The ADIPS Pilot National Diabetes in Pregnancy Benchmarking Programme

Jincy Immanuel, Jeff Flack, Vincent W Wong, Lili Yuen, Carl Eagleton, Dorothy Graham, Janet Lagstrom, Louise Wolmarans, Michele Martin, Ngai Wah Cheung, Suja Padmanabhan, Victoria Rudland, Glynis Ross, Robert G Moses, Louise Maple-Brown, Ian Fulcher, Julie Chemmanam, Christopher J Nolan, Jeremy J N Oats, Arianne Sweeting and David Simmons
Additional contact information
Jincy Immanuel: School of Medicine, Western Sydney University, 2560 Sydney, Australia
Jeff Flack: School of Medicine, Western Sydney University, 2560 Sydney, Australia
Vincent W Wong: South Western Sydney Clinical School, University of New South Wales, 2170 Liverpool, Australia
Lili Yuen: School of Medicine, Western Sydney University, 2560 Sydney, Australia
Carl Eagleton: Department of Endocrinology, Auckland City Hospital, 1023 Auckland, New Zealand
Dorothy Graham: Obstetrics and Gynaecology, King Edward Memorial Hospital, University of Western Australia, 6008 Subiaco, Australia
Janet Lagstrom: Nathalia Cobram Numurkah Health, 3636 Victoria, Australia
Louise Wolmarans: Diabetes Service, Waikato Hospital, 3204 Hamilton, New Zealand
Michele Martin: Diabetes Service, Illawarra Shoalhaven Local Health District, 2500 Wollongong, Australia
Ngai Wah Cheung: Department of Diabetes and Endocrinology, Westmead Hospital, 2145 Sydney, Australia
Suja Padmanabhan: Department of Diabetes and Endocrinology, Westmead Hospital, 2145 Sydney, Australia
Victoria Rudland: Department of Diabetes and Endocrinology, Westmead Hospital, 2145 Sydney, Australia
Glynis Ross: Department of Diabetes and Endocrinology, Royal Prince Alfred Hospital, 2050 Sydney, Australia
Robert G Moses: Diabetes Service, Illawarra Shoalhaven Local Health District, 2500 Wollongong, Australia
Louise Maple-Brown: Menzies School of Health Research, Charles Darwin University, 0810 Darwin, Australia
Ian Fulcher: Department of Obstetrics and Gynaecology, Liverpool Hospital, 2170 Sydney, Australia
Julie Chemmanam: Endocrinology and Diabetes Centre, Women’s and Children’s Hospital, 5006 Adelaide, Australia
Christopher J Nolan: Department of Diabetes and Endocrinology, The Canberra Hospital, 2605 Garran, Australia
Jeremy J N Oats: Melbourne School of Population and Global Health, University of Melbourne, 3053 Victoria, Australia
Arianne Sweeting: Department of Diabetes and Endocrinology, Royal Prince Alfred Hospital, 2050 Sydney, Australia
David Simmons: School of Medicine, Western Sydney University, 2560 Sydney, Australia

IJERPH, 2021, vol. 18, issue 9, 1-15

Abstract: 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.

Keywords: gestational diabetes mellitus; healthcare benchmarking; audit; pregnancy; type 1 diabetes mellitus; type 2 diabetes mellitus; pregnancy outcomes; HbA1c (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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