title: 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.
abstract: BACKGROUND
  Gestational diabetes mellitus (GDM) is increasing, along with obesity and type 2 diabetes (T2DM), with Aboriginal and Torres Strait Islander (Aboriginal(a)) 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
  This 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.
  
  
  CONCLUSIONS
  There 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.
authors: Global Health and Society Unit, Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, L3/89 Commercial Rd, Prahan, Victoria, 3181 Australia.
authors: Catherine
authors: C
authors: Chamberlain
authors: Office of Indigenous Engagement, Central Queensland University, Bruce Highway, North Rockhampton, Queensland, 4701 Australia.
authors: Bronwyn
authors: B
authors: Fredericks
authors: Cairns Diabetes Centre, PO Box 902, Cairns, Queensland 4870 Australia.
authors: Bronwyn
authors: B
authors: Davis
authors: Apunipima Cape York Health Council, 186 McCoombe Street, Cairns, Queensland 4870 Australia.
authors: Jacqueline
authors: J
authors: Mein
authors: Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, L6/96 Commercial Rd, Prahan, Victoria, 3181 Australia.
authors: Catherine
authors: C
authors: Smith
authors: Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales 2006 Australia.
authors: Sandra
authors: S
authors: Eades
authors: Global Health and Society Unit, Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, L3/89 Commercial Rd, Prahan, Victoria, 3181 Australia.
authors: Brian
authors: B
authors: Oldenburg
keywords: Aboriginal; Diabetes; Gestational diabetes mellitus; Indigenous; Pregnancy; Type 2 diabetes mellitus