Exploring the Long-term Outcomes following a PrEgnancy with gestational diabetes mellitus (ELOPE-GDM) – patterns of health service use and lifelong costs
Gestational diabetes mellitus (GDM) is defined as glucose intolerance with onset during pregnancy and resolving after birth. GDM is usually diagnosed by an oral glucose tolerance test (OGTT) at approximately 24-28 weeks gestation. A diagnosis of GDM is made in those who meet a predefined diagnostic threshold, with women diagnosed with GDM typically offered lifestyle advice and encouraged to self-monitor their blood glucose to manage hyperglycemia. GDM is known to be associated with an increased risk of adverse outcomes for mother and her infant during pregnancy and birth, including greater risk of caesarean or assisted delivery, having a large for gestational age (LGA) infant (>4.5kg), shoulder dystocia, pre-eclampsia and also the rare the risk of stillbirth is greater in women with a history of GDM. Furthermore women who get GDM are at substantially greater risk of developing type 2 diabetes, hypertension and ischaemic heart disease compared with women who do not develop GDM during pregnancy.
Despite this evidence of elevated risk of disease, the healthcare usage and costs of caring for GDM women (beyond pregnancy) are not known. In this project we aim to quantify these evidence gaps through the healthcare costs associated with women who receive a diagnosis of GDM during pregnancy. We intend to use the Clinical Practice Research Datalink (CPRD), which provides anonymised patient data from a network of GP practices across the UK. The data encompasses 60 million patients, including 16 million currently registered patients. Our study aims to link CPRD data with Hospital Episode Statistics to determine the number and type of consultations, prescriptions, diagnostic tests and treatments for all women who had at least one singleton pregnancy resulting in a delivery between 2010 and 2021. We will use national reference costs to attribute costs to each type of resource.