Abstract
Background: Hyperglycaemia in pregnancy contributes to adverse outcomes for women and their children. The postpartum period is an opportune time to support women to reduce cardiometabolic and diabetes risk in subsequent pregnancies. Aims: To identify strengths and gaps in current care for Aboriginal women after a pregnancy complicated by hyperglycaemia. Methods: A retrospective review of the 12 month postpartum care provided by primary health centres in remote Australia in 2013–2014 identified 195 women who experienced hyperglycaemia in pregnancy (gestational diabetes (GDM) (n = 147), type 2 diabetes (T2D) (n = 39), and unclear diabetes status (n = 9)). Results: Only 80 women (54%) with GDM had postpartum glycaemic checks. Of these, 32 women were diagnosed with prediabetes (n = 24) or diabetes (n = 8). Compared to women with GDM, women with T2D were more likely to have their weight measured (75% vs. 52%, p <0.01), and smoking status documented as “discussed” (65% vs. 34%, p < 0.01). Most women (97%) accessed the health centre at least once in the 12 month postpartum period but, during these visits, only 52% of women had service provision, either structured or opportunistic, related to diabetes. Conclusion: High rates of dysglycaemia among women screened for T2D after GDM in the 12 month postpartum period highlight the need for increased screening and early intervention to prevent the development of T2D and its complications. Whilst a clear strength was high postpartum attendance, many women did not attend health services for diabetes screening or management.
Highlights
Diabetes is at epidemic levels in Indigenous communities, contributing considerably to the life expectancy gap between Indigenous and non-Indigenous peoples globally [1]
Compared to women with gestational diabetes (GDM), women with type 2 diabetes (T2D) were older, more likely to live in Central
We reviewed the provision of recommended postpartum care, including routine six-week postnatal check-ups, screening for diabetes and care plans provided to women with hyperglycaemia in pregnancy in remote communities across the Northern Territory (NT)
Summary
Diabetes is at epidemic levels in Indigenous communities, contributing considerably to the life expectancy gap between Indigenous and non-Indigenous peoples globally [1]. Hyperglycaemia in pregnancy (which includes gestational diabetes (GDM) and pre-existing type 2 diabetes in pregnancy (T2D)) is increasing, in parallel with the rise in obesity and T2D in women of reproductive age [2]. For women with GDM, there is a high risk of developing GDM in subsequent pregnancies and, later, T2D and cardiovascular disease [6]. The postpartum period is an opportune time to support women to reduce cardiometabolic and diabetes risk in subsequent pregnancies. A retrospective review of the 12 month postpartum care provided by primary health centres in remote Australia in 2013–2014 identified 195 women who experienced hyperglycaemia in pregnancy (gestational diabetes (GDM) (n = 147), type 2 diabetes (T2D) (n = 39), and unclear diabetes status (n = 9)).
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