title: Low rates of postpartum glucose screening among indigenous and non-indigenous women in Australia with gestational diabetes.
abstract: Women with gestational diabetes have a high risk of type 2 diabetes postpartum, with Indigenous women particularly affected. This study reports postpartum diabetes screening rates among Indigenous and non-Indigenous women with gestational diabetes, in Far North Queensland, Australia. Retrospective study including 1,012 women with gestational diabetes giving birth at a regional hospital from 1/1/2004 to 31/12/2010. Data were linked between hospital records, midwives perinatal data, and laboratory results, then analysed using survival analysis and logistic regression. Indigenous women had significantly longer times to first oral glucose tolerance test (OGTT) [hazards ratio (HR) 0.62, 95 % confidence interval (CI) 0.48-0.79, p < 0.0001) and 'any' postpartum glucose test (HR 0.81, 95 % CI 0.67-0.98, p = 0.03], compared to non-Indigenous women. Postpartum screening rates among all women were low. However, early OGTT screening rates (<6 months) were significantly lower among Indigenous women (13.6 vs. 28.3 %, p < 0.0001), leading to a persistent gap in cumulative postpartum screening rates. By 3 years postpartum, cumulative rates of receiving an OGTT, were 24.6 % (95 % CI 19.9-30.2 %) and 34.1 % (95 % CI 30.6-38.0 %) among Indigenous and non-Indigenous women, respectively. Excluding OGTTs in previous periods, few women received OGTTs at 6-24 months (7.8 vs. 6.7 %) or 2-4 years (5.2 vs. 6.5 %), among Indigenous and non-Indigenous women, respectively. Low rates of postpartum diabetes screening demonstrate that essential 'ongoing management' and 'equity' criteria for population-based screening for gestational diabetes are not being met; particularly among Indigenous women, for whom recent guideline changes have specific implications. Strategies to improve postpartum screening after gestational diabetes are urgently needed.
authors: Global Health and Society Unit, Faculty of Medicine, Nursing and Health Sciences, Monash University, L3/89 Commercial Rd, Prahran, VIC, 3181, Australia, Catherine.chamberlain@monash.edu.
authors: Catherine
authors: C
authors: Chamberlain
authors: Anna
authors: A
authors: McLean
authors: Jeremy
authors: J
authors: Oats
authors: Brian
authors: B
authors: Oldenburg
authors: Sandra
authors: S
authors: Eades
authors: Ashim
authors: A
authors: Sinha
authors: Rory
authors: R
authors: Wolfe
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D001786:Blood Glucose / Q000032:analysis*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000208:ethnology; D016640:Diabetes, Gestational / Q000208:ethnology* / Q000503:physiopathology; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D016015:Logistic Models; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D049590:Postpartum Period; D011247:Pregnancy; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose