Oral Presentation International Association of the Diabetes and Pregnancy Study Groups 2022 - Hosted by ADIPS

Early screening for gestational diabetes and birth outcomes among Aboriginal women in remote Northern Territory. (#35)

Anna J Wood 1 2 , Chloe O'Hara 1 , Ariella Joyce-Tubb 1 , Paula Van Dokkum 1 3 , Vanya Hampton 4 , Christine Connors 5 , Megan Hallliday 6 , Mary Wicks 1 , Louise J Maple-Brown 1 2 , Matthew J.L Hare 1 2
  1. Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
  2. Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
  3. Maternity Unit, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
  4. Aboriginal and Torres Strait Islander Advisory Group, Menzies School of Health Research, Darwin, Northern Territory, Australia
  5. Primary Health Care, Top End Region, NT Health, Darwin, Northern Territory, Australia
  6. Department of Obstetrics and Gynaecology, Alice Springs Hospital, Alice Springs, Northern Territory, Australia

Background: Aboriginal women are at high risk of gestational diabetes (GDM) and oral glucose tolerance test (OGTT) screening in early pregnancy is recommended. Rates of screening and outcomes in incompletely screened pregnancies are unclear. We aimed to determine uptake of diabetes screening as per guidelines and birth outcomes among women who had early (<20 weeks) OGTT screening, women who did not have early OGTT screening and women with pre-existing diabetes.

Methods: We conducted a retrospective study of all pregnancies among Aboriginal women (2017-2019) receiving antenatal care in 52 remote clinics across the Northern Territory (NT). Data were extracted from NT Primary Health Care Collection and NT Perinatal Data Collection, supplemented by manual review of individual records (n=902). Birth outcomes were assessed with logistic regression, stratified into three groups (early OGTT, no early OGTT and pre-existing diabetes). The combined primary outcome incorporated any of large for gestational age, caesarean section, neonatal admission to special care nursey, pre-term birth, and preeclampsia.

Results: Of 1191 pregnancies, 6.4% (n=76) had pre-existing diabetes (all type 2). Women without an early OGTT were younger and had lower BMI than both women who had an early OGTT and women with T2D (age: 24 years (SD 5.4) vs. 26 (5.6) vs. 30 (5.0), p=0.03; BMI 25 kg/m2 (SD 6.4) vs. 27 (6.6) vs. 31 (5.6), p<0.01, respectively). Among women without pre-existing T2D, 19% (n=226) had an early OGTT, 50% (n=561) only had a routine OGTT (≥20 weeks), 26% (n=284) only had an HbA1c, 0.7% (n=8) had only a random plasma glucose, and 3% (n=36) had no glycaemic screening throughout their pregnancy. Compared to women with an early OGTT, odds of developing an adverse event were similar for women without an early OGTT (OR 0.8, 95% CI: 0.6-1.1, p=0.23) and higher for women with pre-existing T2D (OR 7.1, 95% CI: 3.3-15.7, p<0.01), with no meaningful change after adjustment for age, smoking, BMI or parity. Concerningly, the stillbirth rate with T2D was 9% (n=7).

Conclusions: Among Aboriginal women in remote NT, uptake of GDM screening with an early pregnancy OGTT was low, though more likely for older women with a higher BMI, suggesting clinicians are further risk stratifying. We report similar birth outcomes for women who did and did not have an OGTT in early pregnancy, yet significantly worse outcomes for women with T2D, highlighting a need to strengthen care for women with pre-existing T2D.