A threefold increase in gestational diabetes over two years: Review of screening practices and pregnancy outcomes in Indigenous women of Cape York, Australia

Davis, Bronwyn; McLean, Anna; Sinha, Ashim; Falhammar, Henrik

doi:10.1111/ajo.12042

Cited by 26 publications

(40 citation statements)

References 18 publications

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“…However, the rates of 14 % postpartum screening among Indigenous women by 6 months postpartum observed in our study, were significantly lower than the rates of 38 % by 6 weeks postpartum reported in Canada in 1998 [31], and 37 % reported among Maori and non-Maori women more recently in New Zealand [32]. The only other study to date to report postpartum diabetes screening among Indigenous women in Australia, also in Far North Queensland during the same study period, noted that OGTTs were performed in 1/6 (16.6 %) Indigenous women diagnosed with gestational diabetes in 2006, and 6/19 (31.6 %) Indigenous women diagnosed with gestational diabetes in 2008 [34]. The variation from our study is likely due to small numbers.…”

Section: Discussionmentioning

confidence: 94%

“…Low rates of postpartum screening have been reported among non-Indigenous women in Australia [29] and internationally [30]; with particularly low rates reported among Indigenous women in similar high income countries, including Canada [31], and New Zealand [32,33]. One small study recently reported low rates of postpartum screening among Indigenous women in Far North Queensland [34]. This study is timely with recent changes to national diabetes screening guidelines [16], which have particular implications for Indigenous women.…”

Section: Introductionmentioning

confidence: 86%

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Low Rates of Postpartum Glucose Screening Among Indigenous and non-Indigenous Women in Australia with Gestational Diabetes

Chamberlain

McLean

Oats

et al. 2014

Matern Child Health J

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Women with gestational diabetes have a high risk of type 2 diabetes postpartum, with Indigenous women particularly affected. This study reports postpartum diabetes screening rates among Indigenous and non-Indigenous women with gestational diabetes, in Far North Queensland, Australia. Retrospective study including 1,012 women with gestational diabetes giving birth at a regional hospital from 1/1/2004 to 31/12/2010. Data were linked between hospital records, midwives perinatal data, and laboratory results, then analysed using survival analysis and logistic regression. Indigenous women had significantly longer times to first oral glucose tolerance test (OGTT) [hazards ratio (HR) 0.62, 95 % confidence interval (CI) 0.48-0.79, p < 0.0001) and 'any' postpartum glucose test (HR 0.81, 95 % CI 0.67-0.98, p = 0.03], compared to non-Indigenous women. Postpartum screening rates among all women were low. However, early OGTT screening rates (<6 months) were significantly lower among Indigenous women (13.6 vs. 28.3 %, p < 0.0001), leading to a persistent gap in cumulative postpartum screening rates. By 3 years postpartum, cumulative rates of receiving an OGTT, were 24.6 % (95 % CI 19.9-30.2 %) and 34.1 % (95 % CI 30.6-38.0 %) among Indigenous and non-Indigenous women, respectively. Excluding OGTTs in previous periods, few women received OGTTs at 6-24 months (7.8 vs. 6.7 %) or 2-4 years (5.2 vs. 6.5 %), among Indigenous and non-Indigenous women, respectively. Low rates of postpartum diabetes screening demonstrate that essential 'ongoing management' and 'equity' criteria for population-based screening for gestational diabetes are not being met; particularly among Indigenous women, for whom recent guideline changes have specific implications. Strategies to improve postpartum screening after gestational diabetes are urgently needed.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 86%

Low Rates of Postpartum Glucose Screening Among Indigenous and non-Indigenous Women in Australia with Gestational Diabetes

Chamberlain

McLean

Oats

et al. 2014

Matern Child Health J

Self Cite

View full text Add to dashboard Cite

show abstract

“…Regarding concerns related to workload and workforce issues, Australian publications have predicted and indeed shown an increase of between 20 and 30% 9,10 in GDM cases with these new criteria, whilst others have shown lesser increases (12.5 and 20%) and indeed no significant change in prevalence in Indigenous women in Cape York. [11][12][13] Regarding the concern about first trimester GDM diagnosis, a recent statement by IADPSG 14 recommends against the use of a fasting glucose threshold ≥ 5.1 mmol/L for GDM diagnosis in early pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Survey on testing for gestational diabetes mellitus in Australia

Flack

Ross

2016

Aust NZ J Obst Gynaeco

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We surveyed members of National Association of Diabetes Centres (NADC) assessing use of new Australasian Diabetes In Pregnancy Society (ADIPS) and Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) Gestational Diabetes Mellitus (GDM) diagnostic guidelines in Australia. We found piecemeal adoption of recommended changes, with cessation of the 50 g glucose challenge test (GCT) universal, early screening implementation common, but by varied methodologies, and new diagnostic criteria acceptance far from complete with significant workload increases almost universal.

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“…Thus, changing testing strategy among Aboriginals in Australia from selective risk-factor-based screening to universal screening resulted in an increase of 40% in prevalence of GDM [25]. Actually, FIGO recommends that all pregnant women are tested for GDM using a 1-step procedure [20].…”

Section: Discussionmentioning

confidence: 99%

Gestational diabetes and macrosomia among Greenlanders. Time to change diagnostic strategy?

Pedersen

Lind

Abelsen

et al. 2018

International Journal of Circumpolar Health

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Gestational diabetes mellitus (GDM) is a serious condition associated to both maternal and offspring complications. Yet, no globally accepted consensus exists on how to test and diagnose GDM. In Greenland, the clinical criteria for testing and diagnosing GDM are adapted from Danish guidelines. The aim of this study was to estimate the prevalence of GDM among Greenlanders using both the current clinical GDM criteria and the recent WHO 2013 criteria and, further, to study the association between GDM, pre-pregnant overweight or obesity and macrosomia. A cross-sectional study of all 450 Greenlandic women who gave birth to a singleton in Nuuk within 1 year was performed. Based on an oral glucose tolerance test measuring capillary whole blood glucose, 119 women were categorised as having clinical GDM, WHO 2013 GDM or not GDM. Macrosomia defined as birth weight above 4,000 g was used as outcome variable. The prevalence of clinical GDM and WHO 2013 GDM was 0.4% (95% CI; 0–1.1) and 6.9% (95% CI; 4.5–9.2). WHO 2013 GDM, fasting blood glucose, pre-pregnant maternal overweight and obesity were associated with macrosomia. WHO 2013 GDM criteria were superior to clinical criteria in predicting macrosomia indicating that it may be time to consider the diagnostic strategy used in Greenland. Pre-pregnant overweight may also need more intensified lifestyle-intervention.Abbreviations: GDM: Gestational diabetes mellitus; VP: venous plasma; CWB: capillary whole blood; OGTT: oral glucose tolerance test; WHO: World Health Organisation; FIGO: The International Federation of Gynaecology and Obstetrics; BMI: body mass index; GA: gestational age

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A threefold increase in gestational diabetes over two years: Review of screening practices and pregnancy outcomes in Indigenous women of Cape York, Australia

Abstract: The rate of GDM tripled after implementation of universal testing. Outcomes improved. There is still need for improvement in testing and follow-up practices in relation to DIP.

Cited by 26 publications

References 18 publications

Low Rates of Postpartum Glucose Screening Among Indigenous and non-Indigenous Women in Australia with Gestational Diabetes

Low Rates of Postpartum Glucose Screening Among Indigenous and non-Indigenous Women in Australia with Gestational Diabetes

Survey on testing for gestational diabetes mellitus in Australia

Gestational diabetes and macrosomia among Greenlanders. Time to change diagnostic strategy?

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