Translational Research Study Group 2007-8

1. Translational Research Study Group 2007-8 David Simmons, Peter Damm Facilitators

2. Members of the group • Rosemary Temple (Consultant Physician) UK • David Pettitt (Paeds/EPI) US/UK • Uriel Elchalal (Ob/Gyn Consultant) Israel • Jeannet Lauenberg (Ob/Gyn) Denmark • Birgitte Bruun Nielsen (Obs) Denmark • Peter Damm (Obs) Denmark • Isabelle Fajardy (Biochem) France • Alicia Jawerbaum (B Science) Argentina • Scott Nelson (Clin Scient) Glasgow • Mark Cavelheim • Lisa Vicente Portugal • Fidelma Dunn Ireland

3. Purpose • To discuss possible areas for research collaboration relating to Translational Research across the DPSG. Translational Research was defined as research around translating scientific knowledge into clinical/health practice.

4. Context • It was acknowledged that Europe had many different health systems and any intervention would need to be able to be tailored to each. Besides clinical research, other interventions included policy, public health, economics, health system funding and community.

5. Scope • In view of time, the need for a concrete issue to work out and relative importance, it was decided that preconception care would be the first topic discussed. This linked into undiagnosed Type 2 diabetes in pregnancy

6. Precon care: Patient groups • Planning vs not planning pregnancy • Secondary care vs primary care • Minority groups, illegal immigrants • Women receiving fertility treatment • Past pregnancies complicated by DM • Register of perinatal death (Portugal) • Undiagnosed T2DM • Post GDM-importance of FU/postnatal OGTT • Early Follow up

7. Pre-con: Interventions • Folate into bread • Wider media campaigns-including eg immigrant groups • Leaflets • When is it appropriate to start talking about contraception? (eg 15yo) • Txt messages • Through pharmacies • Information with insulin/tablets-done in a way to discuss with health professionals and/or pharmacist • Something with pregnancy test kit • Pre-conception advice in the annual review • Have as UK-QoF indicator • Through General Practice • T2DM • Through midwives for post natal OGTT-involved for 3/12 after birth in UK • Lifestyle programmes • “How do we deal with those who do not respond to leaflets/education “

8. Evaluation • Survey of health professionals • CEMACH model for evaluation • Reflected vulnerable groups • Different countries-?a model of best practice that is transferable for vulnerable groups and others • How get data from hospitals/how get completed across all countries? • Birthweight, malformation fetal loss etc-epidemiological framework needed • % planned pregnancies; %entering preg with HBA1c <7.0% • % on folate • % with counseling-how define? If thinking of getting pregnant has someone advised? • % women with Type 1/Type 2 with safe pregnancy

9. Role of DPSG • DPSG make a St Vincent like declaration? Have a DPSG programme-communicate evidence, what to do, implement programme, evaluate, reports at meetings-?abstract next year-have formal session-link into national plans eg DoH-email group • Consensus statement for Diabetologia-could then be published elsewhere and given to practices • Have a logo-pictoral common logo-portraying positive outcome with good precon care-healthy babies-common international symbol • Link in with wider obesity programmes-ecological

10. Action • Presentation and discussion today • Key research questions: • How to increase preconception care • How to prevent undiagnosed type 2 diabetes in pregnancy • Past GDM, obesity • Others • How to pick up undiagnosed GDM early