{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T15:28:22Z","timestamp":1778858902363,"version":"3.51.4"},"reference-count":20,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,9,26]],"date-time":"2021-09-26T00:00:00Z","timestamp":1632614400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To estimate the causal effects of fasting plasma glucose (FPG) and diagnosis of gestational diabetes (GDM) on birthweight and the risks of large for gestational age (LGA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Regression discontinuity analysis of routine data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Two district general hospitals in West Yorkshire, UK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Population<\/jats:title>\n                    <jats:p>A cohort of 7062 women with singleton pregnancies who were screened for GDM and gave birth to a baby at \u226524\u2009weeks of gestation in 2017\u20132019, inclusive.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The causal effects of FPG and GDM diagnosis were estimated using the two\u2010stage least\u2010squares approach, around the diagnostic threshold of FPG\u2009\u2265\u20095.6\u2009mmol\/l recommended by the UK\u2019s National Institute for Health and Care Excellent (NICE), controlling for ethnicity, maternal age, parity, height and weight.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Birthweight (standardised for sex and gestational age) and large for gestational age (standardised as birthweight above the 90th centile).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>For each 1\u2009mmol\/l increase in FPG the observed birthweight increased by Z\u2010score\u2009=\u20090.48 standard deviations (95%\u2009CI 0.39 to 0.57) and the odds of LGA increased by OR\u2009=\u20092.61 (95%\u2009CI 1.86 to 3.66). Conversely, GDM diagnosis reduced the observed birthweight by Z\u2009=\u2009\u22120.61 (95%\u2009CI \u22120.94 to \u22120.29) and lowered the odds of LGA by OR\u2009=\u20090.33 (95%\u2009CI 0.15 to 0.74). Similar, but less certain, patterns were observed for caesarean section, shoulder dystocia and perinatal death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The relationship between FPG and LGA is potent but is dramatically reduced by GDM diagnosis (and all the consequences thereof). Women with mild hyperglycaemia (with\u2009an FPG of 5.1\u20135.5\u2009mmol\/l) who fall below the current NICE threshold for GDM diagnosis have the highest risks of adverse outcomes, suggesting a need to reconsider their current care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Tweetable abstract<\/jats:title>\n                    <jats:p>Regression discontinuity analysis shows that untreated mild hyperglycaemia increases the odds of large for gestational age, but that a diagnosis of gestational #diabetes lowers the odds by three times.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.16906","type":"journal-article","created":{"date-parts":[[2021,9,12]],"date-time":"2021-09-12T14:46:55Z","timestamp":1631458015000},"page":"82-89","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Fasting plasma glucose, diagnosis of gestational diabetes and the risk of large for gestational age: a regression discontinuity analysis of routine data"],"prefix":"10.1111","volume":"129","author":[{"given":"PWG","family":"Tennant","sequence":"first","affiliation":[{"name":"Leeds Institute for Data Analytics University of Leeds Leeds UK"},{"name":"Faculty of Medicine and Health University of Leeds Leeds UK"},{"name":"Alan Turing Institute London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E","family":"Doxford\u2010Hook","sequence":"additional","affiliation":[{"name":"Calderdale and Huddersfield Foundation Trust Huddersfield UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L","family":"Flynn","sequence":"additional","affiliation":[{"name":"Calderdale and Huddersfield Foundation Trust Huddersfield UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K","family":"Kershaw","sequence":"additional","affiliation":[{"name":"Calderdale and Huddersfield Foundation Trust Huddersfield UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Goddard","sequence":"additional","affiliation":[{"name":"Calderdale and Huddersfield Foundation Trust Huddersfield UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2002-6200","authenticated-orcid":false,"given":"T","family":"Stacey","sequence":"additional","affiliation":[{"name":"Calderdale and Huddersfield Foundation Trust Huddersfield UK"},{"name":"School of Human and Health Sciences University of Huddersfield Huddersfield UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,9,26]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2018.02.023"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.287.19.2534"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc10-0719"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2010.02978.x"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.04.006"},{"key":"e_1_2_7_7_1","volume-title":"Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy","year":"2013"},{"key":"e_1_2_7_8_1","volume-title":"Diabetes in Pregnancy: Management from Preconception to the Postnatal Period","author":"NICE","year":"2015"},{"key":"e_1_2_7_9_1","first-page":"1","article-title":"NIH consensus development conference: diagnosing gestational diabetes mellitus","volume":"29","author":"Vandorsten JP","year":"2013","journal-title":"NIH Cons State\u2010of\u2010the\u2010science Stat"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc11-S011"},{"key":"e_1_2_7_11_1","volume-title":"Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy","author":"WHO","year":"2013"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15659"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.1995.06030168.x"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2017-313452"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/00031305.2016.1154108"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i1216"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-015-3647-z"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2016.07.005"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(15)00255-7"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-016621"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15682"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; 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