Charles Darwin University Primary health care for aboriginal australian women in remote communities after a pregnancy with hyperglycaemia Wood,

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.

[1]  E. Keely.  An opportunity not to be missed – how do we improve postpartum screening rates for women with gestational diabetes? , 2012, Diabetes/metabolism research and reviews.

[2]  Yanna Song,et al.  Disparities in Postpartum Follow-Up in Women With Gestational Diabetes Mellitus , 2014, Clinical Diabetes.

[3]  P. Lawton,et al.  Does delay in planned diabetes care influence outcomes for aboriginal Australians? A study of quality in health care , 2019, BMC Health Services Research.

[4]  A. Ferrara,et al.  Trends in Postpartum Diabetes Screening and Subsequent Diabetes and Impaired Fasting Glucose Among Women With Histories of Gestational Diabetes Mellitus , 2009, Diabetes Care.

[5]  T. Weeramanthri,et al.  Improving organisational systems for diabetes care in Australian Indigenous communities , 2007, BMC Health Services Research.

[6]  M. Cheang,et al.  Gestational diabetes in Manitoba during a twenty-year period. , 2008, Clinical and investigative medicine. Medecine clinique et experimentale.

[7]  J. Shaw,et al.  Diabetes care in remote Australia: the antenatal, postpartum and inter-pregnancy period , 2019, BMC Pregnancy and Childbirth.

[8]  C. Collins,et al.  Postnatal testing for diabetes in Australian women following gestational diabetes mellitus , 2009, The Australian & New Zealand journal of obstetrics & gynaecology.

[9]  V. Basevi.  Standards of Medical Care in Diabetes—2011 , 2011, Diabetes Care.

[10]  Y. Jang,et al.  Standards of Medical Care in Diabetes-2010 by the American Diabetes Association: Prevention and Management of Cardiovascular Disease , 2010 .

[11]  P. Martens,et al.  Does First Nations ancestry modify the association between gestational diabetes and subsequent diabetes: a historical prospective cohort study among women in Manitoba, Canada , 2016, Diabetic medicine : a journal of the British Diabetic Association.

[12]  S. James,et al.  Barriers and enablers to postpartum contraception among Aboriginal Australian women: factors influencing contraceptive decisions. , 2018, Australian journal of primary health.

[13]  N. Cheung,et al.  The discordance between HbA1c and glucose tolerance testing for the postpartum exclusion of diabetes following gestational diabetes. , 2015, Diabetes research and clinical practice.

[14]  Sonya S. Shin,et al.  Glycemic control and healthcare utilization following pregnancy among women with pre-existing diabetes in Navajo Nation , 2018, BMC Health Services Research.

[15]  Kent L Thornburg,et al.  Effect of in Utero and Early-life Conditions on Adult Health and Disease Epidemiol Ogic a Nd Clinic a L Observations , 2022 .

[16]  L. Barclay,et al.  From hospital to home: the quality and safety of a postnatal discharge system used for remote dwelling Aboriginal mothers and infants in the top end of Australia. , 2012, Midwifery.

[17]  Nathaniel D Osgood,et al.  The inter- and intragenerational impact of gestational diabetes on the epidemic of type 2 diabetes. , 2011, American journal of public health.

[18]  F. Tinahones,et al.  Hemoglobin A1c Versus Oral Glucose Tolerance Test in Postpartum Diabetes Screening , 2012, Diabetes Care.

[19]  Tamim Ahmed,et al.  Effectiveness of a disease management program for patients with diabetes. , 2004, Health affairs.

[20]  A. Sinha,et al.  Low Rates of Postpartum Glucose Screening Among Indigenous and non-Indigenous Women in Australia with Gestational Diabetes , 2015, Maternal and Child Health Journal.

[21]  A. Sinha,et al.  Improving Models of Care for Diabetes in Pregnancy: Experience of Current Practice in Far North Queensland, Australia , 2019, Front. Public Health.

[22]  A. Hingorani,et al.  Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis , 2009, The Lancet.

[23]  J. Humphreys,et al.  Patterns of resident health workforce turnover and retention in remote communities of the Northern Territory of Australia, 2013–2015 , 2017, Human Resources for Health.

[24]  C. Collins,et al.  Perceived risk of Type 2 diabetes in Australian women with a recent history of gestational diabetes mellitus , 2010, Diabetic medicine : a journal of the British Diabetic Association.

[25]  L. Maple-Brown,et al.  Improving health service delivery for women with diabetes in pregnancy in remote Australia: survey of care in the Northern Territory Diabetes in Pregnancy Partnership , 2014, The Australian & New Zealand journal of obstetrics & gynaecology.

[26]  P. Middleton,et al.  Women's views and knowledge regarding healthcare seeking for gestational diabetes in the postpartum period: A systematic review of qualitative/survey studies. , 2015, Diabetes research and clinical practice.

[27]  T. Farrell,et al.  Congenital anomalies in the offspring of women with Type 1, Type 2 and gestational diabetes , 2002, Diabetic medicine : a journal of the British Diabetic Association.

[28]  Gerard J Fitzsimmons,et al.  From the Australian Institute of Health and Welfare , 2014, Communicable diseases intelligence quarterly report.

[29]  N. McGrath,et al.  Further post‐partum follow‐up of women with gestational diabetes mellitus from Northland, New Zealand , 2012, Diabetic medicine : a journal of the British Diabetic Association.

[30]  T. Buchanan,et al.  Patterns of congenital anomalies and relationship to initial maternal fasting glucose levels in pregnancies complicated by type 2 and gestational diabetes. , 2000, American journal of obstetrics and gynecology.

[31]  R. Holman,et al.  Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study , 2000, BMJ : British Medical Journal.

[32]  R. Wolfe,et al.  Associations with low rates of postpartum glucose screening after gestational diabetes among Indigenous and non‐Indigenous Australian women , 2015, Australian and New Zealand journal of public health.

[33]  S. Belton,et al.  Improving Aboriginal maternal and infant health services in the ‘Top End’ of Australia; synthesis of the findings of a health services research program aimed at engaging stakeholders, developing research capacity and embedding change , 2014, BMC Health Services Research.

[34]  J. Newbury,et al.  Primary health care for Aboriginal women and children in the year after birth: findings from a population‐based study in South Australia , 2016, Australian and New Zealand journal of public health.

[35]  K. Hunt,et al.  Who returns for postpartum glucose screening following gestational diabetes mellitus? , 2008, American journal of obstetrics and gynecology.

[36]  J. Shaw,et al.  Preconception care for women with type 2 diabetes mellitus: A mixed-methods study of provider knowledge and practice. , 2017, Diabetes research and clinical practice.

[37]  R. Dyck,et al.  A comparison of rates, risk factors, and outcomes of gestational diabetes between aboriginal and non-aboriginal women in the Saskatoon health district. , 2002, Diabetes care.

[38]  E. Keely,et al.  Original research: postpartum testing rates among women with a history of gestational diabetes--systematic review. , 2013, Primary care diabetes.

[39]  F. Connell,et al.  Gestational Diabetes Is a Herald of NIDDM in Navajo Women: High rate of abnormal glucose tolerance after GDM , 1997, Diabetes Care.

[40]  R. Wolfe,et al.  Type 2 diabetes after gestational diabetes: greater than fourfold risk among Indigenous compared with non‐Indigenous Australian women , 2016, Diabetes/metabolism research and reviews.

[41]  R. Almog,et al.  Missed opportunities for appropriate postpartum care in women with pregestational diabetes , 2015, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[42]  M. Huffman,et al.  Cardiovascular health in indigenous communities: successful programs. , 2010, Heart, lung & circulation.

[43]  J. Carapetis,et al.  Use of health services by remote dwelling Aboriginal infants in tropical northern Australia: a retrospective cohort study , 2012, BMC Pediatrics.

[44]  N. Roux,et al.  Paths to improving care of Australian Aboriginal and Torres Strait Islander women following gestational diabetes , 2017, Primary Health Care Research &amp; Development.

[45]  Andrew B. Kirke,et al.  Diabetes screening in pregnancy failing women in rural Western Australia: An audit of oral glucose tolerance test completion rates , 2019, The Australian journal of rural health.

[46]  T. Carey,et al.  Long-term trends in supply and sustainability of the health workforce in remote Aboriginal communities in the Northern Territory of Australia , 2017, BMC Health Services Research.