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Associations between maternal characteristics and pharmaceutical treatment of gestational diabetes: an analysis of the UK Born in Bradford (BiB) cohort study

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posted on 11.03.2022, 16:28 by Gilberte Martine-Edith, Will JohnsonWill Johnson, Eugenie HunsickerEugenie Hunsicker, Mark Hamer, Emily PetherickEmily Petherick
Objectives To identify the maternal characteristics associated with pharmaceutical treatment of gestational diabetes mellitus (GDM).

Design Prospective birth cohort study.

Setting Bradford, UK.

Participants 762 women from the Born in Bradford (BiB) cohort who were treated for GDM in a singleton pregnancy. BiB cohort participants were recruited from 2007 to 2010. All women booked for delivery were screened for GDM between 26 and 28 weeks of gestation using a 75 g 2-hour oral glucose tolerance test (OGTT).

Outcome measure GDM treatment type: lifestyle changes advice (lifestyle changes), lifestyle changes advice with supplementary insulin (insulin) and lifestyle changes advice with supplementary metformin (metformin).

Results 244 (32%) women were prescribed lifestyle changes advice alone while 518 (68%) were offered supplemental pharmaceutical treatment. The odds of receiving pharmaceutical treatment relative to lifestyle changes advice alone were increased for mothers who were obese (OR 4.6, 95% CI 2.8 to 7.5), those who smoked (OR 2.6, 95% CI 1.2 to 5.5) and had higher fasting glucose levels at OGTT (OR 2.1, 95% CI 1.6 to 2.7). The odds of being prescribed pharmaceutical treatment rather than lifestyle changes advice were lower for Pakistani women (OR 0.7, 95% CI 0.4 to 1.0)) than White British women. Relative to insulin treatment, metformin was more likely to be offered to obese women than normal weight women (relative risk ratio, RRR 3.2, 95% CI 1.3 to 7.8) and less likely to be prescribed to women with higher fasting glucose concentrations at OGTT (RRR 0.3, 95% CI 0.2 to 0.6).

Conclusions In the BiB cohort, GDM pharmaceutical treatment tended to be prescribed to women who were obese, White British, who smoked and had more severe hyperglycaemia. The characteristics of metformin-treated mothers differed from those of insulin-treated mothers as they were more likely to be obese but had lower glucose concentrations at diagnosis.

Funding

Loughborough University

National Institute for Health Research (NIHR) Leicester Biomedical Research Centre

Body size trajectories and cardio-metabolic resilience to obesity in three United Kingdom birth cohorts

Medical Research Council

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Wellcome Trust infrastructure grant (WT101597MA)

National Institute for Health Research under its Collaboration for Applied Health Research and Care (CLAHRC) (IS-CLA-0113–10020)

History

School

  • Science
  • Sport, Exercise and Health Sciences

Department

  • Mathematical Sciences

Published in

BMJ Open

Volume

11

Issue

11

Publisher

BMJ Publishing Group

Version

VoR (Version of Record)

Rights holder

© The Authors

Publisher statement

This is an Open Access Article. It is published by BMJ Publishing Group under the Creative Commons Attribution 4.0 International Licence (CC BY 4.0). Full details of this licence are available at: https://creativecommons.org/licenses/by/4.0/

Acceptance date

14/09/2021

Publication date

2021-11-03

Copyright date

2021

ISSN

2044-6055

eISSN

2044-6055

Language

en

Depositor

Dr Emily Petherick. Deposit date: 11 March 2022

Article number

e053753