Improving understanding of gestational diabetes
We caught up with Dr Sara White [pictured], a clinician scientist who is based in the Department of Women and Children’s Health, KCL, and specialises both academically and clinically in diabetes in pregnancy, to find out more.
How did you come to specialise in diabetes in pregnancy?
As part of my clinical training in Metabolic Medicine (Chemical Pathology) I was initially intrigued by the weight gain experienced by many individuals as a result of pregnancy. This, coupled with my experience of diabetes in clinic as a trainee, led me to undertake a PhD under the supervision of Profs Lucilla Poston and Dharmintra Pasupathy in the Department of Women and Children’s Health. I investigated early pregnancy gestational diabetes (GDM) prediction in obese women, utilising epidemiological and statistical methods for mathematical modelling, and published algorithms for prediction, and metabolic profiles evident in obese women with GDM.
During this time, I was lucky enough to join the diabetes in pregnancy clinical team where I have continued to work regularly since, giving me regular exposure to the areas of practice that would benefit from dedicated research. My current research interests build on this foundation; working together with local, national and international collaborations, I focus on exploring pathophysiological pathways leading to hyperglycaemia in pregnancy and stratification of potential disease subtypes, as well as pragmatic trials identifying ways to improve outcomes in women (and their offspring) at higher metabolic risk before, during and after pregnancy.
Tell us a bit about UNiCoRN and what the study is aiming to achieve
UNiCoRN is an MRC funded prospective cohort study of pregnant women of white and south Asian descent (n=750), being led by KCL with collaborators at the University of Leicester, due to start recruiting in October 2022.
Despite the one-size-fits-all approach to management and risk assessment, evidence is emerging together with our clinical experience, that GDM is a heterogeneous group of disorders, all leading to hyperglycaemia, which might lead to different outcomes (e.g. different risk of adverse outcomes in pregnancy or after pregnancy) and may benefit from stratified treatments. UNiCoRN aims to unpick different types of GDM, particularly focusing on insulin resistance and insulin secretory dysfunction subtypes and will explore whether these differ by ethnicity.
We will be collecting information about each pregnancy, diet and exercise, glucose measures (including continuous glucose monitoring), and timed blood samples during a five-point oral glucose tolerance test, and other biological samples such as urine. We aim to work towards tailored treatment of each woman (regardless of ethnicity) according to their subtype of GDM, and hope that this will also facilitate ways to best prevent Type 2 diabetes after pregnancy.
What are some of the existing challenges in treating gestational diabetes and how might UniCoRN help?
There are multiple challenges at present partly related to the sheer volume of women now developing GDM and passing through our specialised clinic. Each woman is given a binary ‘yes’/’no’ diagnosis of GDM and risk is assigned as a group, rather than with any individual granularity according to individual phenotype.
Although as clinicians we may have a ‘feel’ for women who are more likely to struggle with glycaemia, need insulin, give birth to a large baby, or develop later T2 diabetes for example (perhaps based on age/glucose values at OGTT/BMI/previous GDM), risk assessment is crude. A better biochemical and phenotypic understanding through the prospective collection of multi-faceted data in UNiCoRN should facilitate a targeted personalised approach to GDM.