Poster Presentation Australasian Diabetes in Pregnancy Society Annual Scientific Meeting 2023

Examining prevalence and outcomes of diabetes in pregnancy at Albury Wodonga Health Between May 2019 and 2022. (#55)

Michael Fogarty 1 2 , Katie Fearnside 3 , Changjia Chai 1 , Ali Hazara 1 , Amanda Goh 1 , Miriam Siever 1 , Stephanie Walton 1 , Fiona Stenning 4 , Simone Mulder 4 , Annie Hung 1
  1. Medicine, Albury Wodonga Health, Albury, NSW, Australia
  2. Medicine, Royal Melbourne Health, Parkville, Victoria, Australia
  3. Nursing, Albury Wodonga Health, Albury, NSW, Australia
  4. Obstetrics, Albury Wodonga Health, Albury, NSW, Australia

Background: Albury Wodonga Health(AWH) is a health service on the border of Victoria and New South Wales that provides obstetric services to a primary catchment population of 99,346 people. As the population as well as our health service expands, we aim to examine our incidence of diabetes in pregnancy and the maternal and neonatal outcomes associated. Diabetes in pregnancy is associated with significant adverse outcomes1, such as preeclampsia, macrosomia or IUGR and birth trauma, as well as congenital defects, particularly with poor diabetic control. Recent audits in gestational diabetes demonstrated poorer outcomes for mothers in rural settings2, we wished to examine our own outcomes.


Objectives: To identify the incidence of diabetes in pregnancy at AWH, and examine the maternal and neonatal outcomes.

Methods: All births in the time period May 1 2019 to April 30 2022 were reviewed. A chart review was completed for documented evidence of a diagnosis of diabetes in pregnancy; Pre-existing Type 1, Type 2 or Gestational. To confirm a diagnosis of Gestational Diabetes, oral glucose tolerance test3 values had to be sighted. Mothers who were tested with HbA1c and fasting glucose levels as screening for GDM during the Covid-19 pandemic were classed as unable to be determined/not-tested/not documented, as such there is likely an underestimation of prevalence4,5. All births were reviewed for gestational age at birth, method of birth and special care nursery(SCN) admission.


Results: 5030 births were analysed. There were 4998 live-births, 39 twin births and 32 stillbirths. There were 19(0.4%) births by mothers classified as having pre-existing type 1 diabetes, 14(0.3%) pre-existing type 2 diabetes, and 649(13%) deliveries by mothers classified as having GDM. 2178 women were classified as having no diagnosis of diabetes, with 2123 undetermined/not-tested/not-documented. The comparative incidence of instrumental birth was 13% to a mother with diabetes vs 15%. The LSCS rate was 41% to a mother with diabetes vs 30%. The incidence of SCN admission was 68.42% for births to a mother with type 1 diabetes, 64.29% type 2 diabetes, 38.78% gestational diabetes, and 18.83% for a mother with no diagnosis or an unknown diabetes status.


Conclusion: Gestational Diabetes is a relatively common condition in pregnancy in AWH. It demonstrates a higher rate of assisted birth. There is also a high requirement for SCN beds for babies born to mothers with GDM. It is imperative that diabetes in pregnancy receives adequate resourcing to deliver good outcomes to mothers and babies.

 

  1. 1. Inkster ME, Fahey TP, Donnan PT, Leese GP, Mires GJ, Murphy DJ. Poor glycated haemoglobin control and adverse pregnancy outcomes in type 1 and type 2 diabetes mellitus: systematic review of observational studies. BMC Pregnancy Childbirth. 2006;6:30. Published 2006 Oct 30. doi:10.1186/1471-2393-6-30
  2. 2. Williamson RL, McCarthy EA, Oats JJ, Churilov L, Lappas M, Shub A. Obstetric and perinatal outcomes for women with pre-existing diabetes in rural compared to metropolitan settings in Victoria, Australia. Aust N Z J Obstet Gynaecol. 2021 Jun;61(3):373-379. doi: 10.1111/ajo.13295. Epub 2021 Jan 24. PMID: 33486753.
  3. 3 HAPO Collaborative Research Group. Hyperglycemia and adverse pregnancy outcomes. New Eng J Med 2008; 358:1991‐2002
  4. 4. Walker B, Edey J, Hall L, Braniff K, Heal C. Impact of new diagnostic pathway for gestational diabetes in time of COVID-19. Obstet Med. 2023;16(2):104-108. doi:10.1177/1753495X221094899
  5. 5. van Gemert TE, Moses RG, Pape AV, Morris GJ. Gestational diabetes mellitus testing in the COVID-19 pandemic: The problems with simplifying the diagnostic process. Aust N Z J Obstet Gynaecol. 2020;60(5):671-674. doi:10.1111/ajo.13203