Tennant, P.W.G. orcid.org/0000-0003-1555-069X, Doxford‐Hook, E., Flynn, L. et al. (3 more authors) (2022) Fasting plasma glucose, diagnosis of gestational diabetes and the risk of large for gestational age: a regression discontinuity analysis of routine data. BJOG: An International Journal of Obstetrics & Gynaecology, 129 (1). pp. 82-89. ISSN 1470-0328
Abstract
Objective: To estimate the causal effects of fasting plasma glucose (FPG) and diagnosis of gestational diabetes (GDM) on birthweight and the risks of large for gestational age (LGA). Design: Regression discontinuity analysis of routine data. Setting: Two district general hospitals in West Yorkshire, UK. Population: A cohort of 7062 women with singleton pregnancies who were screened for GDM and gave birth to a baby at ≥24 weeks of gestation in 2017–2019, inclusive. Methods: The causal effects of FPG and GDM diagnosis were estimated using the two-stage least-squares approach, around the diagnostic threshold of FPG ≥ 5.6 mmol/l recommended by the UK’s National Institute for Health and Care Excellent (NICE), controlling for ethnicity, maternal age, parity, height and weight. Main outcome measures: Birthweight (standardised for sex and gestational age) and large for gestational age (standardised as birthweight above the 90th centile). Results: For each 1 mmol/l increase in FPG the observed birthweight increased by Z-score = 0.48 standard deviations (95% CI 0.39 to 0.57) and the odds of LGA increased by OR = 2.61 (95% CI 1.86 to 3.66). Conversely, GDM diagnosis reduced the observed birthweight by Z = −0.61 (95% CI −0.94 to −0.29) and lowered the odds of LGA by OR = 0.33 (95% CI 0.15 to 0.74). Similar, but less certain, patterns were observed for caesarean section, shoulder dystocia and perinatal death. Conclusions: The relationship between FPG and LGA is potent but is dramatically reduced by GDM diagnosis (and all the consequences thereof). Women with mild hyperglycaemia (with an FPG of 5.1–5.5 mmol/l) who fall below the current NICE threshold for GDM diagnosis have the highest risks of adverse outcomes, suggesting a need to reconsider their current care. Tweetable abstract: Regression discontinuity analysis shows that untreated mild hyperglycaemia increases the odds of large for gestational age, but that a diagnosis of gestational #diabetes lowers the odds by three times.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. |
Keywords: | Birthweight; diabetes; large for gestational age; natural experiment; regression discontinuity design |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) > Clinical & Population Science Dept (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Healthcare (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 18 Jul 2023 10:17 |
Last Modified: | 18 Jul 2023 10:17 |
Status: | Published |
Publisher: | Wiley |
Identification Number: | 10.1111/1471-0528.16906 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:201639 |