Relationships between gestational diabetes subtypes and fetal growth and adiposity

Gestational diabetes (GDM), defined by new onset hyperglycaemia in pregnancy, affects ~14% of pregnancies worldwide, and the prevalence is increasing.

Short term impact includes increased fetal growth and associated complications through labour and birth, increased admission to the neonatal unit and an increase in caesarean section.

The description of GDM as ‘new hyperglycaemia in pregnancy’ and a yes/no binary diagnosis of GDM suggests homogeneity, reinforcing the dogma that hyperglycaemia reflects a single pathological entity.

This ‘one size fits all’ approach to screening, diagnosis, management and short and long-term maternal and neonatal risk is increasingly viewed as naïve, and poorly reflects the diversity seen in clinical settings.

Recent descriptions of 'subtypes' of GDM with distinct pathophysiological pathways to hyperglycaemia has led to a concerted effort to better describe differences in order to personalise treatment approaches.

This studentship is embedded within a unique research study (UNiCoRN) designed to characterise two different subtypes of GDM in women of White and South Asian ethnicity, and will use routine and specialised fetal ultrasound scanning to explore the effect of GDM subtypes on longitudinal fetal growth and fetal adiposity, with the ultimate aim of promoting precision management of GDM according to subtype.