will advance scientific understanding, facilitate evidence-based decision-making, and ultimately improve outcomes for mothers and babies affected by GDM.
[1] We use the term woman/women throughout to refer to women and birthing people who are pregnant or who recently gave birth. It refers to people who share the protected characteristic of pregnancy and maternity.