iginal and non-Aboriginal women: 16.3% v 5.2% had elevated HbA1c (pre-pregnancy prediabetes) whereas 12.4% v 29.6% developed GDM during pregnancy. This suggests fewer non-Aboriginal women had prediabetes going into pregnancy compared to Aboriginal women.
- The risk of having a large baby was twice as high in women with an early HbA1c ≥5.6% compared to women with an early HbA1c <5.6% and without GDM (21.4% v 10.5%). This suggests that women with prediabetes in early pregnancy have high-risk for a large baby.
In the Kimberley all Aboriginal women have been offered an early HbA1c at their first antenatal visit since 2017. We are currently looking at outcomes for Kimberley Aboriginal women who delivered their babies between 2018 and 2021. This will give us a larger, more representative of group of Kimberley women to test the early HbA1c ≥5.6% threshold.
Current and future work:
- We will continue to lobby for Australian pathology labs to use FC Mix tubes for glucose testing – a national pre-analytical glucose working group was formed in 2020 to progress changes to laboratory practice across Australia.
- We are recruiting an additional 200 women to compare OGTT results from the new FC Mix tubes with other tests that are easier for pregnant women to do, so that less women need to do the OGTT after 20 weeks gestation.
- We are working on updating the Kimberley Diabetes in Pregnancy protocol to add the HbA1c ≥5.6% prediabetes cut-point – this will replace the early OGTT (<20 weeks gestation).
- We are planning on co-designing culturally appropriate management strategies for Aboriginal women with prediabetes in pregnancy.
- Kirke AB, Atkinson D, Moore S, Sterry K, Singleton S, Roxburgh C, Parrish K, Porter C, Marley JV. Diabetes screening in pregnancy failing women in rural Western Australia: An audit of oral glucose tolerance test completion rates. Aust J Rural Health 2019. http://dx.doi.org/10.1111/ajr.12465
- Jamieson E, Spry E, Kirke A, Atkinson D, Marley JV. Real-world gestational diabetes screening: problems with the oral glucose tolerance test in rural and remote Australia. Int J Environ Res Public Health 2019; https://www.mdpi.com/1660-4601/16/22/448888
- Jamieson EL, Spry E, Kirke AB, Roxburgh C, Atkinson D, Marley JV. Underestimation of risk for large babies in rural and remote Australia: Time to change plasma glucose collection protocols. J Clin Transl Endocrin; 2020: 100247.
- Jamieson EL, Spry E, Kirke AB, Roxburgh C, Atkinson D, Marley JV. Variations in the Prevalence of Gestational Diabetes Mellitus With Remote Testing and a Pragmatic Solution to Improve Accuracy. Diabetes Care; 2020: 09: 09.
- Jamieson EL, Spry EP, Kirke AB, Griffiths E, Porter C, Roxburgh C, Singleton S, Sterry K, Atkinson DN, Marley JV. Prediabetes and pregnancy: Early pregnancy HbA1c identifies Australian Aboriginal women with high-risk of gestational diabetes mellitus and adverse perinatal outcomes. Diab Res Clin Prac 2021; https://doi.org/10.1016/j.diabres.2021.108868
Checking for Diabetes in rural communities – plain language summary of the ORCHID study (296 KB)
Audit of OGTT completion in 2013 – plain language report (113 KB)
Failure of the sugar drink test to detect GDM – plain language report for community (222 KB)
Failure of the OGTT to detect GDM in rural WA – plain language report for staff (263 KB)
Failure of the OGTT to detect GDM in rural WA – peer reviewed publication (1.43 MB)
Missing risk for large babies – plain language report for staff
Missing risk for large babies – peer reviewed publication
Early HbA1c detects pre-pregnancy prediabetes – plain language report for community
Early HbA1c detects pre-pregnancy prediabetes – plain language report for staff
Early HbA1c detects pre-pregnancy prediabetes – peer reviewed publication
- Assoc Prof Julia Marley, RCSWA Broome
- Erica Spry, KAMS
- Emma Jamieson, RCSWA Bunbury
- Dr Andrew Kirke, RCSWA Bunbury
- Dr Kylie Sterry, RCSWA Kalgoorlie
- Dr Sarah Moore, RCSWA Bussleton
- Dr Carly Roxburgh, RCSWA Albany
- Dr Sally Singleton
- Dr Emma Griffiths, KAMS
- Dr Cynthia Porter, GRAMS
- Pro