Diabetes in pregnancy (DIP), has significant adverse effects on pregnancy outcomes as well as life-long sequelae for the baby. In the Northern Territory (NT), Indigenous mothers account for 33% of all births and have high rates of DIP. In 2011, a clinical register was established in the NT to provide data on the prevalence, treatment and outcomes of DIP. Our aim was to review the major findings of the register from inception until end 2015.
All NT women with any type of DIP were eligible. Referral was by a health professional involved in care of a woman with DIP. Data collected from 2012 to 2015 were analysed using t-tests, chi-squared tests; and multivariable linear regression. Women with Type 1 diabetes were excluded from statistical testing.
Diabetes type differed between Indigenous (n=737) and non-Indigenous mothers (n=673) with DIP (pre-existing type 2 diabetes (T2DM), 28% v 4%; gestational diabetes (GDM), 71% v 93%, p<0.001). Among Indigenous women with GDM, 20.1% had an early (<20 weeks) oral glucose tolerance test. Rates of metformin use were high in Indigenous women (86% T2DM, 34% GDM) and increased over time in non-Indigenous women. In Indigenous mothers birth outcomes were poorer comparing T2DM v GDM with increased serious adverse events and special care admissions (13.6% v 3.6%, p<0.001 and 64.6% v 30.3%, p<0.001). Use of metformin was independently associated with a 4-5 day shorter gestational age (37.7 v 38.4 weeks p<0.001) among Indigenous women with GDM but not with other outcomes.
The markedly higher rates of T2DM in Indigenous women is of population and clinical significance with poorer outcomes in pregnancies with T2DM than with GDM. The NT DIP Clinical Register provides valuable quality assurance data contributing to increased clinician awareness, screening and reporting of DIP and improving DIP models of care in the high-risk Indigenous population.