‘Turning the tide’ on hyperglycemia in pregnancy: insights from multiscale dynamic simulation modeling

作者：Louise Freebairn, Jo-an Atkinson, Yang Qin, Christopher J. Nolan, Alison L. Kent, Paul Kelly, Luke Penza, Ante Prodan, Anahita Safarishahrbijari, Weicheng Qian, Louise Maple‐Brown, Roland Dyck, Allen McLean, Geoff McDonnell, Nathaniel Osgood · 发表于：BMJ Open Diabetes Research & Care · 年份：2020 · DOI：10.1136/bmjdrc-2019-000975 · 被引用次数：11 · 研究领域：Gestational Diabetes Research and Management、Diabetes Management and Research、Complex Systems and Decision Making

INTRODUCTION: Hyperglycemia in pregnancy (HIP, including gestational diabetes and pre-existing type 1 and type 2 diabetes) is increasing, with associated risks to the health of women and their babies. Strategies to manage and prevent this condition are contested. Dynamic simulation models (DSM) can test policy and program scenarios before implementation in the real world. This paper reports the development and use of an advanced DSM exploring the impact of maternal weight status interventions on incidence of HIP. METHODS: A consortium of experts collaboratively developed a hybrid DSM of HIP, comprising system dynamics, agent-based and discrete event model components. The structure and parameterization drew on a range of evidence and data sources. Scenarios comparing population-level and targeted prevention interventions were simulated from 2018 to identify the intervention combination that would deliver the greatest impact. RESULTS: Population interventions promoting weight loss in early adulthood were found to be effective, reducing the population incidence of HIP by 17.3% by 2030 (baseline ('business as usual' scenario)=16.1%, 95% CI 15.8 to 16.4; population intervention=13.3%, 95% CI 13.0 to 13.6), more than targeted prepregnancy (5.2% reduction; incidence=15.3%, 95% CI 15.0 to 15.6) and interpregnancy (4.2% reduction; incidence=15.5%, 95% CI 15.2 to 15.8) interventions. Combining targeted interventions for high-risk groups with population interventions promoting healthy w...