title: A threefold increase in gestational diabetes over two years: review of screening practices and pregnancy outcomes in Indigenous women of Cape York, Australia.
abstract: BACKGROUND
  Australian Aboriginal women have a high prevalence of type 2 diabetes (T2DM) in pregnancy and gestational diabetes (GDM).
  
  
  OBJECTIVE
  To review how screening practice affects the pregnancy data of all Indigenous women and their newborns living in Cape York, Queensland.
  
  
  METHODS
  All medical charts of mothers and their neonates delivered in the regional hospital over two-one-year periods (2006 and 2008) were reviewed. Universal testing with an oral glucose tolerance test (OGTT) was introduced in 2007.
  
  
  RESULTS
  Gestational diabetes (GDM) increased from 4.7 to 14.2%, and T2DM was similar (2.4 and 2.3%). There were 127 deliveries in 2006 and 134 in 2008. Testing rates with OGTT improved from 31.4% in 2006 to 65.6% in 2008. Mothers with diabetes in pregnancy (DIP) were older and heavier than non-DIP mothers. Caesarean section rates were significantly higher in the DIP group compared with the non-DIP group (66 vs 25%) in both time periods. The booking weight of DIP mothers decreased 16 kg, their babies normalised their weight, length and head circumference; respiratory distress and Apgar scores improved comparing the two periods. In DIP, infants >40% had hypoglycaemia; however, rates of serious complications were low. Rates of breastfeeding were similar between groups. Follow-up rates for GDM improved from 16.6% in 2006 to 31.6% in 2008. Of those tested one-third were diagnosed with T2DM.
  
  
  CONCLUSIONS
  The rate of GDM tripled after implementation of universal testing. Outcomes improved. There is still need for improvement in testing and follow-up practices in relation to DIP.
authors.affiliation: Cairns Diabetes Centre, Cairns Base Hospital, Cairns, Queensland, Australia.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Davis
authors.forename: Anna
authors.initials: A
authors.lastname: McLean
authors.forename: Ashim K
authors.initials: AK
authors.lastname: Sinha
authors.forename: Henrik
authors.initials: H
authors.lastname: Falhammar
mesh_terms: D001942:Breast Feeding / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000208:ethnology; D016640:Diabetes, Gestational / Q000175:diagnosis / Q000208:ethnology*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007003:Hypoglycemia / Q000208:ethnology; D007231:Infant, Newborn; D008403:Mass Screening; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000208:ethnology*; D011254:Pregnancy in Diabetics; D011793:Queensland / Q000453:epidemiology
keywords: aboriginal; diabetes in pregnancy; outcomes; quality improvement; type 2 diabetes