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.
- gestational diabetes mellitus
- causal modeling
- population health
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Collaborators Diabetes in Pregnancy Modelling Consortium includes the authors of this paper and Dr Tracey Baker, Ms Lynelle Boisseau, Ms Jacqui Davison, Assoc. Prof. Jeff Flack, Assoc. Prof. Alison Hayes, Ms Eloise O’Donnell, Prof. Michael Peek, Mr Nick Roberts, Prof. David Simmons, Dr Jana Sisnowski, and Ms Christine Whittall.
Contributors Study conceptualization and planning: LF, JA, GM, NDO, CJN, ALK and PMK. Model and scenario programming: NDO, WQ, YQ, AS and AM. Supervision of model programming: NDO. Expert contribution to model development: CJN, ALK, LM-B, RD and members of the Diabetes in Pregnancy Modelling Consortium. Model outputs: YQ. Data processing and analysis: LP, LF and AP. Conceptualization of manuscript and writing the first drafts: LF. Writing and editing multiple draft revisions: all named authors.
Funding This research was supported by The Australian Prevention Partnership Centre through the NHMRC partnership center grant scheme (grant ID: GNT9100001) with the Australian Government Department of Health, NSW Ministry of Health, ACT Health, HCF, and the HCF Research Foundation. The research was also supported by the Australian Government’s Medical Research Future Fund (MRFF). The MRFF provides funding to support health and medical research and innovation, with the objective of improving the health and well-being of Australians. MRFF funding has been provided to The Australian Prevention Partnership Centre under the MRFF Boosting Preventive Health Research Program. Further information on the MRFF is available at www.health.gov.au/mrff. The content of this paper is solely the responsibility of the individual authors and does not reflect the views of the NHMRC or funding partners. LM-B was supported by an NHMRC Practitioner Fellowship (#1078477) to collaborate on this project. The University of Notre Dame has provided the following financial support for this case study: Australian Postgraduate Award scholarship and CRN top-up scholarship for supervision travel expenses.
Competing interests PMK, LF, CJN and ALK were employees of ACT Health at the time of this study.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.
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