15 Gestational diabetes mellitus (GDM) is any degree of glucose intolerance with onset or first recognition during p regnancy (1). Women with undiagnosed or poorly managed GDM are at incre a s e d risk of having a large for gestational age (LGA) infant. A LGA infant may be re s p o nsible for cephalo-pelvic dispro p o rtion and hence an increased risk of obstetric intervention including cesarean section.While it is not invariable that women with GDM will have a higher section rate (2,3), it has been suggested recently that knowledge by the obstetric care pro v i d e r s that a woman has GDM is likely to lead to a higher rate (4-6). If this is the case, then some of the potential advantages of diagnosing GDM may be offset by the cost, inconvenience, and complications of this higher section rate. However, if higher section rates are found only in some hospitals, then knowledge about this local practice should not be endorsed as a general disincentive to test women for GDM.The aim of this study was to determ i n e the cesarean section rate in a consecutive series of women with GDM and to compare the reasons for section with a control gro u p of consecutive glucose-tolerant women. RESEARCH DESIGN AND M E T H O D S -The diagnosis of GDM was based on the recommendations of the Australasian Diabetes in Pregnancy Society (ADIPS) criteria (7). Unless indicated earlier in pre g n a n c y, all women were tested at the beginning of the 3rd trimester with a 75-g oral glucose tolerance test (GTT) administ e red in the morning after an overnight fast. Although the ADIPS criteria allow the option of a pre l i m i n a ry screening test, all women in our Health Area of New South Wales, Australia have the definitive GTT as a one-stage test. Women were diagnosed with GDM if the 2-h plasma glucose level was 8.0 mmol/l (144 mg/dl). Although the ADIPS criteria specify that GDM is also diagnosed if the fasting level is 5.5 mmol/l (99 mg/dl), 92% or more of cases of GDM a re diagnosed on the result of the 2-h level (8). For local logistical reasons some women only have the 2-h test on the GTT (9).The women with GDM who had had a section were from a consecutive series of women re f e rred for the medical management of their GDM to a diabetologist (R.G.M.) over the period 1990-1998. All details were obtained from a compre h e n s i v e clinical database established and maintained for all women treated. All women were seen initially and reviewed as re q u i red by a dietitian and diabetes educator. All women received a carbohydrate-controlled diet and p e rf o rmed home glucose monitoring. The use of insulin was recommended if the fasting glucose was 5.5 mmol/l or the postprandial glucose levels were 8.0 mmol/l 1 h after a meal or 7.0 mmol/l 2 h after a meal. Obstetric care was conducted independently of the medical management and t h e re were no combined appointments. The number of obstetric care providers primarily responsible for the deliveries varied over the period when the data was being collected but was approximately six.For compa...

Objectives:  To explore and describe the work patterns of Australian dietitians working in type 2 diabetes and to identify variations in practice and gaps in applying evidence. Subjects and design:  In‐depth telephone interviews were conducted with a purposive sample of 20 Australian dietitians working in the area of type 2 diabetes to determine elements of current practice and views on best practice. For the purpose of the present study a diabetes dietitian was defined as spending ≥50% of their patient management time in type 2 diabetes. Data were content‐analysed and ethnographic descriptions were developed for practitioners’ daily activities that were sensitive to the context in which the research was conducted. Results:  Interviewees described a standard dietetic process, involving assessment, education, goal setting and the monitoring of outcomes. Their descriptions were consistent with practice guidelines established elsewhere and found in the literature; however, there was some variation in the management of elements within practice. These included dietary assessment, weight management, access to relevant assessment data such as test results and the description of dietary goals and outcome measures. Six components of best practice were identified: the dietetic process, client centredness, multidisciplinary teamwork, reference to evidence‐based practice guidelines, continuing professional development and practice‐based research and quality assurance activities. Conclusion or application:  The present research demonstrated a consistency in practice in diabetes management by Australian dietitians. The ability of interviewees to determine the consequences of competent practice further suggests that the present research would support the development of practice guidelines.

For women with GDM, monitoring either 1 hour or 2 hours postprandially led to similar outcomes. This would suggest that the ADIPS recommendations are equivalent and therefore women can choose the most convenient time for their postprandial monitoring.

Summary To better understand outcomes in postpartum patients who receive peripartum anaesthetic interventions, we aimed to assess quality of recovery metrics following childbirth in a UK‐based multicentre cohort study. This study was performed during a 2‐week period in October 2021 to assess in‐ and outpatient post‐delivery recovery at 1 and 30 days postpartum. The following outcomes were reported: obstetric quality of recovery 10‐item measure (ObsQoR‐10); EuroQoL (EQ‐5D‐5L) survey; global health visual analogue scale; postpartum pain scores at rest and movement; length of hospital stay; readmission rates; and self‐reported complications. In total, 1638 patients were recruited and responses analysed from 1631 (99.6%) and 1282 patients (80%) at one and 30 days postpartum, respectively. Median (IQR [range]) length of stay postpartum was 39.3 (28.5–61.0 [17.7–513.4]), 40.3 (28.5–59.1 [17.8–220.9]), and 35.9 (27.1–54.1 [17.9–188.4]) h following caesarean, instrumental and vaginal deliveries, respectively. Median (IQR [range]) ObsQoR‐10 score was 75 ([62–86] 4–100) on day 1, with the lowest ObsQoR‐10 scores (worst recovery) reported by patients undergoing caesarean delivery. Of the 1282 patients, complications within the first 30 days postpartum were reported by 252 (19.7%) of all patients. Readmission to hospital within 30 days of discharge occurred in 69 patients (5.4%), with 49 (3%) for maternal reasons. These data can be used to inform patients regarding expected recovery trajectories; facilitate optimal discharge planning; and identify populations that may benefit most from targeted interventions to improve postpartum recovery experience.

After adjustment for the gestational age of delivery, women with GDM do not themselves have either a lower or higher birth weight than a matched group. These data suggest that women with GDM are either not a good surrogate for investigating the relationship between birth weight and type 2 diabetes or that correction for the gestational age of delivery removes the most important confounding variable. It is also possible that modern dietary changes may have altered the relationship.

Objective:  To compare procedures used for the development of three sets of dietetic practice guidelines for type 2 diabetes: the Queensland Best Practice Guidelines (Queensland Guidelines), New Zealand Standards of Care (New Zealand Guidelines) (unpublished, 2003) and American Nutrition Practice Guidelines (American Guidelines) against National Health and Medical Research Council (NHMRC) standards for development of clinical practice guidelines. Design:  The Queensland, New Zealand and American guidelines were audited against a checklist based on the NHMRC clinical practice guideline development standards, accounting for the recommended tasks and the order in which they should be completed. Additional information regarding the development processes was obtained from development coordinators of the existing dietetic practice guidelines for type 2 diabetes. Results:  The American guidelines addressed more of the components of development recommended by the NHMRC than the Queensland and New Zealand guidelines. Most importantly the American guidelines were tested for clinical and cost effectiveness. Conclusion or application:  The data presented show that the American Guidelines came closest to meeting the NHMRC criteria. These results suggest that the American Guidelines may best suit Australian requirements.

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