Birth outcomes in women with gestational diabetes managed by lifestyle modification alone: The PANDORA study

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.

Diabetes care in remote Australia: the antenatal, postpartum and inter-pregnancy period

BACKGROUND

Aboriginal and Torres Strait Islander women experience high rates of diabetes in pregnancy (DIP), contributing to health risks for mother and infant, and the intergenerational cycle of diabetes. By enhancing diabetes management during pregnancy, postpartum and the interval between pregnancies, the DIP Partnership aims to improve health outcomes and reduce risks early in the life-course. We describe a mixed methods formative study of health professional's perspectives of antenatal and post-partum diabetes screening and management, including enablers and barriers to care.

METHODS

Health professionals involved in providing diabetes care in pregnancy, from a range of health services across the Northern Territory, completed the survey (n = 82) and/or took part in interviews and/or focus groups (n = 62).

RESULTS

Qualitative findings highlighted factors influencing the delivery of care as reported by health professionals, including: whose responsibility it is, access to care, the baby is the focus and pre-conception care. The main challenges were related to: disjointed systems and confusion around whose role it is to provide follow-up care beyond six weeks post-partum. Quantitative findings indicated that the majority of health professionals reported confidence in their own skills to manage women in the antenatal period (62%, 40/79) and slightly lower rates of confidence in the postpartum interval (57%, 33/58).

CONCLUSION

These findings regarding whose role it is to provide postpartum care, along with opportunities to improve communication pathways and follow up care have informed the design of a complex health intervention to improve health systems and the provision of DIP related care.

Prevalence and correlates of depressive symptoms following traumatic brain injuries in children

The prevalence and correlates of depressive symptoms following childhood traumatic brain injuries (TBI) were examined using data drawn from a prospective longitudinal study. Participants included 38 children with severe TBI, 51 with moderate TBI, and 55 with orthopedic injuries (OI). Assessments occurred shortly after injury (baseline) and at 6- and 12-month follow-ups. Children completed the Child Depression Inventory (CDI). Parents rated depressive symptoms using the Child Behavior Checklist (CBC), with baseline ratings reflecting premorbid status. Assessments also included measures of children's neurocognitive functioning and the family environment. The three groups did not differ overall in self-reported symptoms on the CDI, but did display different trends over time. The three groups did not differ on parent ratings of premorbid depressive symptoms on the CBC, but parents reported more depressive symptoms in the TBI groups than in the OI group at 6- and 12-month follow-ups. Child and parent reports were correlated for children in the TBI groups, but not for those in the OI group. Depressive symptoms were related to socioeconomic status in all groups. Socioeconomic status also was a significant moderator of group differences, such that the effects of TBI were exacerbated in children from more disadvantaged homes. Although self-reports of depressive symptoms were related inconsistently to children's verbal memory, parent reports of depressive symptoms were unrelated to IQ or verbal memory. The findings suggest that TBI increases the risk of depressive symptoms, especially among more socially disadvantaged children, and that depressive symptoms are not strongly related to post-injury neurocognitive deficits.

Community networking as a means for identifying people with diabetes in a rural, predominantly bicultural community in New Zealand

AIMS

To assess the use of community networking to estimate the prevalence of diabetes in a predominantly New Zealand Maori and European community.

METHODS

A cross-sectional survey of people with known diabetes identified either through general practice or community networks (others with diabetes, public notices or public meetings) was undertaken. Ascertainment was compared using capture-recapture methods for two independent samples.

RESULTS

Overall ascertainment by community networking was greater for Maori than Europeans (40 +/- 3% vs 15 +/- 2%, p < 0.001). Ascertainment using general practice registers was comparable in the two ethnic groups (48 +/- 4% vs 55 +/- 5%, respectively). Women were more likely than men to be contacted through community networking (odds ratio 1.47, 1.05-2.06).

CONCLUSION

In closely knit communities, community networking provides an independent source for estimating the prevalence of diabetes.

Perceptions of diabetes among rural Maori elders and spokespersons

AIMS

To assess knowledge and opinions of diabetes among rural Maori elders and spokespersons.

METHODS

Interviews were conducted in rural South Auckland. Subjects were identified through their affiliation with one marae (meeting house), residence near the marae and being recognised locally as either male (kaumatua) or female (kuia) elders or spokespersons. The main researcher was a kuia chosen by and from within the local community. Interviews were conducted with 43/44 (98%) subjects identified.

RESULTS

While specific diabetes knowledge was low, diabetes was seen, along with cancer, as one of the two major health issues for Maori. Results need to be understood in the context of the holistic understanding of health by Maori.

CONCLUSION

The recognition of diabetes as a major health problem was accompanied by a call for diabetes education in a form that will generate interest and participation by Maori. It is timely for the introduction of marae based diabetes awareness and sustained exercise programmes as part of a diabetes prevention and control strategy among Maori communities where diabetes risk is high.

Evaluation of culture and the Gen-Probe PACE 2 assay for detection of Neisseria gonorrhoeae and Chlamydia trachomatis in endocervical specimens transported to a state health laboratory

The Gen-Probe PACE 2 assay (Gen-Probe Inc., San Diego, Calif.) was compared with culture for the detection of Neisseria gonorrhoeae in endocervical specimens that were mailed to the laboratory. During mail transport, the specimens were exposed to extremes of hot and cold weather for several days before arriving in the laboratory. Specimens on culture plates deteriorated during transport, as evidenced by many dead gonococcus-like colonies. The manufacturer's recommendation for reporting PACE 2 assay-positive results was modified to create a suspicious category for samples with relative light units near the positive cutoff value. Of a total of 4,869 specimens tested, 30 were positive by both methods and 102 were positive only by the PACE 2 assay. These additional 102 positive specimens were likely to be true positives, as indicated by several lines of indirect evidence, including detailed probe competition analysis, patient history, and the lack of false-positive results in hand-delivered specimens. Although Gen-Probe Inc. indicates that specimens are stable for up to 7 days, N. gonorrhoeae was easily detectable by the PACE 2 assay after 1 month of incubation at room temperature in the PACE 2 transport buffer. We also compared the Gen-Probe PACE 2 assay for Chlamydia trachomatis with culture on endocervical specimens delivered by same-day courier. Of 398 endocervical specimens tested, the PACE 2 assay detected 19 of 20 culture-positive samples. Although the assay failed to detect one culture-positive sample, it was able to detect two very weak culture-suspicious samples. Finally, PACE 2 assays for N. gonorrhoeae and C. trachomatis performed on the same samples indicated that the coinfection rate was 40% for women attending five family planning clinics. We concluded that the Gen-Probe PACE 2 assay system should be considered for use in testing those specimens that are transported to the laboratory through the mail.