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. 2020 May;8(1):e000975.
doi: 10.1136/bmjdrc-2019-000975.

'Turning the tide' on hyperglycemia in pregnancy: insights from multiscale dynamic simulation modeling

Louise Freebairn  1   2   3 , Jo-An Atkinson  4   5 , Yang Qin  6 , Christopher J Nolan  7   8 , Alison L Kent  8   9 , Paul M Kelly  3   8 , Luke Penza  10 , Ante Prodan  10 , Anahita Safarishahrbijari  6 , Weicheng Qian  6 , Louise Maple-Brown  11   12 , Roland Dyck  13 , Allen McLean  6 , Geoff McDonnell  4 , Nathaniel D Osgood  6 ; Diabetes in Pregnancy Modelling Consortium
Collaborators, Affiliations

'Turning the tide' on hyperglycemia in pregnancy: insights from multiscale dynamic simulation modeling

Louise Freebairn et al. BMJ Open Diabetes Res Care. 2020 May.

Abstract

Introduction: Hyperglycemia in pregnancy (HIP, including gestational diabetes and pre-existing type 1 and type 2 diabetes) is increasing, with associated risks to the health of women and their babies. Strategies to manage and prevent this condition are contested. Dynamic simulation models (DSM) can test policy and program scenarios before implementation in the real world. This paper reports the development and use of an advanced DSM exploring the impact of maternal weight status interventions on incidence of HIP.

Methods: A consortium of experts collaboratively developed a hybrid DSM of HIP, comprising system dynamics, agent-based and discrete event model components. The structure and parameterization drew on a range of evidence and data sources. Scenarios comparing population-level and targeted prevention interventions were simulated from 2018 to identify the intervention combination that would deliver the greatest impact.

Results: Population interventions promoting weight loss in early adulthood were found to be effective, reducing the population incidence of HIP by 17.3% by 2030 (baseline ('business as usual' scenario)=16.1%, 95% CI 15.8 to 16.4; population intervention=13.3%, 95% CI 13.0 to 13.6), more than targeted prepregnancy (5.2% reduction; incidence=15.3%, 95% CI 15.0 to 15.6) and interpregnancy (4.2% reduction; incidence=15.5%, 95% CI 15.2 to 15.8) interventions. Combining targeted interventions for high-risk groups with population interventions promoting healthy weight was most effective in reducing HIP incidence (28.8% reduction by 2030; incidence=11.5, 95% CI 11.2 to 11.8). Scenarios exploring the effect of childhood weight status on entry to adulthood demonstrated significant impact in the selected outcome measure for glycemic regulation, insulin sensitivity in the short term and HIP in the long term.

Discussion: Population-level weight reduction interventions will be necessary to 'turn the tide' on HIP. Weight reduction interventions targeting high-risk individuals, while beneficial for those individuals, did not significantly impact forecasted HIP incidence rates. The importance of maintaining interventions promoting healthy weight in childhood was demonstrated.

Keywords: causal modeling; gestational diabetes mellitus; modeling; population health.

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Conflict of interest statement

Competing interests: PMK, LF, CJN and ALK were employees of ACT Health at the time of this study.

Figures

Figure 1
Figure 1
Overview of the participatory model development process.
Figure 2
Figure 2
Overview of model components and structure. DIP, Diabetes in Pregnancy; GDM, Gestational Diabetes Mellitus; IGR, Impaired Glucose Regulation; IGT, Impaired Glucose Tolerance; T1DM, type 1 diabetes mellitus; T2DM, type 2 diabetes mellitus.
Figure 3
Figure 3
Comparative impact of scenarios on HIP incidence simulated from 2018 to 2040. Dotted lines indicate 95% CI for estimated incidence. HIP, hyperglycemia in pregnancy.
See this image and copyright information in PMC

References

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