Pregnancy And Neonatal Diabetes Outcomes in Remote Australia: The PANDORA study - An observational birth cohort

Louise Maple-Brown, I-Lynn Lee, Danielle Longmore, Federica Barzi, Christine Connors, Jacqueline Boyle, Elizabeth Moore, Cherie Whitbread, Marie Kirkwood, Sian Graham, Vanya Hampton, Alison Simmonds, Paula van Dokkum, Joanna Kelaart, Sujatha Thomas, Shridhar Chitturi, Sandra Eades, Sumaria Corpus, Michael Lynch, Zhong X LuKerin O'Dea, Paul Zimmet, Jeremy Oats, Harold D. McIntyre, Alex DH Brown, Jonathan E. Shaw

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Background: In Australia’s Northern Territory, 33% of babies are born to Indigenous mothers, who experience high rates of hyperglycemia in pregnancy. We aimed to determine the extent to which pregnancy outcomes for Indigenous Australian women are explained by relative frequencies of diabetes type [type 2 diabetes (T2DM) and gestational diabetes (GDM)].


    Methods: This prospective birth cohort study examined participants recruited from a hyperglycemia in pregnancy register. Baseline data collected were antenatal and perinatal clinical information, cord blood and neonatal anthropometry. Of 1135 women (48% Indigenous), 900 had diabetes: 175 T2DM, 86 newly diagnosed diabetes in pregnancy (DIP) and 639 had GDM. A group of 235 women without hyperglycemia in pregnancy was also recruited.


    Results: Diabetes type differed for Indigenous and non-Indigenous women (T2DM, 36 vs 5%; DIP, 15 vs 7%; GDM, 49 vs 88%, p < 0.001). Within each diabetes type, Indigenous women were younger and had higher smoking rates. Among women with GDM/DIP, Indigenous women demonstrated poorer birth outcomes than non-Indigenous women: large for gestational age, 19 vs 11%, p = 0·002; neonatal fat 11.3 vs 10.2%, p < 0.001. In the full cohort, on multivariate regression, T2DM and DIP were independently associated (and Indigenous ethnicity was not) with pregnancy outcomes.


    Conclusions: Higher rates of T2DM among Indigenous women predominantly contribute to absolute poorer pregnancy outcomes among Indigenous women with hyperglycemia. As with Indigenous and minority populations globally, prevention or delay of type 2 diabetes in younger women is vital to improve pregnancy outcomes and possibly to improve the long-term health of their offspring.

    Original languageEnglish
    Article numberdyy245
    Pages (from-to)307-318
    Number of pages12
    JournalInternational Journal of Epidemiology
    Volume48
    Issue number1
    Early online date30 Nov 2018
    DOIs
    Publication statusPublished - 1 Feb 2019

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