1
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Wood AJ, Lee I, Barr ELM, Barzi F, Boyle JA, Connors C, Moore E, Oats JJN, McIntyre HD, Titmuss A, Simmonds A, Zimmet PZ, Brown ADH, Corpus S, Shaw JE, Maple‐Brown LJ. Postpartum uptake of diabetes screening tests in women with gestational diabetes: The PANDORA study. Diabet Med 2023; 40:e14999. [PMID: 36336995 PMCID: PMC10946515 DOI: 10.1111/dme.14999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 09/21/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
AIMS To determine rates and predictors of postpartum diabetes screening among Aboriginal and/or Torres Strait Islander and non-Indigenous women with gestational diabetes mellitus (GDM). METHODS PANDORA is a prospective longitudinal cohort of women recruited in pregnancy. Postpartum diabetes screening rates at 12 weeks (75-g oral glucose tolerance test (OGTT)) and 6, 12 and 18 months (OGTT, glycated haemoglobin [HbA1C ] or fasting plasma glucose) were assessed for women with GDM (n = 712). Associations between antenatal factors and screening with any test (OGTT, HbA1C , fasting plasma glucose) by 6 months postpartum were examined using Cox proportional hazards regression. RESULTS Postpartum screening rates with an OGTT by 12 weeks and 6 months postpartum were lower among Aboriginal and/or Torres Strait Islander women than non-Indigenous women (18% vs. 30% at 12 weeks, and 23% vs. 37% at 6 months, p < 0.001). Aboriginal and/or Torres Strait Islander women were more likely to have completed a 6-month HbA1C compared to non-Indigenous women (16% vs. 2%, p < 0.001). Screening by 6 months postpartum with any test was 41% for Aboriginal and/or Torres Strait Islander women and 45% for non-Indigenous women (p = 0.304). Characteristics associated with higher screening rates with any test by 6 months postpartum included, insulin use in pregnancy, first pregnancy, not smoking and lower BMI. CONCLUSIONS Given very high rates of type 2 diabetes among Aboriginal and Torres Strait Islander women, early postpartum screening with the most feasible test should be prioritised to detect prediabetes and diabetes for intervention.
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Affiliation(s)
- Anna J. Wood
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
- Department of EndocrinologyRoyal Darwin HospitalDarwinNorthern TerritoryAustralia
| | - I‐Lynn Lee
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
| | - Elizabeth L. M. Barr
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
- Baker Heart and Diabetes InstituteMelbourneVictoriaAustralia
| | - Federica Barzi
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
| | - Jacqueline A. Boyle
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
- Monash Centre for Health Research and ImplementationMonash UniversityClaytonVictoriaAustralia
| | - Christine Connors
- Top End Health ServiceNorthern Territory Department of HealthCasuarinaNorthern TerritoryAustralia
| | - Elizabeth Moore
- Aboriginal Medical Services Alliance Northern TerritoryNorthern TerritoryDarwinAustralia
| | - Jeremy J. N. Oats
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Harold D. McIntyre
- Mater ResearchThe University of QueenslandSouth BrisbaneQueenslandAustralia
| | - Angela Titmuss
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
- Department of Paediatrics, Division of WomenChildren and Youth, Royal Darwin HospitalCasuarinaNorthern TerritoryAustralia
| | - Alison Simmonds
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
| | - Paul Z. Zimmet
- Department of DiabetesCentral Clinical School, Monash UniversityClaytonVictoriaAustralia
| | - Alex D. H. Brown
- University of AdelaideAdelaideSouth AustraliaAustralia
- South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
| | - Sumaria Corpus
- Aboriginal and Torres Strait Islander Advisory GroupMenzies School of Health Research, Charles Darwin UniversityCasuarinaNorthern TerritoryAustralia
| | | | - Louise J. Maple‐Brown
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
- Department of EndocrinologyRoyal Darwin HospitalDarwinNorthern TerritoryAustralia
- Aboriginal and Torres Strait Islander Advisory GroupMenzies School of Health Research, Charles Darwin UniversityCasuarinaNorthern TerritoryAustralia
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2
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Wood AJ, Boyle JA, Barr ELM, Barzi F, Hare MJL, Titmuss A, Longmore DK, Death E, Kelaart J, Kirkwood M, Graham S, Connors C, Moore E, O'Dea K, Oats JJN, McIntyre HD, Zimmet PZ, Lu ZX, Brown A, Shaw JE, Maple-Brown LJ. Type 2 diabetes after a pregnancy with gestational diabetes among first nations women in Australia: The PANDORA study. Diabetes Res Clin Pract 2021; 181:109092. [PMID: 34653565 DOI: 10.1016/j.diabres.2021.109092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/22/2021] [Accepted: 09/29/2021] [Indexed: 11/20/2022]
Abstract
AIMS To determine among First Nations and Europid pregnant women the cumulative incidence and predictors of postpartum type 2 diabetes and prediabetes and describe postpartum cardiovascular disease (CVD) risk profiles. METHODS PANDORA is a prospective longitudinal cohort of women recruited in pregnancy. Ethnic-specific rates of postpartum type 2 diabetes and prediabetes were reported for women with diabetes in pregnancy (DIP), gestational diabetes (GDM) or normoglycaemia in pregnancy over a short follow-up of 2.5 years (n = 325). Pregnancy characteristics and CVD risk profiles according to glycaemic status, and factors associated with postpartum diabetes/prediabetes were examined in First Nations women. RESULTS The cumulative incidence of postpartum type 2 diabetes among women with DIP or GDM were higher for First Nations women (48%, 13/27, women with DIP, 13%, 11/82, GDM), compared to Europid women (nil DIP or GDM p < 0.001). Characteristics associated with type 2 diabetes/prediabetes among First Nations women with GDM/DIP included, older age, multiparity, family history of diabetes, higher glucose values, insulin use and body mass index (BMI). CONCLUSIONS First Nations women experience a high incidence of postpartum type 2 diabetes after GDM/DIP, highlighting the need for culturally responsive policies at an individual and systems level, to prevent diabetes and its complications.
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Affiliation(s)
- Anna J Wood
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia; Department of Endocrinology, Royal Darwin Hospital, 58 Rocklands Drive, Tiwi, NT 0810, Australia.
| | - Jacqueline A Boyle
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia; Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, Vic 3168, Australia
| | - Elizabeth L M Barr
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia; Baker Heart and Diabetes Institute, 75 Commercial Road, Vic 3004, Australia
| | - Federica Barzi
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia; UQ Poche Centre for Indigenous Health, The University of Queensland, 31 Upland Road, St Lucia, QLD 4067, Australia
| | - Matthew J L Hare
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia; Department of Endocrinology, Royal Darwin Hospital, 58 Rocklands Drive, Tiwi, NT 0810, Australia
| | - Angela Titmuss
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia; Department of Paediatrics, Division of Women, Children and Youth, Royal Darwin Hospital, 58 Rocklands Drive, Tiwi, NT 0810, Australia
| | - Danielle K Longmore
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia
| | - Elizabeth Death
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia
| | - Joanna Kelaart
- Baker Heart and Diabetes Institute, 75 Commercial Road, Vic 3004, Australia
| | - Marie Kirkwood
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia
| | - Sian Graham
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia
| | - Christine Connors
- Top End Health Service, Northern Territory Department of Health, P.O. Box 41326, Casuarina, NT 0811, Australia
| | - Elizabeth Moore
- Aboriginal Medical Services Alliance Northern Territory, 43 Mitchell Street, Darwin City, NT 0800, Australia
| | - Kerin O'Dea
- University of South Australia, 101 Currie Street, SA 5001, Australia
| | - Jeremy J N Oats
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Vic 3053, Australia
| | - Harold D McIntyre
- Mater Research, The University of Queensland, Raymond Terrace, South Brisbane, QLD 4101, Australia
| | - Paul Z Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Wellington Road, Clayton, Vic 3800, Australia
| | - Zhong X Lu
- Monash Health Pathology, Monash Health, Clayton Road, Clayton, Vic 3168, Australia; Department of Medicine, Monash University, Wellington Road, Clayton, Vic 3800, Australia
| | - Alex Brown
- University of Adelaide, SA 5005, Australia; South Australian Health and Medical Research Institute, North Terrace, SA 5000, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, 75 Commercial Road, Vic 3004, Australia
| | - Louise J Maple-Brown
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia; Department of Endocrinology, Royal Darwin Hospital, 58 Rocklands Drive, Tiwi, NT 0810, Australia
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3
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Rohit A, Roulston T, Henderson T, Lee IL, Webster V, McIntyre HD, Connors C, Brown A, Shaw JE, Maple-Brown LJ, Barr ELM. Screening rates for diabetic retinopathy among Aboriginal and Torres Strait Islander women with hyperglycaemia in pregnancy: The PANDORA cohort study. Clin Exp Ophthalmol 2021; 49:765-767. [PMID: 34410037 DOI: 10.1111/ceo.13985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/06/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Athira Rohit
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | | | - Tim Henderson
- Central Australian Health Services, Alice Springs Hospital, Alice Springs, Australia
| | - I-Lynn Lee
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Vanya Webster
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Diabetes across Lifecourse Northern Australia Partnership Indigenous Reference Group, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - H David McIntyre
- Mater Medical Research Institute, University of Queensland, Brisbane, Australia
| | - Christine Connors
- Top End Health Services, Northern Territory Department of Health, Darwin, Australia
| | - Alex Brown
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Jonathan E Shaw
- Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Louise J Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Department of Endocrinology, Royal Darwin Hospital, Darwin, Australia
| | - Elizabeth L M Barr
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Australia
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4
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Lucas IM, Barr ELM, Barzi F, Longmore DK, Lee IL, Kirkwood M, Whitbread C, Connors C, Boyle JA, Simon D, Goodrem A, Brown ADH, Oats J, McIntyre HD, Shaw JE, Maple-Brown L. Gestational diabetes is associated with postpartum hemorrhage in Indigenous Australian women in the PANDORA study: A prospective cohort. Int J Gynaecol Obstet 2021; 155:296-304. [PMID: 34328645 DOI: 10.1002/ijgo.13846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess associations of hyperglycemia in pregnancy with the risk of postpartum hemorrhage (PPH) in a prospective cohort of Indigenous and non-Indigenous women, compared with normoglycemia. METHODS Data were from 1102 (48% Indigenous) women of the Pregnancy And Neonatal Diabetes Outcomes in Remote Australia (PANDORA) Study. Age-adjusted associations of gestational diabetes mellitus (GDM) or pre-existing type 2 diabetes mellitus (T2DM), obstetric and demographic covariables with PPH (blood loss ≥500 ml) were assessed using logistic regression. Multivariable-adjusted models included Indigenous ethnicity, diabetes type and their interaction. RESULTS A higher proportion of Indigenous women developed PPH than non-Indigenous women (32% versus 22%; P < 0.001). Compared with non-Indigenous women with normoglycemia, risks of PPH for Indigenous women with GDM or T2DM were higher (odds ratio [OR] 1.83, 95% confidence intervals [CI] 1.11-3.02, and OR 1.72, 95% CI 0.99-3.00 after age adjustment, OR 1.84, 95% CI 1.06-3.19, and OR 1.33, 95% CI 0.70-2.54 after adjustment for school education and delivery mode, and OR 1.62, 95% CI 0.95-2.77, and OR 0.99, 95% CI 0.53-1.86 after adjustment for birth weight). Importantly, Indigenous women without hyperglycemia in pregnancy were not at increased risk of PPH. CONCLUSION The significantly higher rates of PPH experienced by Indigenous women compared with non-Indigenous women may be explained by a greater effect of GDM among Indigenous women that was only partly accounted for by birth weight.
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Affiliation(s)
- Isabelle M Lucas
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Obstetrics & Gynaecology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Department of Obstetrics & Gynaecology, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Elizabeth L M Barr
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Federica Barzi
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Danielle K Longmore
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Paediatrics, Western Health, Melbourne, Victoria, Australia
| | - I-Lynn Lee
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Marie Kirkwood
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Cherie Whitbread
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Christine Connors
- Population & Primary Health, Top End Health Service, Darwin, Northern Territory, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Simon
- Department of Obstetrics & Gynaecology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Adeliesje Goodrem
- Midwifery Group Practice, Top End Health Service, Darwin, Northern Territory, Australia
| | - Alex D H Brown
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,The University of Adelaide, Adelaide, South Australia, Australia
| | - Jeremy Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Harold D McIntyre
- Mater Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Louise Maple-Brown
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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5
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Rohit A, Kirkham R, McCarthy L, Puruntatameri V, Maple-Brown L, Brimblecombe J. Exploring differences in perceptions of child feeding practices between parents and health care professionals: a qualitative study. BMC Public Health 2021; 21:1449. [PMID: 34301222 PMCID: PMC8299622 DOI: 10.1186/s12889-021-11493-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence on child feeding practice is often based on the perspectives and experiences of parents and less that of health practitioners. In this study, we explored child feeding practice in Aboriginal communities in northern Australia from both the parents and health practitioners' perspectives with the aim of informing nutrition improvement programs. METHODS Qualitative research methods were employed. Using semi-structured interviews, parents (n = 30) of children aged 2-5 years, and 29 service providers who were involved in the delivery of child health and nutrition programs in the same communities, were asked about child feeding attitudes and practices. Responses were analyzed through inductive and deductive analysis, recognizing that worldviews influence child feeding practices. RESULTS Sharing food was a central practice within families. Parents highly valued development of child independence in food behavior but were conflicted with the easy access to unhealthy food in their communities. This easy access to unhealthy food and inadequate food storage and kitchen facilities for some families were major challenges to achieving optimal diets for children identified by Aboriginal families and service providers. The responsive style of parenting described by parents was often misunderstood by service providers as sub-optimal parenting when viewed through a dominant western lens. CONCLUSIONS Approaches to support healthy feeding practices and optimal child nutrition require health-enabling food environments. Along with a community-based Aboriginal health workforce, it is paramount that the non-Aboriginal workforce be supported to be reflective of the impact of worldview on their practice, to ensure a culturally safe environment for families where parenting styles are understood and appropriately supported.
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Affiliation(s)
- Athira Rohit
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810 Australia
| | - Renae Kirkham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810 Australia
| | - Leisa McCarthy
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810 Australia
| | - Valentina Puruntatameri
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810 Australia
| | - Louise Maple-Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810 Australia
- Department of Endocrinology, Royal Darwin Hospital, Darwin, NT 0810 Australia
| | - Julie Brimblecombe
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810 Australia
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, 3168 Australia
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6
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Pylypjuk C, Sellers E, Wicklow B. Perinatal Outcomes in a Longitudinal Birth Cohort of First Nations Mothers With Pregestational Type 2 Diabetes and Their Offspring: The Next Generation Study. Can J Diabetes 2020; 45:27-32. [PMID: 32800764 DOI: 10.1016/j.jcjd.2020.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/17/2020] [Accepted: 05/04/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVES There is emerging evidence that First Nations women with diabetes in pregnancy and their offspring have poorer health outcomes than non-First Nations women. The aim of this study was to describe the perinatal outcomes of pregnancies complicated by type 2 diabetes. METHODS The Next Generation longitudinal study is a First Nations birth cohort of children born to mothers diagnosed in childhood with type 2 diabetes. Pregnant women were prospectively enrolled in the birth cohort, and a review of medical records (including stored fetal ultrasound images) was performed to determine perinatal outcomes for 112 child-mother pairs between 2005 and 2015. Maternal demographics, antenatal variables, fetal ultrasound findings, obstetric and delivery information and neonatal birth outcomes were collected and analyzed. RESULTS Mothers in our cohort were young and most were overweight at the start of pregnancy. Most had suboptimal glycemic control in the first trimester (median glycated hemoglobin, 9.3%). The cesarean section rate was high at 41%. Over one-half of newborns had macrosomia at birth, and almost 1 in 5 were born with a structural anomaly, mainly renal. Fetal ultrasound significantly underestimated the proportion of infants born with macrosomia (p<0.05) and missed 3 of 7 cardiac defects in this cohort. CONCLUSIONS High rates of anomalies, macrosomia and cesarean deliveries provide insight into pregnancy management and disease processes for First Nations women with pregestational type 2 diabetes and their offspring, and highlights opportunities for improvement in prenatal care of these women.
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Affiliation(s)
- Christy Pylypjuk
- Department of Obstetrics, Gynecology and Reproductive Sciences (Section of Maternal-Fetal Medicine), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; The Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth Sellers
- The Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health (Section of Endocrinology and Metabolism), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brandy Wicklow
- The Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health (Section of Endocrinology and Metabolism), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
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7
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Maple-Brown L, Lee IL, Longmore D, Barzi F, Connors C, Boyle JA, Moore E, Whitbread C, Kirkwood M, Graham S, Hampton V, Simmonds A, Van Dokkum P, Kelaart J, Thomas S, Chitturi S, Eades S, Corpus S, Lynch M, Lu ZX, O'Dea K, Zimmet P, Oats J, McIntyre HD, Brown ADH, Shaw JE. Pregnancy And Neonatal Diabetes Outcomes in Remote Australia: the PANDORA study-an observational birth cohort. Int J Epidemiol 2020; 48:307-318. [PMID: 30508095 DOI: 10.1093/ije/dyy245] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In Australia's Northern Territory, 33% of babies are born to Indigenous mothers, who experience high rates of hyperglycemia in pregnancy. We aimed to determine the extent to which pregnancy outcomes for Indigenous Australian women are explained by relative frequencies of diabetes type [type 2 diabetes (T2DM) and gestational diabetes (GDM)]. METHODS This prospective birth cohort study examined participants recruited from a hyperglycemia in pregnancy register. Baseline data collected were antenatal and perinatal clinical information, cord blood and neonatal anthropometry. Of 1135 women (48% Indigenous), 900 had diabetes: 175 T2DM, 86 newly diagnosed diabetes in pregnancy (DIP) and 639 had GDM. A group of 235 women without hyperglycemia in pregnancy was also recruited. RESULTS Diabetes type differed for Indigenous and non-Indigenous women (T2DM, 36 vs 5%; DIP, 15 vs 7%; GDM, 49 vs 88%, p < 0.001). Within each diabetes type, Indigenous women were younger and had higher smoking rates. Among women with GDM/DIP, Indigenous women demonstrated poorer birth outcomes than non-Indigenous women: large for gestational age, 19 vs 11%, p = 0·002; neonatal fat 11.3 vs 10.2%, p < 0.001. In the full cohort, on multivariate regression, T2DM and DIP were independently associated (and Indigenous ethnicity was not) with pregnancy outcomes. CONCLUSIONS Higher rates of T2DM among Indigenous women predominantly contribute to absolute poorer pregnancy outcomes among Indigenous women with hyperglycemia. As with Indigenous and minority populations globally, prevention or delay of type 2 diabetes in younger women is vital to improve pregnancy outcomes and possibly to improve the long-term health of their offspring.
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Affiliation(s)
- Louise Maple-Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - I-Lynn Lee
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Danielle Longmore
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Federica Barzi
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Christine Connors
- Remote Primary Health Care, Top End Health Services, Northern Territory Department of Health, Darwin, NT, Australia
| | - Jacqueline A Boyle
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Elizabeth Moore
- Public Health Unit, Aboriginal Medical Services Alliance, Darwin, NT, Australia
| | - Cherie Whitbread
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Marie Kirkwood
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Sian Graham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Vanya Hampton
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Alison Simmonds
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Paula Van Dokkum
- Aboriginal Health Domain, Baker Heart and Diabetes Institute, Alice Springs, NT, Australia
| | - Joanna Kelaart
- Aboriginal Health Domain, Baker Heart and Diabetes Institute, Alice Springs, NT, Australia
| | - Sujatha Thomas
- Division of Maternal and Child Health, Royal Darwin Hospital, Darwin, NT, Australia
| | - Shridhar Chitturi
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Sandra Eades
- Clinical and Population Health, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Sumaria Corpus
- Clinical Services, Danila Dilba Health Service, Darwin, NT, Australia
| | - Michael Lynch
- Pathology Network, Top End Health and Hospital Services, Darwin, NT, Australia
| | - Zhong X Lu
- Biochemistry Department, Melbourne Pathology, Melbourne, VIC, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Kerin O'Dea
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Paul Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jeremy Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Harold D McIntyre
- Faculty of Medicine, Mater Medical Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Alex D H Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Jonathan E Shaw
- Clinical and Population Health, Baker Heart and Diabetes Institute, Melbourne, Australia
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8
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Cheng E, Longmore DK, Barzi F, Barr ELM, Lee IL, Whitbread C, Boyle JA, Oats J, Connors C, McIntyre HD, Kirkwood M, Dempsey K, Zhang X, Thomas S, Williams D, Zimmet P, Brown ADH, Shaw JE, Maple-Brown LJ. Birth outcomes in women with gestational diabetes managed by lifestyle modification alone: The PANDORA study. Diabetes Res Clin Pract 2019; 157:107876. [PMID: 31586661 DOI: 10.1016/j.diabres.2019.107876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/08/2019] [Accepted: 10/02/2019] [Indexed: 12/16/2022]
Abstract
AIMS To assess outcomes of women in the Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) cohort with gestational diabetes mellitus (GDM) managed by lifestyle modification compared with women without hyperglycaemia in pregnancy. METHODS Indigenous (n = 97) and Europid (n = 113) women managed by lifestyle modification were compared to women without hyperglycaemia (n = 235). Multivariate linear and logistic regressions assessed whether GDM-lifestyle women had poorer outcomes compared to women without hyperglycaemia. RESULTS Women with GDM-lifestyle had higher body mass index and lower gestational weight gain than women without hyperglycaemia. On univariate analysis, gestational age at delivery was lower and induction rates were higher in women with GDM-lifestyle than without hyperglycaemia. On multivariable regression, GDM-lifestyle was associated with lower gestational age at delivery (by 0.73 weeks), lower birthweight z-score (by 0.26, p = 0.007), lower likelihood of large for gestational age (LGA) [OR (95% CI): 0.55 (0.28, 1.02), p = 0.059], and greater likelihood of labour induction [2.34 (1.49, 3.66), p < 0.001] than women without hyperglycaemia. CONCLUSION Women with GDM managed by lifestyle modification had higher induction rates and their offspring had lower birthweight z-scores, with a trend to lower LGA than those without hyperglycaemia in pregnancy. Further studies are indicated to explore reasons for higher induction rates.
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Affiliation(s)
- E Cheng
- Menzies School of Health Research, NT, Australia; Division of Obstetrics and Gynaecology, Royal Darwin Hospital, NT, Australia; Danila Dilba Health Service, Darwin, NT, Australia.
| | - D K Longmore
- Menzies School of Health Research, NT, Australia.
| | - F Barzi
- Menzies School of Health Research, NT, Australia.
| | - E L M Barr
- Menzies School of Health Research, NT, Australia; Baker Heart and Diabetes Institute, VIC, Australia.
| | - I L Lee
- Menzies School of Health Research, NT, Australia.
| | - C Whitbread
- Menzies School of Health Research, NT, Australia; Division of Medicine, Royal Darwin Hospital, NT, Australia.
| | - J A Boyle
- Menzies School of Health Research, NT, Australia; Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Australia.
| | - J Oats
- Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - C Connors
- Primary Health Care Branch, Top End Health Service, NT, Australia.
| | - H D McIntyre
- Mater Medical Research Institute, University of Queensland, Australia.
| | - M Kirkwood
- Menzies School of Health Research, NT, Australia.
| | - K Dempsey
- Menzies School of Health Research, NT, Australia.
| | - X Zhang
- Innovation and Research, Department of Health, NT, Australia.
| | - S Thomas
- Division of Obstetrics and Gynaecology, Royal Darwin Hospital, NT, Australia.
| | - D Williams
- Darwin Midwifery Group, NT Health, Australia.
| | - P Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Australia.
| | - A D H Brown
- South Australian Health and Medical Research Institute, Australia; Faculty of Health and Medical Science, University of Adelaide, Australia.
| | - J E Shaw
- Baker Heart and Diabetes Institute, VIC, Australia.
| | - L J Maple-Brown
- Menzies School of Health Research, NT, Australia; Division of Medicine, Royal Darwin Hospital, NT, Australia.
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9
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McLean A, Kirkham R, Campbell S, Whitbread C, Barrett J, Connors C, Boyle J, Brown A, Mein J, Wenitong M, McIntyre HD, Barzi F, Oats J, Sinha A, Maple-Brown L. Improving Models of Care for Diabetes in Pregnancy: Experience of Current Practice in Far North Queensland, Australia. Front Public Health 2019; 7:192. [PMID: 31380333 PMCID: PMC6659099 DOI: 10.3389/fpubh.2019.00192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 06/26/2019] [Indexed: 12/14/2022] Open
Abstract
Aims: To map health practitioners' experiences and describe knowledge regarding screening and management of Diabetes in Pregnancy (DIP) in Far North Queensland, Australia. Methods: Mixed methods including a cross-sectional survey (101 respondents) and 8 focus groups with 61 health practitioners. All participants provided clinical care for women with DIP. Results: A wide range of healthcare professionals participated; 96% worked with Indigenous women, and 63% were from regional or remote work settings. Universal screening for gestational diabetes at 24-28 weeks gestation was reported as routine with 87% using a 75 g Oral Glucose Tolerance Test. Early screening for DIP was reported by 61% although there was large variation in screening methods and who should be screened <24 weeks. Health practitioners were confident providing lifestyle advice (88%), dietary, and blood glucose monitoring education (67%, 81%) but only 50% were confident giving insulin education. Electronic medical records were used by 80% but 55% also used paper records. Dissatisfaction with information from hospitals was reported by 40%. In the focus groups improving communication and information technology systems were identified as key areas. Other barriers described were difficulties in care coordination and access for remote women. Conclusions: Communication, information technology systems, coordination of care, and education for health professionals are key areas that will be addressed by a complex health systems intervention being undertaken by the DIP Partnership in North Queensland.
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Affiliation(s)
- Anna McLean
- Cairns Hospital, North Cairns, QLD, Australia
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, University Drive North, Casuarina, NT, Australia
| | - Renae Kirkham
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, University Drive North, Casuarina, NT, Australia
| | - Sandra Campbell
- Department of Health, Central Queensland University, Cairns, QLD, Australia
| | - Cherie Whitbread
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, University Drive North, Casuarina, NT, Australia
- Royal Darwin Hospital, Tiwi, NT, Australia
| | | | - Christine Connors
- Top End Health Service, Northern Territory Department of Health, Darwin City, NT, Australia
| | - Jacqueline Boyle
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, University Drive North, Casuarina, NT, Australia
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Alex Brown
- Population Health Research, University of South Australia, Adelaide, SA, Australia
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | | | - Mark Wenitong
- Apunipima Cape York Health Council, Bungalow, QLD, Australia
| | - H. David McIntyre
- Mater Medical Research Institute, University of Queensland, South Brisbane, QLD, Australia
| | - Federica Barzi
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, University Drive North, Casuarina, NT, Australia
| | - Jeremy Oats
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Ashim Sinha
- Cairns Hospital, North Cairns, QLD, Australia
| | - Louise Maple-Brown
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, University Drive North, Casuarina, NT, Australia
- Royal Darwin Hospital, Tiwi, NT, Australia
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10
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Lee IL, Purbrick B, Barzi F, Brown A, Connors C, Whitbread C, Moore E, Kirkwood M, Simmonds A, van Dokkum P, Death E, Svenson S, Graham S, Hampton V, Kelaart J, Longmore D, Titmuss A, Boyle J, Brimblecombe J, Saffery R, D'Aprano A, Skilton MR, Ward LC, Corpus S, Chitturi S, Thomas S, Eades S, Inglis C, Dempsey K, Dowden M, Lynch M, Oats J, McIntyre HD, Zimmet P, O'Dea K, Shaw JE, Maple-Brown LJ. Cohort Profile: The Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) Study. Int J Epidemiol 2019; 47:1045-1046h. [PMID: 29618003 DOI: 10.1093/ije/dyy046] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- I-Lynn Lee
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Brydie Purbrick
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, NT, Australia
| | - Federica Barzi
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Sansom Institute of Health Research, University of South Australia, Adelaide, SA, Australia
| | | | - Cherie Whitbread
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Elizabeth Moore
- Public Health Unit, Aboriginal Medical Services Alliance of Northern Territory, Darwin, NT, Australia
| | - Marie Kirkwood
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Alison Simmonds
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Paula van Dokkum
- Aboriginal Health Domain, Baker Heart and Diabetes Institute, Alice Springs, NT, Australia
| | - Elizabeth Death
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Stacey Svenson
- Aboriginal Health Domain, Baker Heart and Diabetes Institute, Alice Springs, NT, Australia
| | - Sian Graham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Vanya Hampton
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Joanna Kelaart
- Aboriginal Health Domain, Baker Heart and Diabetes Institute, Alice Springs, NT, Australia
| | - Danielle Longmore
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Angela Titmuss
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Jacqueline Boyle
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Julie Brimblecombe
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Richard Saffery
- Cancer and Disease Epigenetics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Anita D'Aprano
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, VIC, Australia
| | - Michael R Skilton
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, QLD, Australia
| | - Sumaria Corpus
- Clinical Services, Danila Dilba Health Service, Darwin, NT, Australia
| | - Shridhar Chitturi
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Sujatha Thomas
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, NT, Australia
| | - Sandra Eades
- Clinical and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | | | - Karen Dempsey
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | | | - Michael Lynch
- Pathology Network, Top End Health and Hospital Services, Darwin, NT, Australia
| | - Jeremy Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Harold D McIntyre
- Faculty of Medicine, Mater Medical Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Paul Zimmet
- Monash University, Medicine, Nursing and Health Sciences, Melbourne, VIC, Australia
| | - Kerin O'Dea
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,Sansom Institute of Health Research, University of South Australia, Adelaide, SA, Australia
| | - Jonathan E Shaw
- Clinical and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Louise J Maple-Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
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11
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Longmore DK, Barr ELM, Lee IL, Barzi F, Kirkwood M, Whitbread C, Hampton V, Graham S, Van Dokkum P, Connors C, Boyle JA, Catalano P, Brown ADH, O'Dea K, Oats J, McIntyre HD, Shaw JE, Maple-Brown LJ. Maternal body mass index, excess gestational weight gain, and diabetes are positively associated with neonatal adiposity in the Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) study. Pediatr Obes 2019; 14:e12490. [PMID: 30650263 DOI: 10.1111/ijpo.12490] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 09/27/2018] [Accepted: 10/03/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND In-utero exposures likely influence the onset and severity of obesity in youth. With increasing rates of type 2 diabetes mellitus (T2DM) and maternal adiposity in pregnancy globally, it is important to assess the impact of these factors on neonatal adipose measures. OBJECTIVES To evaluate the contribution of maternal ethnicity, body mass index (BMI), gestational weight gain, and hyperglycaemia to neonatal adiposity. METHODS Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) is a longitudinal cohort study of Australian mother and neonate pairs. In this analysis, Indigenous (n = 519) and Europid (n = 358) women were included, of whom 644 had hyperglycaemia (type 2 diabetes [T2DM], diabetes in pregnancy [DIP], or gestational diabetes [GDM]). Associations between maternal ethnicity, hyperglycaemia, BMI and gestational weight gain, and the neonatal outcomes of length, head circumference, sum of skinfolds, total body fat, and percentage body fat were examined. Models were adjusted for maternal age, smoking status, parity, education, neonatal gender, and gestational age. RESULTS Among those with hyperglycaemia in pregnancy, Indigenous women had a higher proportion of T2DM and DIP (36%, 13%) compared with Europid women (4%, 3%). In multivariate analysis, maternal T2DM (compared with no hyperglycaemia), BMI during pregnancy, and excess compared with appropriate gestational weight gain, were significantly associated with greater neonatal measures. DIP was associated with greater sum of skinfolds, total body fat, and percentage body fat. Indigenous ethnicity was associated with greater sum of skinfolds. CONCLUSIONS Maternal BMI, excess gestational weight gain, and hyperglycaemia operated as independent factors influencing neonatal adiposity. Interventions addressing these factors are needed to reduce neonatal adiposity.
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Affiliation(s)
- Danielle K Longmore
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia.,Department of Paediatrics, Western Health, Melbourne, Australia
| | - Elizabeth L M Barr
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia.,Baker Heart and Diabetes Institute, Melbourne, Australia
| | - I-Lynn Lee
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia
| | - Federica Barzi
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia
| | - Marie Kirkwood
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia
| | - Cherie Whitbread
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, Australia
| | - Vanya Hampton
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia
| | - Sian Graham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia
| | - Paula Van Dokkum
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia.,Baker Heart and Diabetes Institute, Alice Springs, Australia
| | | | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Alex D H Brown
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Kerin O'Dea
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia
| | - Jeremy Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - H David McIntyre
- Mater Medical Research Institute, University of Queensland, Brisbane, Australia
| | | | - Louise J Maple-Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, Australia
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12
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Kirkham R, MacKay D, Barzi F, Whitbread C, Kirkwood M, Graham S, Van Dokkum P, McIntyre HD, Shaw JE, Brown A, O'Dea K, Connors C, Oats J, Zimmet P, Boyle J, Maple-Brown L. Improving postpartum screening after diabetes in pregnancy: Results of a pilot study in remote Australia. Aust N Z J Obstet Gynaecol 2018; 59:430-435. [PMID: 30276799 DOI: 10.1111/ajo.12894] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/07/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND The postpartum period is a critical time to improve health outcomes for Aboriginal women, particularly for those who have chronic conditions. AIMS To assess enhanced support methods (for women following diabetes in pregnancy (DIP)) to improve completion rates of recommended postpartum health checks. MATERIALS AND METHODS Fifty-three Aboriginal women in the Northern Territory (NT) were contacted in the postpartum period to encourage medical check-ups. Messages were delivered through phone (call or text messages) or other methods (Facebook or email). The primary outcome was postpartum blood glucose testing (oral glucose tolerance testing (OGTT), random or fasting glucose and HbA1c). RESULTS Establishing contact with women was difficult. Of 137 messages sent to 52 women, 22 responded (42%). Phone was the most common contact method with successful contact made from 16 of 119 (13%) attempts. Rates of postpartum OGTT completion were higher in the group successfully contacted (32% vs 7%). However, for any postpartum glucose testing (including OGTT and HbA1c) rates were 25 of 42 (60%) and neither success in making contact nor the contact method was associated with higher rates. CONCLUSIONS The small sample size limits our conclusions; however, results highlight that engaging remote women postpartum is difficult. While rates of postpartum OGTT completion differed according to successful contacts, rates of any postpartum blood glucose testing did not. Further research is needed to explore feasible intervention methods to improve postpartum screening after a pregnancy complicated by diabetes.
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Affiliation(s)
- Renae Kirkham
- Menzies School of Health Research, Darwin, Australia
| | | | | | - Cherie Whitbread
- Menzies School of Health Research, Darwin, Australia.,Royal Darwin Hospital, Darwin, Australia
| | | | - Sian Graham
- Menzies School of Health Research, Darwin, Australia
| | - Paula Van Dokkum
- Baker IDI Heart and Diabetes Institute, Alice Springs, Australia.,Alice Springs Hospital, Alice Springs, Australia
| | - H David McIntyre
- Mater Medical Research Institute, Brisbane, Australia.,Obstetric Medicine, University of Queensland, Brisbane, Australia
| | - Jonathan E Shaw
- Clinical and Population Health Research, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Alex Brown
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Kerin O'Dea
- Population Health Research, University of South Australia, Adelaide, Australia
| | - Christine Connors
- Darwin Region & Strategic Primary Health Care Branch, Top End Health Service, Northern Territory Department of Health, Darwin, Australia
| | - Jeremy Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Paul Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Louise Maple-Brown
- Menzies School of Health Research, Darwin, Australia.,Royal Darwin Hospital, Darwin, Australia
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13
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The Relative Validity of the Menzies Remote Short-Item Dietary Assessment Tool (MRSDAT) in Aboriginal Australian Children Aged 6⁻36 Months. Nutrients 2018; 10:nu10050590. [PMID: 29748493 PMCID: PMC5986470 DOI: 10.3390/nu10050590] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 01/21/2023] Open
Abstract
The Menzies Remote Short-item Dietary Assessment Tool (MRSDAT) can be used to derive a dietary index score, which measures the degree of compliance with the Australian Dietary Guidelines. This study aimed to determine the relative validity of a dietary index score for children aged 6–24 months, living in a Remote Aboriginal Community (RAC), derived using MRSDAT. This validation study compared dietary index scores derived using MRSDAT with those derived from the average of three 24-h recalls. Participants were aged 6–36 months at the first dietary assessment and were living in a RAC. The level of agreement between the two methods was explored using Lin’s concordance correlation coefficient (CCC), Bland-Altman plots, weighted Cohen’s kappa, and Fischer’s exact and paired t-tests. Forty participants were recruited. The CCC was poor between methods (R = 0.35, 95% CI 0.06, 0.58), with MRSDAT estimating higher dietary intake scores for all food groups except fruit, and higher dietary quality scores by an average of 4.78 points/100. Community-based Aboriginal researchers were central to this validation study. MRSDAT was within the performance range of other short-item dietary assessment tools developed for young children, and shows promise for use with very young children in RACs.
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14
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Rohit A, Brimblecombe J, O'Dea K, Tonkin E, Maypilama Ḻ, Maple-Brown L. Development of a short-item diet quality questionnaire for Indigenous mothers and their young children: The Menzies remote short-item dietary assessment tool. Aust J Rural Health 2018; 26:220-224. [PMID: 29672986 DOI: 10.1111/ajr.12412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Athira Rohit
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Julie Brimblecombe
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Kerin O'Dea
- Menzies School of Health Research, Darwin, Northern Territory, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
| | - Emma Tonkin
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | | | - Louise Maple-Brown
- Menzies School of Health Research, Darwin, Northern Territory, Australia
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15
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Health service changes to address diabetes in pregnancy in a complex setting: perspectives of health professionals. BMC Health Serv Res 2017; 17:524. [PMID: 28774291 PMCID: PMC5543438 DOI: 10.1186/s12913-017-2478-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 07/27/2017] [Indexed: 01/22/2023] Open
Abstract
Background Australian Aboriginal and Torres Strait Islander women have high rates of gestational and pre-existing type 2 diabetes in pregnancy. The Northern Territory (NT) Diabetes in Pregnancy Partnership was established to enhance systems and services to improve health outcomes. It has three arms: a clinical register, developing models of care and a longitudinal birth cohort. This study used a process evaluation to report on health professional’s perceptions of models of care and related quality improvement activities since the implementation of the Partnership. Methods Changes to models of care were documented according to goals and aims of the Partnership and reviewed annually by the Partnership Steering group. A ‘systems assessment tool’ was used to guide six focus groups (49 healthcare professionals). Transcripts were coded and analysed according to pre-identified themes of orientation and guidelines, education, communication, logistics and access, and information technology. Results Key improvements since implementation of the Partnership include: health professional relationships, communication and education; and integration of quality improvement activities. Focus groups with 49 health professionals provided in depth information about how these activities have impacted their practice and models of care for diabetes in pregnancy. Co-ordination of care was reported to have improved, however it was also identified as an opportunity for further development. Recommendations included a central care coordinator, better integration of information technology systems and ongoing comprehensive quality improvement processes. Conclusions The Partnership has facilitated quality improvement through supporting the development of improved systems that enhance models of care. Persisting challenges exist for delivering care to a high risk population however improvements in formal processes and structures, as demonstrated in this work thus far, play an important role in work towards improving health outcomes.
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16
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Bovill M, Gruppetta M, Cadet-James Y, Clarke M, Bonevski B, Gould GS. Wula (Voices) of Aboriginal women on barriers to accepting smoking cessation support during pregnancy: Findings from a qualitative study. Women Birth 2017; 31:10-16. [PMID: 28689764 DOI: 10.1016/j.wombi.2017.06.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/19/2017] [Accepted: 06/06/2017] [Indexed: 11/17/2022]
Abstract
AIM To gather Aboriginal women's stories of smoking and becoming pregnant to identify the barriers in accepting smoking cessation support during pregnancy. METHODS Qualitative data were collected through use of yarning methodology between August 2015 and January 2016 by an Aboriginal Researcher with experience in social and community services. A short on-line survey was used to collect quantitative data. Interviews only recorded the therapeutic yarning process, which ranged from 9 to 45min duration, averaging 30min. Audio-recorded interviews were transcribed and independently coded. A general inductive analysis was used to determine emergent themes. RESULTS Twenty Aboriginal women between 17-38 years of age, who were pregnant or recently given birth, living in the Hunter New England (HNE) area took part. Eleven women were still smoking; nine had quit. Most were highly aware of the implications of smoking for their babies. Major themes identified for accepting support were: ambivalence towards a need for support, health professional advice, reduction in smoking, and attitudes to Nicotine Replacement Therapy (NRT). Women reported being advised to cut down, rather than to quit; reducing consumption may be a barrier to accepting NRT. Women recommended enhanced clinical support and Aboriginal community engagement in cessation care. DISCUSSION/CONCLUSIONS Aboriginal women in the HNE area reported quitting or reducing their cigarette intake during pregnancy. Health Professionals working with Aboriginal women during pregnancy should give consistent messages to quit smoking completely, and offer increased, ongoing and extensive smoking cessation support to Aboriginal mothers. Clinical practices could partner with Aboriginal communities to support the delivery of smoking cessation services.
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Affiliation(s)
- M Bovill
- School of Medicine & Public Health, University of Newcastle, NSW, Australia.
| | - M Gruppetta
- Wollotuka, University of Newcastle, NSW, Australia
| | - Y Cadet-James
- Indigenous Centre, James Cook University, QLD, Australia
| | - M Clarke
- OBGYN, Clarence Specialist Clinic, NSW, Australia
| | - B Bonevski
- School of Medicine & Public Health, University of Newcastle, NSW, Australia
| | - G S Gould
- School of Medicine & Public Health, University of Newcastle, NSW, Australia
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17
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Klein J, Boyle JA, Kirkham R, Connors C, Whitbread C, Oats J, Barzi F, McIntyre D, Lee I, Luey M, Shaw J, Brown ADH, Maple-Brown LJ. Preconception care for women with type 2 diabetes mellitus: A mixed-methods study of provider knowledge and practice. Diabetes Res Clin Pract 2017; 129:105-115. [PMID: 28521194 DOI: 10.1016/j.diabres.2017.03.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/03/2017] [Accepted: 03/28/2017] [Indexed: 11/18/2022]
Abstract
AIMS Preconception care may decrease adverse pregnancy outcomes associated with pre-existing diabetes mellitus. Aboriginal Australians are at high risk of type 2 diabetes mellitus (T2DM), with earlier onset. We explored practitioner views on preconception care delivery for women with T2DM in the Northern Territory, where 31% of births are to Aboriginal women. METHODS Mixed-methods study including cross-sectional survey of 156 health practitioners and 11 semi-structured interviews. RESULTS Practitioners reported low attendance for preconception care however, 51% provided counselling on an opportunistic basis. Rural/remote practitioners were most likely to find counselling feasible. The majority (69%) utilised appropriate guidelines and addressed lifestyle modifications including smoking (81%), weight management (79%), and change medications appropriately such as ceasing ACE inhibitors (69%). Fewer (40%) prescribed the recommended dose of folate (5mg) or felt comfortable recommending delaying pregnancy to achieve optimal preconception glucose control (42%). Themes identified as barriers to care included the complexity of care setting and infrequent preconception consultations. There was a focus on motivation of women to make informed choices about conception, including birth spacing, timing and contraception. Preconception care enablers included cross-cultural communication, a multi-disciplinary care team and strong client-based relationships. CONCLUSIONS Health practitioners are keen to provide preconception counselling and reported knowledge of evidence-based guidelines. Improvements are needed in recommending high dose folate and optimising glucose control. Cross-cultural communication and team-based care were reported as fundamental to successful preconception care in women with T2DM. Continued education and policy changes are required to support practitioners in opportunities to enhance pregnancy planning.
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Affiliation(s)
- J Klein
- Royal Darwin Hospital, Darwin, Australia; Department of Obstetrics and Gynaecology, Eastern Health, Melbourne, Australia
| | - J A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Menzies School of Health Research, Darwin, Australia
| | - R Kirkham
- Menzies School of Health Research, Darwin, Australia
| | - C Connors
- Northern Territory Department of Health, Darwin, Australia
| | - C Whitbread
- Royal Darwin Hospital, Darwin, Australia; Menzies School of Health Research, Darwin, Australia
| | - J Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - F Barzi
- Menzies School of Health Research, Darwin, Australia
| | - D McIntyre
- Mater Medical Research Institute, University of Queensland, Brisbane, Australia
| | - I Lee
- Menzies School of Health Research, Darwin, Australia
| | - M Luey
- Central Australian Aboriginal Congress, Alice Springs, Australia
| | - J Shaw
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - A D H Brown
- South Australian Health and Medical Research Institute, Adelaide, Australia; University of South Australia, Adelaide, Australia
| | - L J Maple-Brown
- Royal Darwin Hospital, Darwin, Australia; Menzies School of Health Research, Darwin, Australia.
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Duong V, Davis B, Falhammar H. Pregnancy and neonatal outcomes in Indigenous Australians with diabetes in pregnancy. World J Diabetes 2015; 6:880-888. [PMID: 26131329 PMCID: PMC4478583 DOI: 10.4239/wjd.v6.i6.880] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 03/17/2015] [Accepted: 04/29/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To perform a systematic review of reported neonatal and pregnancy outcomes of Indigenous Australians with diabetes in pregnancy (DIP).
METHODS: Electronic searches of PubMed and Web of Science were carried out. Articles were selected if they contained original data on DIP outcomes in Indigenous Australians. There were no specific exclusion criteria.
RESULTS: A total of eight articles, predominantly from Queensland and Western Australia were identified once inclusion criteria were applied. Birth data from midwifery registries or paper charts encompassing years 1985-2008 were used. A total of 465591 pregnant women with and without DIP were included in the eight studies, with 1363 being Indigenous women with DIP. Indigenous Australians experienced increased rates of many known adverse outcomes of DIP including: macrosomia, caesarean section, congenital deformities, low birth weight, hypoglycaemia, and neonatal trauma. There were regional differences among Indigenous Australians, particularly regional/remote vs metropolitan populations where the regional/remote data showed worse outcomes. Two of the articles did not note a difference between Aboriginals and Caucasians in the rates of measured adverse outcome. Studies varied significantly in size, measured outcomes, and subsequent analysis.
CONCLUSION: The health disparities between Indigenous Australians and non-Indigenous Australians are further evidenced by poorer outcomes in DIP. This has broader implications for Indigenous health in general.
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Chamberlain C, Fredericks B, McLean A, Oldenburg B, Mein J, Wolfe R. Associations with low rates of postpartum glucose screening after gestational diabetes among Indigenous and non-Indigenous Australian women. Aust N Z J Public Health 2014; 39:69-76. [DOI: 10.1111/1753-6405.12285] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/01/2014] [Accepted: 07/01/2014] [Indexed: 01/08/2023] Open
Affiliation(s)
- Catherine Chamberlain
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine; Nursing and Health Sciences, Monash University; Victoria
- Onemda VicHealth Koori Health Unit, School of Population and Global Health; University of Melbourne; Victoria
| | | | | | - Brian Oldenburg
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine; Nursing and Health Sciences, Monash University; Victoria
- School of Population and Global Health; University of Melbourne; Victoria
| | | | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine; Nursing and Health Sciences, Monash University; Victoria
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Edwards L, Connors C, Whitbread C, Brown A, Oats J, Maple-Brown L. Improving health service delivery for women with diabetes in pregnancy in remote Australia: survey of care in the Northern Territory Diabetes in Pregnancy Partnership. Aust N Z J Obstet Gynaecol 2014; 54:534-40. [PMID: 25308373 DOI: 10.1111/ajo.12246] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 07/14/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND In the Northern Territory (NT), 38% of 3500 births each year are to Indigenous women, 80% of whom live in regional and remote areas. Compared with the general Australian population, rates of pre-existing type 2 diabetes in pregnancy are 10-fold higher and rates of gestational diabetes are 1.5-fold higher among Indigenous women. Current practices in screening for diabetes in pregnancy in remote Australia are not known. AIMS To assess current health service delivery for NT women with diabetes in pregnancy (DIP) by surveying healthcare professionals' views and practices in DIP screening and management. MATERIALS AND METHODS A cross-sectional survey of NT healthcare professionals providing clinical care for women with DIP was conducted based on pre-identified themes of communication, care-coordination, education, orientation and guidelines, logistics and access, and information technology. RESULTS Of the 116 responders to the survey, 78% were primary healthcare professionals, 32% midwives and 25% general practitioners. High staff turnover was evident: of Central Australian professionals, only 33% (urban) and 18% (regional/remote) had been in their current position over 5 years. DIP screening was conducted at first antenatal visit by 66% and at 24-28-week gestation by 81%. Only 50% of respondents agreed that most women at their health service received appropriate care for DIP, and 41% of primary care practitioners were neutral or not confident in their skills to manage DIP. CONCLUSIONS It is promising that many healthcare professionals report following new guidelines in conducting early pregnancy screening for DIP in high risk women. Several challenges were identified in healthcare delivery to a high risk population in remote Australia.
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Affiliation(s)
- Laura Edwards
- Department of Health, Top End Remote Health, Darwin, Northern Territory, Australia
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