Oral Presentation Australasian Diabetes in Pregnancy Society and Society of Obstetric Medicine Australia and New Zealand Joint Scientific Meeting 2021

The ADIPS Pilot National Diabetes in Pregnancy Benchmarking Programme (#2)

Jincy Immanuel 1 , Jeff Flack 1 2 3 , Vincent W Wong 3 4 , Lili Yuen 1 , Carl Eagleton 5 , Dorothy Graham 6 , Janet Lagstrom 7 , Louise Wolmarans 8 , Michele Martin 9 , N Wah Cheung 10 , Suja Padmanabhan 10 , Victoria Rudland 10 , Glynis Ross 11 , Robert G Moses 9 , Louise Maple-Brown 12 13 , Ian Fulcher 14 , Julie Chemmanam 15 , Christopher J Nolan 16 17 , Jeremy J N Oats 18 , Arianne Sweeting 11 , David Simmons 1 19
  1. School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
  2. Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia
  3. South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
  4. Diabetes and Endocrinology Service, Liverpool Hospital, Sydney, New South Wales, Australia
  5. Department of Endocrinology, Auckland City Hospital, Auckland, New Zealand
  6. Obstetrics and Gynaecology, King Edward Memorial Hospital, University of Western Australia, Western Australia, Australia
  7. Nathalia Cobram Numurkah Health, Victoria, Australia
  8. Diabetes Service, Waikato Hospital, Hamilton, North Island, New Zealand
  9. Diabetes Service, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia.
  10. Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, New South Wales, Australia.
  11. Department of Diabetes and Endocrinology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
  12. Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
  13. Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
  14. Department of Obstetrics and Gynaecology, Liverpool Hospital, Sydney, New South Wales, Australia
  15. Women’s and Children’s Hospital, Adelaide, South Australia, Australia
  16. Department of Diabetes and Endocrinology, The Canberra Hospital, Garran, Australian Capital Territory, Australia
  17. Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
  18. Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
  19. Campbelltown Hospital, Campbelltown, New South Wales, Australia

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%(range 28.8–57.3%), metformin alone in 18.8% (0.4-43.7%) and metformin+insulin in 10.1% (1.5-23.4%); birth was by elective (12.1%) or emergency (9.5%) caesarean delivery in 3.6-23.7% and 3.5-21.2% respectively (all p<0.001).  Preterm birth (<37 weeks) ranged from 3.7-9.4% (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% (48mmol/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 provide opportunities to identify policy and clinical approaches to improve pregnancy outcomes among women with hyperglycaemia in pregnancy.