Diabetes in pregnancy - understanding the role of intensified treatment, social inequalities, and co-creation of care strategies to improve maternal and infant outcomes

Research problem and specific questionsType-2 diabetes (T2DM) and gestational diabetes (GDM) prevalence are increasing in Sweden.

Effective disease management and interventions during pregnancy could improve pregnancy outcomes and long-term health of the mother and child.This project consists of two parts; one epidemiological, and the other implementation.

The epidemiological part will use contemporary cohorts to understand pregnancy outcomes in women with T2DM/GDM, in relation to disease management.

Specifically, we will:Investigate the modifying effect of intensified medical surveillance and treatment – glucose control and medication.Quantify whether these associations are socially (region of birth, socioeconomic position) and BMI patterned.For the implementation part, we will explore:Barriers/facilitators for providing optimal care and self-managing diabetes during pregnancy and postnatally.Whether a co-creational process - involving health care professionals and women with T2DM/GDM - can lead to improved strategies to support person-centred care, shared decision making, and self-management of T2DM/GDM during pregnancy.Data and methodsSingleton births in the Medical Birth Register from 2003-2020 (N=2,070,000) and the Pregnancy Register from 2016-2022 (N=380,000) will be linked to quality (diabetes and neonatal) and national health registers.

Regression analysis will be used to estimate the association between T2DM and GDM and maternal/infant outcomes, modified by glucose levels, treatment, BMI and social factors.The implementation part uses a multiple methods approach; focus group discussions (FGD) and individual interviews with women with T2DM/GDM and health care professionals - to explore barriers/facilitators for optimal care; and participatory action research (PAR) to co-create strategies for improved self-care.Societal relevance and utilizationEven though pregnancy is a unique opportunity for interventions targeted towards lifestyle modifications, the barriers and obstacles need to be explored.

This would positively influence maternal and infant health in the short-term, reducing the likelihood of diabetes in subsequent pregnancies and later life.Plan for project realisationThe project will be conducted at the Clinical Epidemiology Division (Department of Medicine, Solna, Karolinska Institutet) and Karolinska University Hospital.

Project costs include salaries (PhD student, researchers, biostatistician, data manager) and acquiring register data.