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

Changes in birth outcomes following a multi-component health systems intervention for hyperglycaemia in pregnancy in Australia’s Northern Territory (#37)

Diana MacKay 1 2 , Renae Kirkham 2 , Jacqueline Boyle 3 , Sandra Campbell 4 , Federica Barzi 5 , Alex Brown 6 7 , Jeremy Oats 8 , Paul Zimmet 9 , Anthony Hanley 10 , Holger Unger 1 2 , Louise Maple-Brown 1 2
  1. Royal Darwin Hospital, Tiwi, NT, Australia
  2. Menzies School of Health Research, Tiwi, NT, Australia
  3. Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
  4. College of Nursing and Midwifery, Charles Darwin University, Cairns, QLD, Australia
  5. Poche Centre for Indigenous Health, University of Queensland, Brisbane, QLD, Australia
  6. Telethon Kids Institute, Adelaide, SA, Australia
  7. National Centre for Indigenous Genomics, Australian National University, Adelaide, SA, Australia
  8. Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
  9. Department of Diabetes, Central Clinical School, Monash University, Melbourne University, VIC, Australia
  10. Department of Nutritional Sciences, Joannah & Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Canada

Background: In countries with a history of colonisation, hyperglycaemia in pregnancy disproportionately affects First Nations women. In regional and remote Australia there are many barriers to providing optimal care for women with hyperglycaemia in pregnancy. Since 2011, the Diabetes Across the Lifecourse: Northern Australia Partnership has aimed to improve systems of care for women with hyperglycaemia in pregnancy in Australia’s Northern Territory (NT). Here we report on changes to birth outcomes in women with hyperglycaemia in pregnancy between 2012 and 2019.


Methods: This study included singleton births occurring between 2012 and 2019 to women with gestational diabetes (GDM), newly diagnosed overt diabetes in pregnancy (DIP) or pre-existing type 2 diabetes (T2D) enrolled in the NT Diabetes in Pregnancy Clinical Register. Changes in birth outcomes over the study period were assessed with odds ratios (OR) for each calendar year compared to the previous, estimated with logistic regression. Models were stratified by diabetes type and First Nations status and were adjusted for maternal age, body mass index, alcohol use, smoking status, pre-existing hypertension and study region (Top End or Central Australia).


Results: Data for 2603 births (47.6% to First Nations women) were included. GDM accounted for 68.8% of births, DIP 13.1% and T2D 18.1%, with proportions of DIP and T2D higher for First Nations women. The adjusted risk of macrosomia increased by 17% per year for First Nations women with GDM (OR 1.17 per year; 95%CI 1.01, 1.35); macrosomia risk was unchanged for First Nations women with DIP and T2D, and for all diabetes categories of non-First Nations women. Risk of neonatal hypoglycaemia decreased for non-First Nations women with GDM (OR 0.84; 95%CI 0.79, 0.90) and DIP (OR 0.80; 95%CI 0.65, 0.99). Exclusive breastfeeding at hospital discharge decreased in First Nations women across all diabetes types (GDM OR 0.83; 95%CI 0.71, 0.98; DIP OR 0.76; 95%CI 0.97; T2D OR 0.82; 95%CI 0.73, 0.93). Any breastfeeding at discharge increased among non-First Nations women with T2D (OR 1.48; 95%CI 1.03, 2.14). Large for gestational age, delivery by caesarean, gestational age at birth and admission to special care nursery were unchanged across all groups.


Conclusion: Despite efforts to improve systems of care, birth outcomes for Australian First Nations women with hyperglycaemia in pregnancy in the NT did not improve over the study period. Further work is needed to strengthen the cultural safety of models of care and address the social determinants of health.