UK Policy on preventing gestational diabetes (GDM) using diet and physical activity interventions.

Background

Gestational diabetes mellitus (GDM) is a critical pregnancy complication that can be defined as glucose intolerance, with an onset or first recognition during pregnancy (1).

The prevalence of GDM is gradually increasing in the UK, affecting up to 5% of all pregnancies (Infographic). This increase has been witnessed alongside rising obesity levels and physical inactivity, as well as the increase in type 2 diabetes in the general population (2).

GDM has important health implications for both the mother and the offspring. In the short term, GDM is associated with an increased risk of hypertensive disorders of pregnancy, namely preeclampsia and eclampsia. It is also associated with excessive foetal growth, which can, in turn, result in shoulder dystocia, neonatal hypoglycaemia, polycythaemia, birth injuries and emergency caesarean delivery, amongst other complications. In the long term, GDM has been linked to an increased likelihood of type 2 diabetes and cardiovascular diseases in the mother and the offspring. Thus, it is imperative that the condition is managed and where possible, prevented. (3)

While the National Institute of Clinical Excellence (NICE) guidelines have a policy on diagnosing and managing women diagnosed with GDM (4), as well as a separate policy on the prevention of type 2 diabetes (5), there is no explicit policy for the prevention of GDM in the UK.

Lifestyle interventions are fundamental for GDM management and prevention. A large body of research has investigated the efficacy of diet and physical activity interventions designed to prevent GDM (6,7). However, it is still unclear whether policy frameworks are based on all available evidence. Therefore, it is essential to systematically review current UK guidelines for GDM prevention in order to identify novel policies that could be implemented to reduce GDM risk.

Project Aims and Objectives

Our systematic review will address three main research questions: what are the current GDM-prevention policies targeting diet and physical activity in the UK; are these backed by evidence-based data; and which other evidence-based policies and governmental regulations for GDM prevention could be implemented in the UK?

We will systematically screen and extract data from peer-reviewed publications and grey literature sources, evaluate the quality of the evidence used to design GDM-prevention policies using an adapted 'Grading the Strength of Evidence' tool and identify novel, evidence-based recommendations that could be introduced in the UK.

Authors

Researchers:

• Fern Pattinson is a fourth-year medical student at Brighton and Sussex Medical School, with an iBSc in Global Health from the University of Bristol.

• Jennifer Ding is a first-year medical student at Imperial College London.

• Lauren Green is a third year BSc Biology student at Southampton University.

• Radhika Gulati is an incoming F1 in North London from Belfast with a Master’s in Public Health from LSHTM.

• Sarah Goddard is a 5th year medical student at UCL with an iBSc in Global Health.

• Tisha Dasgupta is a Research Assistant at King’s College London, with a BSc. in Genetics and Neuroscience from the University of British Columbia and a MSc. in Public Health from the London School of Hygiene and Tropical Medicine.

Editors:

• Mariam Shwea holds a BSc in Biomedical Science, and an MPH from Imperial College London.

• Sophia Douiri-Beghdad is a Research Analyst with an MSc in Public Policy from UCL and a BA in Political Science and International Relations from the University of Birmingham.

Project Commissioner:

• Dr Shakila Thangaratinam, Professor of Maternal and Perinatal Health at the University of Birmingham, NIHR Senior Investigator and consultant obstetrician at Birmingham Women’s and Children’s NHS Foundation Trust.

References

1. Alfadhli EM. Gestational diabetes mellitus. Saudi Med J. 2015;36(4):399-406.

2. Diabetes UK. Facts and stats. 2016. [accessed 28/05/2021] Available from https://www.diabetes.org.uk/Documents/Position%20statements/DiabetesUK_Facts_Stats_Oct16.pdf

3. Plows JF, Stanley JL, Baker PN, Reynolds CM, Vickers MH. The Pathophysiology of Gestational Diabetes Mellitus. Int J Mol Sci. 2018;19(11).

4. National Institute for Health and Care Excellence (NICE). Diabetes in pregnancy: management from preconception to the postnatal period 2020 [accessed 28/05/2021]. Available from: https://www.nice.org.uk/guidance/ng3.

5. National Institute for Health and Care Excellence (NICE). Type 2 diabetes in adults: management 2020 [accessed 28/05/2021]. Available from: https://www.nice.org.uk/guidance/ng28.

6. Hopkins S, Artal R. The Role of Exercise in Reducing the Risks of Gestational Diabetes Mellitus. Women's Health. 2013;9(6):569-581.

7. Shepherd E, Gomersall JC, Tieu J, Han S, Crowther CA, Middleton P. Combined diet and exercise interventions for preventing gestational diabetes mellitus. Cochrane Database of Systematic Reviews 2017;11(CD010443). DOI: 10.1002/14651858.CD010443.pub3.

This blog post was prepared by members of the Polygeia London Branch.