PT  - JOURNAL ARTICLE
AU  - Louise Freebairn
AU  - Jo-an Atkinson
AU  - Yang Qin
AU  - Christopher J Nolan
AU  - Alison L Kent
AU  - Paul M Kelly
AU  - Luke Penza
AU  - Ante Prodan
AU  - Anahita Safarishahrbijari
AU  - Weicheng Qian
AU  - Louise Maple-Brown
AU  - Roland Dyck
AU  - Allen McLean
AU  - Geoff McDonnell
AU  - Nathaniel D Osgood
ED  - ,
TI  - ‘Turning the tide’ on hyperglycemia in pregnancy: insights from multiscale dynamic simulation modeling
AID  - 10.1136/bmjdrc-2019-000975
DP  - 2020 May 01
TA  - BMJ Open Diabetes Research & Care
PG  - e000975
VI  - 8
IP  - 1
4099  - http://drc.bmj.com/content/8/1/e000975.short
4100  - http://drc.bmj.com/content/8/1/e000975.full
SO  - BMJ Open Diab Res Care2020 May 01; 8
AB  - 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.