Gestational diabetes (GDM) defined by new onset hyperglycaemia in pregnancy is associated with short and long-term maternal and offspring morbidity, affects ~14% of pregnancies worldwide and prevalence is increasing. The yes/no diagnosis at 24-28 weeks’ gestation suggests homogeneity, reinforcing the dogma of a single pathological entity. This is discordant with the observed clinical diversity, including variation in time of onset, hyperglycaemic patterns and treatment response. Better understanding of the biological pathways that distinguish GDM subgroups will facilitate a personalised approach to management.
This project, using data collected as part of the MRC-funded UNiCoRN Study (Understanding the causes of Hyperglycaemia in Pregnancy; MR/W003740/1) will explore pathophysiologically distinct subgroups leading to hyperglycaemia in a cohort comprising women of White and South Asian descent. Disease subtypes will be elucidated through integration of maternal and clinical data and targeted hormonal profiles captured at oral glucose tolerance tests in early and mid-pregnancy. A breadth of training spanning biostatistical analysis and precision medicine will be offered. This study will lay the foundation for targeted therapy for GDM leading to improved outcomes for mother and child.
Principal Objectives will include:
1. Identification of factors (clinical/biochemical) that distinguish between subtypes of GDM at 24-28 weeks’ gestation to facilitate targeted management.
2. Identification of factors (clinical/biochemical) in early pregnancy associated with GDM subtypes to facilitate earlier targeted intervention.
3. Exploration of distributions of GDM subtypes across White and South Asian groups.
Overarching objectives:
1. Years 1 and 2: specific PhD training in biostatistics, epidemiology and other targeted data courses. Training and involvement in UNiCoRN study procedures. Towards the middle of year 2 which should coincide with completion of recruitment, collation, cleaning, and understanding of the breadth of data prior to analyses.
2. Year 3: Hypothesis-driven specific analyses as detailed in principal objectives, preparation of manuscripts and thesis completion.