Real-world screening for diabetes in early pregnancy: Improved screening uptake using universal glycated haemoglobin. Issue 6 (December 2021)

• Record Type: Journal Article
• Authors: Jamieson, Emma L.; Spry, Erica P.; Kirke, Andrew B.; Griffiths, Emma; Porter, Cynthia; Roxburgh, Carly; Singleton, Sally; Sterry, Kylie; Atkinson, David N.; Marley, Julia V.
• Is Part Of: Primary care diabetes. Volume 15:Issue 6(2021)
• Page Start: 995
• Page End: 1001
• Publication Date: 2021-12
• Subjects: ADIPS Australasian Diabetes in Pregnancy Society -- GDM gestational diabetes mellitus -- HbA1c glycated haemoglobin -- IADPSG International Association of the Diabetes and Pregnancy Study Groups -- NHMRC National Health and Medical Research Council -- OGTT 75 g oral glucose tolerance test -- RACGP The Royal Australian College of General Practitioners -- RANZCOG The Royal Australian and New Zealand College of Obstetricians and Gynaecologists; Aboriginal health -- Oral glucose tolerance test -- HbA1c -- Gestational diabetes mellitus; Diabetes -- Periodicals; 616.462
• DOI: 10.1016/j.pcd.2021.09.011
• Languages: English
• ISSNs: 1751-9918

Abstract

Highlights: Australian Aboriginal women have high-risk for diabetes in pregnancy. Uptake of early pregnancy oral glucose tolerance testing is low. By contrast, uptake of early pregnancy glycated haemoglobin (HbA1c ) is high. Early detection of abnormal pregnancy HbA1c can expedite self-management of diabetes. Abstract: Aims: To improve perinatal outcomes, screening for hyperglycaemia using 75 g oral glucose tolerance test (OGTT) is recommended for all pregnant women at 24–28 weeks gestation (routine), and earlier if high-risk. Screening coverage for remote and Aboriginal Australian women is less than ideal. This study examined OGTT completion (early and routine) by women from rural and remote Western Australia compared with early glycated haemoglobin (HbA1c ). Methods: In 2015–2018, 27 primary health care sites recruited 600 (233 Aboriginal) women aged ≥16-years, without pre-existing diabetes, who delivered >30-weeks gestation. All women presenting <20-weeks gestation (541) were offered an early study HbA1c . Early OGTTs were requested at the discretion of the local clinician, with routine OGTT offered at 24–28 weeks. Results: HbA1c uptake was high (85.7% Aboriginal, 86.4% non-Aboriginal); OGTT completion in Aboriginal women was low (early OGTT: 38.6% v 69.6% non-Aboriginal, P < 0.001; routine OGTT: 44.5% v 84.7% non-Aboriginal, P < 0.001). Aboriginal women with both early tests had HbA1c completed 3-weeks prior to OGTT (9.6 ± 3.5 v 12.5 ± 3.5 weeks gestation, P < 0.001). Conclusions: Universal early pregnancy HbA1c appears feasible as an early screening test for women at risk of hyperglycaemia in pregnancy and would expedite and increase screening in Aboriginal women compared to an early OGTT.