Real-world screening for diabetes in early pregnancy: Improved screening uptake using universal glycated haemoglobin

Emma L Jamieson; Erica P Spry; Andrew B Kirke; Emma Griffiths; Cynthia Porter; Carly Roxburgh; Sally Singleton; Kylie Sterry; David N Atkinson; Julia V Marley

doi:10.1016/j.pcd.2021.09.011

Real-world screening for diabetes in early pregnancy: Improved screening uptake using universal glycated haemoglobin

Prim Care Diabetes. 2021 Dec;15(6):995-1001. doi: 10.1016/j.pcd.2021.09.011. Epub 2021 Oct 23.

Authors

Affiliations

¹ The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 412, Bunbury, Western Australia 6230, Australia. Electronic address: emma.jamieson@rcswa.edu.au.
² Kimberley Aboriginal Medical Services, 12 Napier Terrace, Broome, Western Australia 6725, Australia; The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, Western Australia 6725, Australia. Electronic address: research@kamsc.org.au.
³ The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 412, Bunbury, Western Australia 6230, Australia. Electronic address: andrew.kirke@rcswa.edu.au.
⁴ The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, Western Australia 6725, Australia. Electronic address: emma.griffiths@rcswa.edu.au.
⁵ Geraldton Regional Aboriginal Medical Service, PO Box 5276, Geraldton, Western Australia 6531, Australia. Electronic address: cporter@westnet.com.au.
⁶ The Rural Clinical School of Western Australia, The University of Western Australia, 35 Stirling Terrace, Albany, Western Australia 6330, Australia. Electronic address: carly.roxburgh@rcswa.edu.au.
⁷ The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, Western Australia 6725, Australia. Electronic address: s.singleton@acrrm.org.au.
⁸ The Rural Clinical School of Western Australia, The University of Western Australia, St Alban's Road (rear Kalgoorlie Hospital), Kalgoorlie, Western Australia 6433, Australia. Electronic address: kylie.sterry@plazamedicalkalgoorlie.com.au.
⁹ The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, Western Australia 6725, Australia. Electronic address: david.atkinson@rcswa.edu.au.
¹⁰ Kimberley Aboriginal Medical Services, 12 Napier Terrace, Broome, Western Australia 6725, Australia; The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, Western Australia 6725, Australia. Electronic address: julia.marley@rcswa.edu.au.

PMID: 34696991
DOI: 10.1016/j.pcd.2021.09.011

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 (HbA_1c).

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 HbA_1c. Early OGTTs were requested at the discretion of the local clinician, with routine OGTT offered at 24-28 weeks.

Results: HbA_1c 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 HbA_1c completed 3-weeks prior to OGTT (9.6 ± 3.5 v 12.5 ± 3.5 weeks gestation, P < 0.001).

Conclusions: Universal early pregnancy HbA_1c 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.

Keywords: Aboriginal health; Gestational diabetes mellitus; HbA(1c); Oral glucose tolerance test.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia
Blood Glucose
Diabetes, Gestational* / diagnosis
Female
Glucose Tolerance Test
Glycated Hemoglobin / analysis
Humans
Mass Screening
Pregnancy

Substances

Blood Glucose
Glycated Hemoglobin A