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

Authors

  • Bronwyn Davis,

    1. Cairns Diabetes Centre, Cairns Base Hospital, Cairns, Queensland, Australia
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    • These authors contributed equally.
  • Anna McLean,

    1. Cairns Diabetes Centre, Cairns Base Hospital, Cairns, Queensland, Australia
    2. Department of Endocrinology, Cairns Base Hospital, Cairns, Queensland, Australia
    3. Department of Medicine, James Cook University, Cairns, Queensland, Australia
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    • These authors contributed equally.
  • Ashim K. Sinha,

    1. Cairns Diabetes Centre, Cairns Base Hospital, Cairns, Queensland, Australia
    2. Department of Endocrinology, Cairns Base Hospital, Cairns, Queensland, Australia
    3. Department of Medicine, James Cook University, Cairns, Queensland, Australia
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  • Henrik Falhammar

    Corresponding author
    1. Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
    • Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
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Correspondence: Dr Henrik Falhammar, Department of Endocrinology, Metabolism and Diabetes, D02:04, Karolinska University Hospital. Stockholm, SE-171 76, Sweden. Email: henrik.falhammar@ki.se

Abstract

Background

Australian Aboriginal women have a high prevalence of type 2 diabetes (T2DM) in pregnancy and gestational diabetes (GDM).

Aims

To review how screening practice affects the pregnancy data of all Indigenous women and their newborns living in Cape York, Queensland.

Methods

All medical charts of mothers and their neonates delivered in the regional hospital over two-one-year periods (2006 and 2008) were reviewed. Universal testing with an oral glucose tolerance test (OGTT) was introduced in 2007.

Results

Gestational diabetes (GDM) increased from 4.7 to 14.2%, and T2DM was similar (2.4 and 2.3%). There were 127 deliveries in 2006 and 134 in 2008. Testing rates with OGTT improved from 31.4% in 2006 to 65.6% in 2008. Mothers with diabetes in pregnancy (DIP) were older and heavier than non-DIP mothers. Caesarean section rates were significantly higher in the DIP group compared with the non-DIP group (66 vs 25%) in both time periods. The booking weight of DIP mothers decreased 16 kg, their babies normalised their weight, length and head circumference; respiratory distress and Apgar scores improved comparing the two periods. In DIP, infants >40% had hypoglycaemia; however, rates of serious complications were low. Rates of breastfeeding were similar between groups. Follow-up rates for GDM improved from 16.6% in 2006 to 31.6% in 2008. Of those tested one-third were diagnosed with T2DM.

Conclusion

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.

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