Maternal and neonatal outcomes in the Torres Strait Islands with a sixfold increase in type 2 diabetes in pregnancy over six years

Abstract

Torres Strait Islander population has a high prevalence of type 2 diabetes (T2DM). To review pregnancy data of women and their newborns living in the Torres Strait area. All medical charts of mothers and their neonates delivered in two one-year periods (1999 and 2005/2006) were reviewed. The initial screening test for diabetes in pregnancy (DIP) was a random blood glucose level followed by an oral glucose challenge test in 1999 and from 2000 an oral glucose tolerance test. Diabetes in pregnancy increased by 4.3-13.3% and T2DM by 0.8-4.6%. During the two periods, 258 and 196 mothers delivered respectively 84-92% by midwives/general practitioners at the local hospital and 7-16% by midwives/obstetricians at the regional hospital; in 2005/2006, 58% of women with DIP delivered at the regional hospital. Screening increased from 89.2 to 99.5%. DIP mothers were older and heavier with more hypertension and previous miscarriages. Parity decreased in the DIP mother during the two periods. Caesarean section was five times more common for DIP in 2005/2006 versus non-DIP, while in 1999, there was no difference. In 1999, the DIP infants were heavier, longer (P = 0.053) and had a larger head circumference not seen 2005/2006. There was more neonatal trauma, hypoglycaemia and IV dextrose in the DIP infants. Breastfeeding numbers increased in DIP. In 2005/2006, follow-up of gestational diabetes occurred in 47% (all normal). A massive increase in DIP was seen. The neonatal outcomes improved slightly. There is need for improvement in follow-up of gestational diabetes.