Poster Presentation Australasian Diabetes in Pregnancy Society Annual Scientific Meeting 2024

Preconception antenatal and postpartum screening for hyperglycaemia in Kimberley Aboriginal women (#35)

Emma L Jamieson 1 , Erica P Spry 2 3 , Matt Le Lievre 3 , Steve Pratt 3 , Lorraine Anderson 2 , Julia V Marley 3
  1. The Rural Clinical School of Western Australia, The University of Western Australia, Bunbury, WA, Australia
  2. Kimberley Aboriginal Medical Services, Broome, WA, Australia
  3. The Rural Clinical School of Western Australia, The University of Western Australia, Broome, WA, Australia

Background: Kimberley Clinical Guidelines standardise screening for, and management of, health conditions that are more prevalent in the Kimberley region of WA. Developed by multidisciplinary teams of local healthcare providers, Kimberley diabetes guidelines acknowledge that screening may differ from national guidelines due to the extreme remoteness of the region. In addition to ADIPS guidelines, Kimberley guidelines recommend:

  1. Annual HbA1c (>15 years): diabetes ≥5%; and prediabetes 5.7-6.4%;
  2. Universal HbA1c at first antenatal presentation: diabetes in pregnancy ≥5%; and
  3. Four-months postpartum HbA1c.

Aim: To describe preconception, antenatal and postpartum screening outcomes for hyperglycaemia in Aboriginal women attending a Kimberley Aboriginal Community Controlled Health Service (ACCHS) for antenatal care between 2017 and 2022.

Methods: Electronic medical records were audited to record maternal characteristics, completion of preconception, antenatal and postpartum screening tests and antenatal management for hyperglycaemia.

Results: Of 1149 pregnancies, 3.5% (40) were complicated by pregestational type 2 diabetes (T2D). Of the remaining 1109 pregnancies 36.6% (406) of women had a HbA1c measurement in the 12-months prior to conception: 56 prediabetes (15.5% of tested).

Most women (84.7%) presented for antenatal care before 20-weeks gestation (7.7 ± 4.5 weeks). Despite 52.7% of women having at least one risk-factor for hyperglycaemia in pregnancy in addition to Aboriginal ethnicity, a risk-based early OGTT was only completed by 12.4% of women (Table). HbA1c was completed 7.8 weeks earlier in gestation [6.9-8.6, P<0.001] and more often than an early OGTT (P< 0.001). Despite higher completion of other antenatal investigations >24-weeks (78.0%), universal OGTT completion was low: 115 hyperglycaemia (26.7% of tested).

Table. Antenatal screening outcomes

 

<20 weeks gestation

N=939

<20 weeks gestation

N=939

≥24 gestation

N=852

Screening outcome:

HbA1c

OGTT

OGTT

Number (%)

591 (63.9%)

138 (12.4%)

430 (50.5%)

Gestation (weeks)

7.8 ± 4.6

15.6 ± 3.7

28.6 ± 2.2 weeks

Diabetes in pregnancy

1

5

8

Prediabetes / GDM

42 (4.5%)

43 (4.6%)

107 (12.5%)

Of 177 women managed for hyperglycaemia in pregnancy 54.2% had a HbA1c measurement within 12-months postpartum: 9 T2D (4.8%); 29 prediabetes (28.2%).

Conclusion: Efforts to increase preconception and postpartum screening for hyperglycaemia are warranted in this population. Compared to an early pregnancy OGTT, universal early screening by HbA1c appears more acceptable, and is completed significantly earlier in pregnancy providing more time for education and management. More acceptable tests are needed to improve screening participation and detection of hyperglycaemia after 24-weeks gestation.