The ADIPS Pilot National Diabetes in Pregnancy Benchmarking Programme.

Publisher: MDPI Country of Publication: Switzerland NLM ID: 101238455 Publication Model: Electronic Cited Medium: Internet ISSN: 1660-4601 (Electronic) Linking ISSN: 16604601 NLM ISO Abbreviation: Int J Environ Res Public Health Subsets: MEDLINE

Original Publication: Basel : MDPI, c2004-

Diabetes Mellitus, Type 2*/epidemiology ; Diabetes Mellitus, Type 2*/therapy ; Diabetes, Gestational*/epidemiology ; Diabetes, Gestational*/therapy; Adolescent ; Adult ; Australia/epidemiology ; Benchmarking ; Child ; Female ; Humans ; Infant, Newborn ; New Zealand/epidemiology ; Pregnancy ; Pregnancy Outcome/epidemiology ; Retrospective Studies ; Young Adult

Background: To test the feasibility of benchmarking the care of women with pregnancies complicated by hyperglycaemia.
Methods: A retrospective audit of volunteer diabetes services in Australia and New Zealand involving singleton pregnancies resulting in live births between 2014 and 2020. Ranges are shown and compared across services.
Results: The audit included 10,144 pregnancies (gestational diabetes mellitus (GDM) = 8696; type 1 diabetes (T1D) = 435; type 2 diabetes (T2D) = 1013) from 11 diabetes services. Among women with GDM, diet alone was used in 39.4% (ranging among centres from 28.8-57.3%), metformin alone in 18.8% (0.4-43.7%), and metformin and insulin in 10.1% (1.5-23.4%); when compared between sites, all p < 0.001. Birth was by elective caesarean in 12.1% (3.6-23.7%) or emergency caesarean in 9.5% (3.5-21.2%) (all p < 0.001). Preterm births (<37 weeks) ranged from 3.7% to 9.4% ( p < 0.05), large for gestational age 10.3-26.7% ( p < 0.001), admission to special care nursery 16.7-25.0% ( p < 0.001), and neonatal hypoglycaemia (<2.6 mmol/L) 6.0-27.0% ( p < 0.001). Many women with T1D and T2D had limited pregnancy planning including first trimester hyperglycaemia (HbA1c > 6.5% (48 mmol/mol)), 78.4% and 54.6%, respectively ( p < 0.001).
Conclusion: Management of maternal hyperglycaemia and pregnancy outcomes varied significantly. The maintenance and extension of this benchmarking service provides opportunities to identify policy and clinical approaches to improve pregnancy outcomes among women with hyperglycaemia in pregnancy.

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Keywords: HbA1c; audit; gestational diabetes mellitus; healthcare benchmarking; pregnancy; pregnancy outcomes; type 1 diabetes mellitus; type 2 diabetes mellitus

Date Created: 20210602 Date Completed: 20210621 Latest Revision: 20210621

20221213

PMC8125192

10.3390/ijerph18094899

34064492