{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T18:30:04Z","timestamp":1774377004370,"version":"3.50.1"},"reference-count":42,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2024,12,25]],"date-time":"2024-12-25T00:00:00Z","timestamp":1735084800000},"content-version":"unspecified","delay-in-days":24,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009287","name":"NSW Health","doi-asserted-by":"publisher","award":["Prevention Research Support Program"],"award-info":[{"award-number":["Prevention Research Support Program"]}],"id":[{"id":"10.13039\/501100009287","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1186572"],"award-info":[{"award-number":["1186572"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,11,18]]},"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>The incidence of gestational diabetes mellitus (GDM) in Australia has tripled in the last 20 years. Consequently, over 40\u2009000 pregnancies are now diagnosed as \u2018higher risk\u2019 each year. This has increased antenatal surveillance and obstetric intervention, often in the form of delivery earlier than 39 weeks gestation. The StUdy of Gestational diabetes And Risk using Electronic Data (SUGARED) project aims to use large population-based and routinely collected linked health data to (1) personalise risk prediction of adverse pregnancy outcomes for women undergoing glucose tolerance testing, (2) guide optimal birth timing for women with diet-controlled GDM and (3) examine variation in GDM management and pregnancy outcomes in New South Wales (NSW), Australia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and analysis<\/jats:title><jats:p>This retrospective cohort study using linked, routinely collected health data includes all women who gave birth from January 2016 to December 2020 in NSW. The cohort will include approximately 475\u2009000 pregnancies, with &gt;70\u2009000 diagnosed with GDM. The study will link birth data to hospital data and birth\/death registry data. In addition, clinical pathology results and detailed clinical information from a subset of public hospital pregnancies in 13 of 15 area health services will be linked. To address the three main aims, we will use statistical methods including logistic regression and K-fold cross-validation for risk prediction, a propensity-score matching \u2018target trial\u2019 method to examine birth timing, and multilevel modelling to examine hospital variation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Ethics and dissemination<\/jats:title><jats:p>Ethics approval for the study has been granted by the NSW Population and Health Services Research Ethics Committee. We will communicate evidence generated from SUGARED to the local health districts and their clinicians, as well as potentially optimising dissemination using existing digital infrastructure.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2024-087248","type":"journal-article","created":{"date-parts":[[2024,12,26]],"date-time":"2024-12-26T12:50:52Z","timestamp":1735217452000},"page":"e087248","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["StUdy of Gestational diabetes And Risk using Electronic Data (SUGARED): a population-based cohort study\u2014study protocol"],"prefix":"10.1136","volume":"14","author":[{"given":"Deborah","family":"Randall","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6024-2958","authenticated-orcid":false,"given":"Ibinabo","family":"Ibiebele","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanya","family":"Nippita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0795-669X","authenticated-orcid":false,"given":"Siranda","family":"Torvaldsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan M","family":"Morris","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felicity","family":"Gallimore","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tessa L","family":"Weir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9317-1348","authenticated-orcid":false,"given":"Sarah","family":"Glastras","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,12,26]]},"reference":[{"key":"2024122604501472000_14.12.e087248.1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-011-2150-4"},{"key":"2024122604501472000_14.12.e087248.2","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1080\/17446651.2018.1476135","article-title":"Gestational diabetes risk factors and long-term consequences for both mother and offspring: a literature review","volume":"14","author":"Farahvar","year":"2019","journal-title":"Expert Rev Endocrinol Metab"},{"key":"2024122604501472000_14.12.e087248.3","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph17249387","article-title":"A Review of the Current Status of Gestational Diabetes Mellitus in Australia-The Clinical Impact of Changing Population Demographics and Diagnostic Criteria on Prevalence","volume":"17","author":"Laurie","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"2024122604501472000_14.12.e087248.4","unstructured":"Australian Institute of Health and Welfare . Diabetes: web report. Contract no.: CVD 82. Canberra, Australia AIHW; 2020."},{"key":"2024122604501472000_14.12.e087248.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0707943"},{"key":"2024122604501472000_14.12.e087248.6","doi-asserted-by":"crossref","first-page":"338","DOI":"10.5694\/j.1326-5377.2011.tb03001.x","article-title":"The impact of potential new diagnostic criteria on the prevalence of gestational diabetes mellitus in Australia","volume":"194","author":"Moses","year":"2011","journal-title":"Med J Aust"},{"key":"2024122604501472000_14.12.e087248.7","doi-asserted-by":"crossref","DOI":"10.1136\/bmjdrc-2021-002277","article-title":"Are newly introduced criteria for the diagnosis of gestational diabetes mellitus associated with improved pregnancy outcomes and\/or increased interventions in New South Wales, Australia? A population-based data linkage study","volume":"9","author":"Randall","year":"2021","journal-title":"BMJ Open Diabetes Res Care"},{"key":"2024122604501472000_14.12.e087248.8","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182255999"},{"key":"2024122604501472000_14.12.e087248.9","doi-asserted-by":"crossref","first-page":"113","DOI":"10.5694\/mja2.51388","article-title":"A large trial of screening for gestational diabetes mellitus in the United States highlights the need to revisit the Australian diagnostic criteria","volume":"216","author":"Doust","year":"2022","journal-title":"Med J Aust"},{"key":"2024122604501472000_14.12.e087248.10","first-page":"278","article-title":"CRITERIA FOR THE ORAL GLUCOSE TOLERANCE TEST IN PREGNANCY","volume":"13","author":"O\u2019Sullivan","year":"1964","journal-title":"Diabetes"},{"key":"2024122604501472000_14.12.e087248.11","doi-asserted-by":"publisher","DOI":"10.2337\/dc09-1848"},{"key":"2024122604501472000_14.12.e087248.12","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1111\/ajo.12457","article-title":"Survey on testing for gestational diabetes mellitus in Australia","volume":"56","author":"Flack","year":"2016","journal-title":"Aust NZ J Obst Gynaeco"},{"key":"2024122604501472000_14.12.e087248.13","unstructured":"World Health Organization . Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Contract No.: WHO\/NMH\/MND\/13.2. WHO; 2013."},{"key":"2024122604501472000_14.12.e087248.14","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1111\/jog.13544","article-title":"Impact of new diagnostic criteria for gestational diabetes","volume":"44","author":"Sexton","year":"2018","journal-title":"J Obstet Gynaecol Res"},{"key":"2024122604501472000_14.12.e087248.15","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-023293","article-title":"Implications of the introduction of new criteria for the diagnosis of gestational diabetes: a health outcome and cost of care analysis","volume":"9","author":"Cade","year":"2019","journal-title":"BMJ Open"},{"key":"2024122604501472000_14.12.e087248.16","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2204091"},{"key":"2024122604501472000_14.12.e087248.17","unstructured":"National Institute for Health and Care Excellence . Diabetes in pregnancy: management from preconception to the postnatal period. 2015. Available: https:\/\/www.nice.org.uk\/guidance\/ng3\/chapter\/1-Recommendations#antenatal-care-for-women-with-diabetes-2"},{"key":"2024122604501472000_14.12.e087248.18","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002501"},{"key":"2024122604501472000_14.12.e087248.19","unstructured":"Queensland Health . Queensland clinical guidelines. Gestational diabetes mellitus (GDM). Queensland, Australia Queensland Health; 2021."},{"key":"2024122604501472000_14.12.e087248.20","unstructured":"SA Health . South Australian perinatal practice guideline. Diabetes mellitus and gestational diabetes. South Australia, Australia SA Health; 2019."},{"key":"2024122604501472000_14.12.e087248.21","unstructured":"Centre for health record linkage. 2017. Available: http:\/\/www.cherel.org.au"},{"key":"2024122604501472000_14.12.e087248.22","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-842X.2002.tb00682.x"},{"key":"2024122604501472000_14.12.e087248.23","unstructured":"Centre for Health Record Linkage (CHeReL) . Quality assurance. 2022. Available: http:\/\/www.cherel.org.au\/quality-assurance [Accessed 05 Oct 2022]."},{"key":"2024122604501472000_14.12.e087248.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2008.03.001"},{"key":"2024122604501472000_14.12.e087248.25","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1002\/bimj.4710300805","article-title":"Goodness\u2010of\u2010Fit Testing for the Logistic Regression Model when the Estimated Probabilities are Small","volume":"30","author":"Hosmer","year":"1988","journal-title":"Biometrical J"},{"key":"2024122604501472000_14.12.e087248.26","first-page":"S83","article-title":"Sensitivity, specificity, receiver-operating characteristic (ROC) curves and likelihood ratios: communicating the performance of diagnostic tests","volume":"29 Suppl 1","author":"Florkowski","year":"2008","journal-title":"Clin Biochem Rev"},{"key":"2024122604501472000_14.12.e087248.27","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2022-071108","article-title":"Target trial emulation: applying principles of randomised trials to observational studies","volume":"378","author":"Matthews","year":"2022","journal-title":"BMJ"},{"key":"2024122604501472000_14.12.e087248.28","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2004.029454"},{"key":"2024122604501472000_14.12.e087248.29","unstructured":"Snijders T , Bosker R . Multivariate Multilevel Models. Multilevel Analysis: An Introduction to Basic and Advanced Multilevel Modeling. 2nd edn. London: SAGE Publications Ltd, 2012:282\u20138."},{"key":"2024122604501472000_14.12.e087248.30","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/155.2.176"},{"key":"2024122604501472000_14.12.e087248.31","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwv254"},{"key":"2024122604501472000_14.12.e087248.32","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwx348"},{"key":"2024122604501472000_14.12.e087248.33","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2021.01.008"},{"key":"2024122604501472000_14.12.e087248.34","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1177\/1094428117703686","article-title":"Multiple Imputation of Missing Data for Multilevel Models: Simulations and Recommendations","volume":"21","author":"Grund","year":"2018","journal-title":"Org Res Methods"},{"key":"2024122604501472000_14.12.e087248.35","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e31821d2b1d"},{"key":"2024122604501472000_14.12.e087248.36","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3016.2008.00980.x"},{"key":"2024122604501472000_14.12.e087248.37","first-page":"97","article-title":"Validation Study: NSW Midwives Data Collection 1998","volume":"9","year":"1998","journal-title":"NSW Mothers and Babies"},{"key":"2024122604501472000_14.12.e087248.38","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e318178eae4"},{"key":"2024122604501472000_14.12.e087248.39","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1111\/j.1479-828X.2005.00339.x","article-title":"How useful are hospital morbidity data for monitoring conditions occurring in the perinatal period?","volume":"45","author":"Taylor","year":"2005","journal-title":"Aust NZ J Obst Gynaeco"},{"key":"2024122604501472000_14.12.e087248.40","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1016\/j.pec.2015.04.004","article-title":"Decisions, choice and shared decision making in antenatal clinics: An observational study","volume":"98","author":"Garrard","year":"2015","journal-title":"Pat Educ Couns"},{"key":"2024122604501472000_14.12.e087248.41","unstructured":"Australian Commission on Safety and Quality in Health Care . Shared decision making. 2019. Available: https:\/\/www.safetyandquality.gov.au\/our-work\/shared-decision-making"},{"key":"2024122604501472000_14.12.e087248.42","unstructured":"NSW clinical excellence commission. QIDS and QARS. n.d. Available: https:\/\/www.cec.health.nsw.gov.au\/improve-quality\/qids-and-qars"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-087248","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,26]],"date-time":"2024-12-26T12:51:01Z","timestamp":1735217461000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-087248"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12]]},"references-count":42,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12,26]]},"published-print":{"date-parts":[[2024,12]]}},"alternative-id":["10.1136\/bmjopen-2024-087248"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-087248","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12]]}}}