Trends and burden of diabetes in pregnancy among Aboriginal and non-Aboriginal mothers in Western Australia, 1998–2015

Ahmed, Marwan Awad; Bailey, Helen D.; Pereira, Gavin; White, Scott W.; Wong, Kingsley; Shepherd, Carrington

doi:10.1186/s12889-022-12663-6

Cited by 11 publications

(11 citation statements)

References 65 publications

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“…An early study conducted in a single community in Central Australia, showed that the prevalence of diabetes increased from 11.6% in 1987 to 20.7% in 1995 22. More recent studies from Western Australia and the NT have examined diabetes prevalence trends during pregnancy, showing substantial growth in the number of Aboriginal women with type 2 diabetes diagnosed prior to pregnancy 23 24. In addition, the incidence of diabetes among Aboriginal and Torres Strait Islander children (aged under 16 years) in Western Australia increased considerably between 2000 and 2019 25.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and incidence of diabetes among Aboriginal people in remote communities of the Northern Territory, Australia: a retrospective, longitudinal data-linkage study

et al. 2022

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ObjectivesTo assess the prevalence and incidence of diabetes among Aboriginal peoples in remote communities of the Northern Territory (NT), Australia.DesignRetrospective cohort analysis of linked clinical and administrative data sets from 1 July 2012 to 30 June 2019.SettingRemote health centres using the NT Government Primary Care Information System (51 out of a total of 84 remote health centres in the NT).ParticipantsAll Aboriginal clients residing in remote communities serviced by these health centres (N=21 267).Primary outcome measuresDiabetes diagnoses were established using hospital and primary care coding, biochemistry and prescription data.ResultsDiabetes prevalence across all ages increased from 14.4% (95% CI: 13.9% to 14.9%) to 17.0% (95% CI: 16.5% to 17.5%) over 7 years. Among adults (≥20 years), the 2018/2019 diabetes prevalence was 28.6% (95% CI: 27.8% to 29.4%), being higher in Central Australia (39.5%, 95% CI: 37.8% to 41.1%) compared with the Top End region (24.2%, 95% CI: 23.3% to 25.1%, p<0.001). Between 2016/2017 and 2018/2019, diabetes incidence across all ages was 7.9 per 1000 person-years (95% CI: 7.3 to 8.7 per 1000 person-years). The adult incidence of diabetes was 12.6 per 1000 person-years (95% CI: 11.5 to 13.8 per 1000 person-years).ConclusionsThe burden of diabetes in the remote Aboriginal population of the NT is among the highest in the world. Strengthened systems of care and public health prevention strategies, developed in partnership with Aboriginal communities, are needed.

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Section: Discussionmentioning

confidence: 99%

Prevalence and incidence of diabetes among Aboriginal people in remote communities of the Northern Territory, Australia: a retrospective, longitudinal data-linkage study

et al. 2022

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“…Maternal smoking and SLT use increases the risk of a small for gestation age (SGA) neonate [ 109 , 110 ]. Likewise, elevated maternal glucose increases the likelihood of an earlier (spontaneous or induced) birth, and increases the likelihood of an SGA or a large for gestation age (LGA) neonate dependent upon neonatal genome [ 111 , 112 ]. In Australian Aboriginal pregnancies, the immediate foetal impact of exposure to pre-gestational and gestational diabetes is different to that evidenced in Australian non-Aboriginal pregnancies.…”

Section: Discussionmentioning

confidence: 99%

“…In the presence of pre-gestational diabetes, there is a slightly higher incidence of an LGA birth in Aboriginal pregnancies compared with non-Aboriginal pregnancies (32.9% versus 32.7%) and an increase in SGA births (8.2% versus 4.6%). In the presence of gestational diabetes there is an increased incidence of an LGA neonate in Aboriginal pregnancies compared with non-Aboriginal pregnancies (21.1% versus 13.3%) and the reverse for the incidence of an SGA birth in Aboriginal pregnancies compared with non-Aboriginal pregnancies (7.1% versus 8.3%) [ 111 , 112 ].…”

Section: Discussionmentioning

confidence: 99%

Higher blood nicotine concentrations following smokeless tobacco (pituri) and cigarette use linked to adverse pregnancy outcomes for Central Australian Aboriginal pregnancies

Ratsch¹,

Bogossian

Burmeister³

et al. 2022

BMC Public Health

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Background In central Australia, Aboriginal women use wild tobacco plants, Nicotiana spp. (locally known as pituri) as a chewed smokeless tobacco, with this use continuing throughout pregnancy and lactation. Our aim was to describe the biological concentrations of nicotine and metabolites in samples from mothers and neonates and examine the relationships between maternal self-reported tobacco use and maternal and neonatal outcomes. Methods Central Australian Aboriginal mothers (and their neonates) who planned to birth at the Alice Springs Hospital (Northern Territory, Australia) provided biological samples: maternal blood, arterial and venous cord blood, amniotic fluid, maternal and neonatal urine, and breast milk. These were analysed for concentrations of nicotine and five metabolites. Results A sample of 73 women were enrolled who self-reported: no-tobacco use (n = 31), tobacco chewing (n = 19), or smoking (n = 23). Not all biological samples were obtained from all mothers and neonates. In those where samples were available, higher total concentrations of nicotine and metabolites were found in the maternal plasma, urine, breast milk, cord bloods and Day 1 neonatal urine of chewers compared with smokers and no-tobacco users. Tobacco-exposed mothers (chewers and smokers) with elevated blood glucose had higher nicotine and metabolite concentrations than tobacco-exposed mothers without elevated glucose, and this was associated with increased neonatal birthweight. Neonates exposed to higher maternal nicotine levels were more likely to be admitted to Special Care Nursery. By Day 3, urinary concentrations in tobacco-exposed neonates had reduced from Day 1, although these remained higher than concentrations from neonates in the no-tobacco group. Conclusions This research provides the first evidence that maternal pituri chewing results in high nicotine concentrations in a wide range of maternal and neonatal biological samples and that exposure may be associated with adverse maternal and neonatal outcomes. Screening for the use of all tobacco and nicotine products during pregnancy rather than focusing solely on smoking would provide a more comprehensive assessment and contribute to a more accurate determination of tobacco and nicotine exposure. This knowledge will better inform maternal and foetal care, direct attention to targeted cessation strategies and ultimately improve long-term clinical outcomes, not only in this vulnerable population, but also for the wider population. Note to readers In this research, the central Australian Aboriginal women chose the term ‘Aboriginal’ to refer to themselves, and ‘Indigenous’ to refer to the broader group of Australian First Peoples. That choice has been maintained in the reporting of the research findings.

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“…Maternal smoking and SLT use increases the risk of a small for gestation age (SGA) neonate [108,109]. Likewise, elevated maternal glucose increases the likelihood of an earlier (spontaneous or induced) birth, and increases the likelihood of an SGA or a large for gestation age (LGA) neonate dependent upon neonatal genome [110,111]. In Australian Aboriginal pregnancies, the immediate foetal impact of exposure to pre-gestational and gestational diabetes is different to that evidenced in Australian non-Aboriginal pregnancies.…”

Section: Neonatal Nicotine Exposure and Outcomesmentioning

confidence: 99%

Section: Neonatal Nicotine Exposure and Outcomesmentioning

confidence: 99%

Higher blood nicotine concentrations following smokeless tobacco (pituri) and cigarette use linked to adverse pregnancy outcomes for central Australian Aboriginal pregnancies

Ratsch

Bogossian

Burmeister

et al. 2022

Preprint

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Background: In central Australia, Aboriginal women use wild tobacco plants, Nicotiana spp. (locally known as pituri) as a chewed smokeless tobacco, with this use continuing throughout pregnancy and lactation. Our aim was to describe the biological concentrations of nicotine and metabolites in samples from mothers and neonates and examine the relationships to maternal self-reported tobacco use, maternal and neonatal outcomes.Methods: Central Australian Aboriginal mothers (and their neonates) who planned to birth at the Alice Springs Hospital (Northern Territory, Australia) provided biological samples: maternal blood, arterial and venous cord blood, amniotic fluid, maternal and neonatal urine, and breast milk. These were analysed for concentrations of nicotine and five metabolites.Results: A sample of 73 women were enrolled who self-reported: no-tobacco use (n=31), tobacco chewing (n=19), or smoking (n=23). Not all biological samples were obtained from all mothers and neonates. In those where samples were available, higher total concentrations of nicotine and metabolites were found in the maternal plasma, urine, breast milk, cord bloods and Day 1 neonatal urine of chewers compared with smokers and no-tobacco users. Tobacco-exposed mothers (chewers and smokers) with elevated blood glucose had higher nicotine and metabolite concentrations than tobacco-exposed mothers without elevated glucose, and this was associated with increased neonatal birthweight. Neonates exposed to higher maternal nicotine levels were more likely to be admitted to Special Care Nursery. By Day 3, urinary concentrations in tobacco-exposed neonates had reduced from Day 1, although these remained higher than concentrations from neonates in the no-tobacco group.Conclusions: This research provides the first evidence that maternal pituri chewing results in high nicotine concentrations in both the mother and neonate and that exposure may be associated with adverse maternal and neonatal outcomes similar to those from smoked tobacco use in pregnancy. Screening for the use of a broader range of tobacco and nicotine products during pregnancy would provide a more inclusive assessment and contribute to a more accurate determination of tobacco exposure. This knowledge will better inform maternal and foetal care, and direct attention to targeted cessation strategies that are appropriate to the tobacco and nicotine use profile of the population.Note to readers: In this research, the central Australian Aboriginal women chose the term ‘Aboriginal’ to refer to themselves, and ‘Indigenous’ to refer to the broader group of Australian First Peoples. That choice has been maintained in the reporting of the research findings.

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Trends and burden of diabetes in pregnancy among Aboriginal and non-Aboriginal mothers in Western Australia, 1998–2015

Cited by 11 publications

References 65 publications

Prevalence and incidence of diabetes among Aboriginal people in remote communities of the Northern Territory, Australia: a retrospective, longitudinal data-linkage study

Prevalence and incidence of diabetes among Aboriginal people in remote communities of the Northern Territory, Australia: a retrospective, longitudinal data-linkage study

Higher blood nicotine concentrations following smokeless tobacco (pituri) and cigarette use linked to adverse pregnancy outcomes for Central Australian Aboriginal pregnancies

Higher blood nicotine concentrations following smokeless tobacco (pituri) and cigarette use linked to adverse pregnancy outcomes for central Australian Aboriginal pregnancies

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