Study Explores Future Research Priorities in Diabetes and Pregnancy Relationship

Göher Ayman, PhD

The risk of pregnancy complications from either pre-existing or gestational diabetes affects approximately 1 in 10 women, while rates also increase due to obesity and pregnancy at a later age.

Data show the risk is 2 to 6 times greater compared to the population without diabetes, with adverse outcomes including congenital anomalies, still birth, preterm birth, and infant death within the first month of life.

Investigators, led by Göher Ayman, PhD of the National Perinatal Epidemiology Unit at the University of Oxford, established a Priority Setting Partnership (PSP) to prioritize women’s health and pregnancy, particularly for future research in diabetes and pregnancy.

The team used the James Lind Alliance (JLA), an initiative based in the UK, to identify research questions that matter most to this subset of patients and healthcare professionals and align funding towards the prioritized needs.

Study

Ayman and team established a PSP between the University of Oxford, Diabetes UK, Diabetes Research and Wellness Foundation, JDRF charity, and JLA.

Women with experience of pregnancy or planning pregnancy, with any type of diabetes, as well as healthcare professionals were invited by investigators in an open survey from June – November 2019.

The participants were asked to suggest 3 questions about any time before, during, and after pregnancy with diabetes, with an intentionally broad scope to reflect public need.

Investigators categorized responses from underrepresented groups, including direct outreach in diabetes and pregnancy clinics and support groups. They also noted outreach efforts were made to address health inequalities in ethnic minorities.

The data was analyzed and grouped into categories, with some questions mapped into 2 or more categories to retain the integrity of the original submission.

Investigators used databases, including the Cochrane Database of Systemic Review, to find evidence of substantial uncertainty for each question. If the list of indicative question had sufficient evidence already available, the phrasing was amended to show the remaining uncertainty.

A second survey from May to July 2020 asked participants to choose up to 10 questions they felt were most important to answer. Investigators then tailed the points for each question, separating the point totals by women, support networks and healthcare professionals.

A final process included a JLA workshop with 25 participants in 4 groups, leading discussions and ranking to agree on the top 10 most important questions for future research.

Results

The original survey had total of 466 responses, with 64% women and support networks, 32% healthcare professionals and 4% who did not answer.

In the survey, participants suggested 1161 questions, with the long-term effects of diabetes in pregnancy on the child being the most frequently asked (20.1%).

The second survey aggregated a total of 60 questions, with 614 responses (20% healthcare professionals). The top questions included long-term effects of diabetes in pregnancy on the child’s general health in women/support groups, and the use of technology for healthcare professionals.

Out of these, 18 questions were then shortlisted for the workshop, which were narrowed down to 10 questions after the workshop concluded.

Investigators found the top 10 areas that needed the most research included:

• diabetes technology at any stage pre- to post-pregnancy
• the best test for diabetes during pregnancy
• diet and lifestyle Interventions for diabetes management during pregnancy
• emotional and wellbeing needs of women with diabetes pre- to post-pregnancy
• safe birth at full-term
• postnatal care and support needs of women
• diagnosis and management late in pregnancy
• prevention of other types of diabetes in women with gestational diabetes
• women’s labor and birth experiences and choices
• improving planning for pregnancy

Conclusion

Investigators concluded the study can inform future research on evidence gaps of need and impact in the concerns of diabetes and pregnancy.

The team also noted that risks to child’s health was the top concern in the US and Canada exercises, but it did not make the top 10 question list. However, they still consider it a highly important topic for a separate study.

“Further research is needed to provide evidence-based health care for women, with or at risk of diabetes complications, who are planning pregnancy or are pregnant, to ensure the best outcomes for them and their children in the short and long-term,” investigators wrote.

The study, “The top ten research priorities in diabetes and pregnancy according to women, support networks and healthcare professionals,” was published online in Diabetic Medicine.