Care provided to women during and after a pregnancy complicated by hyperglycaemia: the impacts of a multi-component health systems intervention

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific Pub Date : 2025-03-13 DOI:10.1016/j.lanwpc.2025.101514

Diana MacKay , Jacqueline A. Boyle , Sandra Campbell , Natasha Freeman , Anna McLean , Denella Hampton , Cherie Whitbread , Paula Van Dokkum , Kirby Murtha , Christine Connors , Elizabeth Moore , Ashim Sinha , Yvonne Cadet-James , Sharni Cardona , Jeremy Oats , H David McIntyre , Anthony J. Hanley , Alex Brown , Jonathan E. Shaw , Renae Kirkham , Louise Maple-Brown

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引用次数: 0

Abstract

Background

Aboriginal and Torres Strait Islander women experience a disproportionate burden of hyperglycaemia in pregnancy. A multi-component health systems intervention aiming to improve antenatal and postpartum care was implemented across Australia’s Northern Territory (NT) and Far North Queensland (FNQ) between 2016 and 2019. Components included clinician education, improving recall systems, enhancing policies and guidelines, and embedding Diabetes in Pregnancy (DIP) Clinical Registers in systems of care. This program was evaluated to determine impacts on clinical practice and maternal health.

Methods

Data for women with hyperglycaemia in pregnancy from primary care clinical records and the DIP Clinical Registers were analysed to assess changes in: antenatal and postpartum diabetes testing; HbA1c/glucose levels; medication use; weight checks performed, weight and body mass index; and postpartum contraception, smoking and breastfeeding.

Findings

Clinical practice in the NT improved, including increased uptake of the recommended first trimester 75 g oral glucose tolerance test among women with hyperglycaemia risk factors (Aboriginal and Torres Strait Islander women 11.7% to 26.5%, p < 0.001; non-Indigenous women 6.2% to 19.3%, p < 0.001). In the NT, postpartum diabetes monitoring (56% to 68%, p = 0.039) and contraceptive use (41% to 60%, p = 0.001) increased among Aboriginal and Torres Strait Islander women. In FNQ, postpartum glucose monitoring increased among women with T2D (26% to 68% Aboriginal and Torres Strait Islander, p = 0.002; 50% to 100% non-Indigenous, p = 0.008), although there were no improvements in antenatal care indicators.

Interpretation

Aspects of care for women with hyperglycaemia in pregnancy improved in the NT and FNQ following a multi-component health systems intervention.

Funding

This study is funded by the Australian National Health and Medical Research Council (NHMRC) Global Alliance for Chronic Diseases Grant 1092968.

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来源期刊

The Lancet Regional Health: Western Pacific Medicine-Pediatrics, Perinatology and Child Health

CiteScore

8.80

自引率

2.80%

发文量

305

审稿时长

11 weeks

期刊介绍： The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.