Maryam Sina1, Thomas J Cade2, Jeff Flack3, Christopher J Nolan4, Rohit Rajagopal5, Vincent Wong6, Linda Burcher7, Alison Barry8, Emily Gianatti9, Ana McCarthy10, Catharine McNamara11, Marina Mickelson12, Ruth Hughes13, Tara Jones14, Cathy Latino9, David McIntyre8, Sarah Price15, David Simmons1,5. 1. Western Sydney University, Sydney, New South Wales, Australia. 2. Royal Women's Hospital, Melbourne, Victoria, Australia. 3. Bankstown Hospital, Sydney, New South Wales, Australia. 4. The Canberra Hospital, Canberra, Australian Capital Territory, Australia. 5. Campbelltown Hospital, Sydney, New South Wales, Australia. 6. Liverpool Hospital, Sydney, New South Wales, Australia. 7. Flinders Medical Centre, Adelaide, South Australia, Australia. 8. Mater Medical Research Institute, Brisbane, Queensland, Australia. 9. Fiona Stanley Hospital, Perth, Western Australia, Australia. 10. Lyell McEwin Hospital, Adelaide, South Australia, Australia. 11. Deakin University, Burwood, Victoria and The Mercy Hospital for Women, Heidelberg, Victoria, Australia. 12. King Edward Memorial Hospital, Western Australia, Australia. 13. University of Otago, Christchurch, New Zealand. 14. Goulburn Valley Health, Shepparton, Victoria, Australia. 15. University of Melbourne, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: Gestational diabetes (GDM) is one of the commonest pregnancy complications and is placing an increasing burden on diabetes and obstetric resources. AIMS: To describe different antenatal models of care that have developed to address the increasing proportion of pregnancies complicated by GDM. MATERIALS AND METHODS: Narrative review with thematic analysis from 15 volunteer antenatal diabetes in pregnancy services from Australia and New Zealand identified through a national diabetes organisation. Main outcomes were approaches to patient education, medical nutrition therapy (MNT), ongoing management and escalation of therapy for women with GDM. RESULTS: All clinics provided at least one group education and one MNT session within 1-2 weeks of GDM diagnosis. Women from culturally and linguistically diverse communities usually required 1:1 education. Ongoing management of women with GDM was through either all women being seen in the GDM clinic, a step-up approach (ongoing management by the primary antenatal team with diabetes team referral if self-blood glucose monitoring (SBGM) or insulin therapy dosage criteria are reached) or step-down approach (ongoing management by the diabetes team with step-down to the primary antenatal team if SBGM criteria are reached). Telehealth was used to reduce the burden of clinic attendance, particularly in rural areas. CONCLUSIONS: Increasing numbers, earlier diagnoses, the need to provide care to women in rural, remote areas, and cultural/language differences, have generated a range of different antenatal models of care, allowed better workload accommodation and probably reduced costs. Randomised controlled trials of different models of care, with associated health economic analyses, are urgently needed.
BACKGROUND:Gestational diabetes (GDM) is one of the commonest pregnancy complications and is placing an increasing burden on diabetes and obstetric resources. AIMS: To describe different antenatal models of care that have developed to address the increasing proportion of pregnancies complicated by GDM. MATERIALS AND METHODS: Narrative review with thematic analysis from 15 volunteer antenatal diabetes in pregnancy services from Australia and New Zealand identified through a national diabetes organisation. Main outcomes were approaches to patient education, medical nutrition therapy (MNT), ongoing management and escalation of therapy for women with GDM. RESULTS: All clinics provided at least one group education and one MNT session within 1-2 weeks of GDM diagnosis. Women from culturally and linguistically diverse communities usually required 1:1 education. Ongoing management of women with GDM was through either all women being seen in the GDM clinic, a step-up approach (ongoing management by the primary antenatal team with diabetes team referral if self-blood glucose monitoring (SBGM) or insulin therapy dosage criteria are reached) or step-down approach (ongoing management by the diabetes team with step-down to the primary antenatal team if SBGM criteria are reached). Telehealth was used to reduce the burden of clinic attendance, particularly in rural areas. CONCLUSIONS: Increasing numbers, earlier diagnoses, the need to provide care to women in rural, remote areas, and cultural/language differences, have generated a range of different antenatal models of care, allowed better workload accommodation and probably reduced costs. Randomised controlled trials of different models of care, with associated health economic analyses, are urgently needed.
Authors: Jackson Harrison; Sarah Melov; Adrienne C Kirby; Neil Athayde; Araz Boghossian; Wah Cheung; Emma Inglis; Kavita Maravar; Suja Padmanabhan; Melissa Luig; Monica Hook; Dharmintra Pasupathy Journal: BMJ Open Date: 2022-09-26 Impact factor: 3.006
Authors: Jincy Immanuel; Jeff Flack; Vincent W Wong; Lili Yuen; Carl Eagleton; Dorothy Graham; Janet Lagstrom; Louise Wolmarans; Michele Martin; Ngai Wah Cheung; Suja Padmanabhan; Victoria Rudland; Glynis Ross; Robert G Moses; Louise Maple-Brown; Ian Fulcher; Julie Chemmanam; Christopher J Nolan; Jeremy J N Oats; Arianne Sweeting; David Simmons Journal: Int J Environ Res Public Health Date: 2021-05-04 Impact factor: 3.390