AbstractFirst Nations Peoples experience a higher prevalence of type 2 diabetes (T2D) than non-Indigenous people. As women are increasingly being diagnosed at younger ages and gestational diabetes (GDM) is a strong predictor of T2D, the postpartum period presents an opportunity for intervention.
The aims of this thesis are to evaluate 1) postpartum screening for diabetes among women with GDM; 2) progression to T2D after GDM; 3) strength and gaps in primary healthcare in the postpartum period; and 4) women’s preferences for a T2D prevention program after a pregnancy with hyperglycaemia.
Three studies were conducted: 1. The Pregnancy And Neonatal Diabetes Outcomes in Remote Australia (PANDORA) study, which is a longitudinal birth cohort of women across the Northern Territory (NT), assessed in pregnancy and followed-up postpartum. 2. An evaluation of the postpartum care provided to women with hyperglycaemia in pregnancy in remote NT communities. 3. Interviews with Aboriginal women and health professionals related to T2D prevention postpartum.
After a pregnancy with GDM, when diabetes screening included a 75 gram oral glucose tolerance test (OGTT), HbA1C or fasting plasma glucose, Aboriginal and/or Torres Strait Islander women were as likely as non-Indigenous women to have postpartum screening (43% by 6 months postpartum, ethnicity combined). Aboriginal women had a high cumulative incidence of T2D after GDM (22%) over a short timeframe (median 2.5 years). Whilst many remote dwelling women were engaged in the healthcare system after a pregnancy with hyperglycaemia, diabetes was not discussed with 52% of women within 12 months postpartum (data from medical records). Women advocated for co-designed programs coupled with structural change to prevent and manage diabetes after pregnancy.
We report high rates of T2D after GDM among NT Aboriginal women. The findings inform postpartum care and T2D prevention programs for women with hyperglycaemia in pregnancy.
|Date of Award||Feb 2022|
|Supervisor||Louise Maple-Brown (Supervisor) & Federica Barzi (Supervisor)|