Bronwyn Davis

A threefold increase in gestational diabetes over two years: review of screening practices and pregnancy outcomes in Indigenous women of Cape York, Australia

Australian Aboriginal women have a high prevalence of type 2 diabetes (T2DM) in pregnancy and gestational diabetes (GDM).

Maternal and neonatal outcomes following diabetes in pregnancy in Far North Queensland, Australia

Background: Diabetes in pregnancy (DIP) is increasing and is associated with a number of adverse consequences for both the mother and the child.

Maternal and neonatal outcomes in the Torres Strait Islands with a sixfold increase in type 2 diabetes in pregnancy over six years

Background:  Torres Strait Islander population has a high prevalence of type 2 diabetes (T2DM).

Postpartum care for Aboriginal and non-Aboriginal women with Gestational Diabetes Mellitus across urban, rural and remote locations: A protocol for a cohort linkage study

BackgroundGestational diabetes mellitus (GDM) is increasing, along with obesity and type 2 diabetes (T2DM), with Aboriginal and Torres Strait Islander (Aboriginala) women in Australia particularly affected. GDM causes serious complications in pregnancy, birth, and the longer term, for women and their infants. Women with GDM have an eightfold risk of developing T2DM after pregnancy, compared to women without GDM. Indigenous women have an even higher risk, at a younger age, and progress more quickly from GDM to T2DM, compared to non-Indigenous women. If left undetected and untreated, T2DM increases risks in subsequent pregnancies, and can lead to heart disease, stroke, kidney failure, limb amputations and blindness for the woman in the longer term. A GDM diagnosis offers a ‘window of opportunity’ to provide acceptable and effective prevention, treatment, and postpartum care. Low rates of postpartum T2DM screening are reported among non-Aboriginal women in Australia and Indigenous women in other countries, however, data for Aboriginal women in Australia are scarce. A healthy diet, exercise and breastfeeding can delay the onset of T2DM, and together with T2DM screening are recommended elements of postpartum care for women with GDM. This paper describes methods for a study evaluating postpartum care among Aboriginal and non-Aboriginal women with GDM.Methods/DesignThis retrospective cohort includes all women who gave birth at Cairns Hospital in far north Queensland, Australia, from 2004 to 2010, coded as having GDM in the Cairns Hospital Clinical Coding system. Data is being linked with the Midwives Perinatal Data Collection, and the three local laboratories. Hospital medical records are being reviewed to validate accuracy of GDM case ascertainment, and gather information on breastfeeding and provision of dietary advice. Survival analysis is being used to estimate time to screening, and rates of progression from GDM to T2DM. Logistic regression is being used to compare postpartum care between Aboriginal and non-Aboriginal women, and assess factors that may be associated with provision of postpartum care.DiscussionThere are challenges to collecting postpartum data for women with GDM, however, this research is urgently needed to ensure adequate postpartum care is provided for women with GDM.

Gestational Diabetes Mellitus in far north Queensland, Australia, 2004 to 2010: midwives' perinatal data most accurate source

Objectives: This study examines the accuracy of Gestational Diabetes Mellitus (GDM) case‐ascertainment in routinely collected data.

Pregnancy and neonatal outcomes in Indigenous Australians with diabetes in pregnancy

AIM To perform a systematic review of reported neonatal and pregnancy outcomes of Indigenous Australians with diabetes in pregnancy (DIP). METHODS Electronic searches of PubMed and Web of Science were carried out. Articles were selected if they contained original data on DIP outcomes in Indigenous Australians. There were no specific exclusion criteria. RESULTS A total of eight articles, predominantly from Queensland and Western Australia were identified once inclusion criteria were applied. Birth data from midwifery registries or paper charts encompassing years 1985-2008 were used. A total of 465591 pregnant women with and without DIP were included in the eight studies, with 1363 being Indigenous women with DIP. Indigenous Australians experienced increased rates of many known adverse outcomes of DIP including: macrosomia, caesarean section, congenital deformities, low birth weight, hypoglycaemia, and neonatal trauma. There were regional differences among Indigenous Australians, particularly regional/remote vs metropolitan populations where the regional/remote data showed worse outcomes. Two of the articles did not note a difference between Aboriginals and Caucasians in the rates of measured adverse outcome. Studies varied significantly in size, measured outcomes, and subsequent analysis. CONCLUSION The health disparities between Indigenous Australians and non-Indigenous Australians are further evidenced by poorer outcomes in DIP. This has broader implications for Indigenous health in general.