Lynne Chepulis1, Ryan Paul2, Elizabeth Lewis-Hills3, Manjula Ratnaweera3, Neve Mclean4, Louise Wolmarans5, Jade Tamatea6. 1. Medical Research Centre, University of Waikato, Hamilton. 2. Medical Research Centre, University of Waikato, Hamilton; Waikato Regional Diabetes Service, Waikato District Health Board, Hamilton. 3. Waikato Regional Diabetes Service, Waikato District Health Board, Hamilton. 4. Department of Human Nutrition, University of Otago, Dunedin. 5. Waikato Regional Diabetes Service, Waikato District Health Board, Hamilton; Department of Medicine, University of Auckland, Auckland. 6. Waikato Regional Diabetes Service, Waikato District Health Board, Hamilton; Department of Medicine, University of Auckland, Auckland; Te Kupenga Hauora Māori, University of Auckland, Auckland.
Abstract
AIM: The aim of this study was to assess adherence to the 2014 Ministry of Health (MoH) screening guidelines for diabetes in pregnancy (DiP) by Māori and non-Māori in the Waikato region. METHODS: Clinical records were reviewed for women without known diabetes before pregnancy who delivered in hospitals or community birth centres in the Waikato region during June-August 2017. Screening rates for DiP were assessed using HbA1c, glucose challenge and/or glucose tolerance tests. RESULTS: Of a total of 807 women, 94% received some form of screening for DiP; 527 (65.3%) underwent HbA1c screening at <20 weeks and 267 (33.1%) underwent testing for gestational diabetes at 24-28 weeks' gestation. However, only 213 (26.4%) received all screening as per the MoH guideline. HbA1c testing was the most common screening performed (83.9% of all pregnancies), and three quarters of women had a glucose load screen at some point during pregnancy. In all measures, screening rates were lower in Māori, with only 17.5% (46 of 263 women) receiving both HbA1c and further glucose load screening in the recommended gestation windows (versus 31.6% (171 of 541) for non-Māori; P<0.0005). CONCLUSIONS: Adherence to screening guidelines for DiP was poor with a marked ethnic inequity. Further work is needed to investigate the barriers to care that drive these differences.
AIM: The aim of this study was to assess adherence to the 2014 Ministry of Health (MoH) screening guidelines for diabetes in pregnancy (DiP) by Māori and non-Māori in the Waikato region. METHODS: Clinical records were reviewed for women without known diabetes before pregnancy who delivered in hospitals or community birth centres in the Waikato region during June-August 2017. Screening rates for DiP were assessed using HbA1c, glucose challenge and/or glucose tolerance tests. RESULTS: Of a total of 807 women, 94% received some form of screening for DiP; 527 (65.3%) underwent HbA1c screening at <20 weeks and 267 (33.1%) underwent testing for gestational diabetes at 24-28 weeks' gestation. However, only 213 (26.4%) received all screening as per the MoH guideline. HbA1c testing was the most common screening performed (83.9% of all pregnancies), and three quarters of women had a glucose load screen at some point during pregnancy. In all measures, screening rates were lower in Māori, with only 17.5% (46 of 263 women) receiving both HbA1c and further glucose load screening in the recommended gestation windows (versus 31.6% (171 of 541) for non-Māori; P<0.0005). CONCLUSIONS: Adherence to screening guidelines for DiP was poor with a marked ethnic inequity. Further work is needed to investigate the barriers to care that drive these differences.