Diabetes screening in pregnancy failing women in rural Western Australia: An audit of oral glucose tolerance test completion rates

Abstract

Objective: To quantify screening rate for gestational diabetes mellitus and completion of oral glucose tolerance test in rural and remote Western Australia. Design and participants: Retrospective audit of 551 antenatal records from women of 16 years and older without pre-existing diabetes and with singleton pregnancies delivered in 2013. Main outcome measures: Number of women recorded screened for gestational diabetes mellitus in second or third trimester using oral glucose tolerance test or other tests; gestational diabetes mellitus rate. Results: Only 278 (50.5%) women were screened with oral glucose tolerance test; 113 (20.5%) had no record of any screening related to gestational diabetes mellitus. In a nested mixed-effects logistic regression model, women with a previous gestational diabetes mellitus diagnosis, two or more risk factors (excluding ethnicity) or high-risk gestational diabetes mellitus ethnicity other than Australian Aboriginal were more likely to be screened, while Australian Aboriginal women were less likely to be screened with oral glucose tolerance test. Clinicians reported patient and clinician factors and logistical difficulties as reasons for the oral glucose tolerance test not being completed at their site. Of those screened with oral glucose tolerance test, a high rate of gestational diabetes mellitus was diagnosed (14.7% versus Western Australia state-wide average of 7.4%). Conclusion: Adherence to oral glucose tolerance test screening in rural Western Australia is inadequate for effective screening for gestational diabetes mellitus. Screening was not acceptable or available for a significant proportion of women at risk. Efforts to improve oral glucose tolerance test adherence and exploration of alternative gestational diabetes mellitus screening strategies are required.

Primary Health Care for Aboriginal Australian Women in Remote Communities after a Pregnancy with Hyperglycaemia

“…The issue of low postpartum OGTT testing raises similar concerns to those raised by low rates of OGTT screening for GDM during pregnancy reported in regional and remote Western Australia [38].…”

“…In this context, it is critical that we improve adherence to OGTT screening guidelines both during pregnancy and after pregnancy and enable this high-risk group to access timely intervention. It also raises the question as to whether alternate screening strategies that are less cumbersome such as an HbA1C or a risk prediction tool can be further explored [38]. Indeed, whilst reportedly less sensitive [39,40], but cheaper and more convenient, guidelines in regional and remote NT now (after this study period) recommend an HbA1C four months postpartum if an OGTT is not able to be performed [41].…”

Real-World Gestational Diabetes Screening: Problems with the Oral Glucose Tolerance Test in Rural and Remote Australia

“…However, as the fasting algorithms were robust, and the pattern of predominant diagnosis by fasting sample held true for both FLOX ICE and FC Mix adjustments, it is likely our FC Mix GDM estimates will prove to be accurate when tested prospectively. Furthermore, by standardising pre-analytical processes for glucose, screening by fasting plasma glucose alone, as suggested by other groups, may become a viable option to improve screening coverage in our population with poor OGTT completion [21,32].…”

“…The prospective Optimisation of Rural Clinical and Haematological Indicators for Diabetes in pregnancy (ORCHID) study was conducted in regional, rural and remote Western Australian clinical settings. Only 50% of women complete screening for GDM by OGTT in these settings [21]. ORCHID aimed to investigate ways to improve screening for GDM and relied on OGTT collected using local clinical and laboratory protocols.…”

The ADIPS Pilot National Diabetes in Pregnancy Benchmarking Programme

“…The risks of hyperglycaemia and related adverse pregnancy outcomes are greater among women of Indigenous background, and those born outside Australia [ 4 , 5 ]. Adverse events remain high in pregnancies complicated by diabetes [ 4 , 5 , 6 , 7 ], suggesting insufficient pre-pregnancy preparation and antenatal management. Profound urban–rural disparities [ 6 ] and variation in obstetric care across Australia [ 8 ] limit access to optimal care for many women.…”