The MACAW Study: models of antenatal care for Aboriginal women with diabetes

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[Truncated abstract] Introduction: Australian Aboriginal people do not experience the same health as Australian non- Aboriginal people. The Australian universal health care is not universally provided in rural and remote locations of Australia. Diabetes in pregnancy adds further to the health gap for Australian Aboriginal people. Methodology A systematic review for all Indigenous women with diabetes in pregnancy was completed. Quantitative research used the Western Australian Midwifery Notification Database, 2000-2007. The data analysis included maternal descriptive analysis, place of birth and maternal and infant health outcomes. The data analysis included time trends over the eight years for health outcomes. A final comparison of Caucasian and Aboriginal maternal health outcomes, with maternal diabetes present was completed between birthing health regions. Using qualitative research methodology midwives recruited participants who lived in Western Australia and attended Aboriginal Medical Services antenatal clinics with diabetes in pregnancy, at varying stages of their pregnancy or postnatally. Using interpretative phenomenological analysis, the resulting themes and subthemes were presented to supporting Aboriginal communities to confirm accuracy and reliability of the data. Results: From 142 potential studies a total 42 peer reviewed journal articles were included in the systematic review. Gestational diabetes mellitus prevalence in 65% of studies was greater for Indigenous and Aboriginal women than the comparison group. Of the studies 86% reported higher macrosomia prevalence and 63% had higher stillbirth rates. A total of 210,883 births to WA women were analysed. With maternal diabetes, Aboriginal infant's birth weight increases and stillbirth rate is 22/1000 for gestational diabetes mellitus (GDM) and 53/1000 for pre-existing diabetes while for Caucasian infant's birth weight decreases and stillbirth rate is 3/1000 for GDM and 11/1000 for pre-existing diabetes In all nine participants were interview up to three separate occasions. Aboriginal women negotiate many demands both family and community, however with diabetes in pregnancy there is an imposed demand from health professionals. Aboriginal women use logistical skills to attempt to meet all the demands placed on them. Discussion: Aboriginal women who become pregnant with a diabetes complication are disadvantaged in access to quality antenatal care. They are further disadvantage due to the inequity of diabetes educational services, resulting in poor glycemic control before, during and after the pregnancy. Further, Aboriginal infants born to mothers with diabetes in pregnancy, have worse health outcomes particularly stillbirth. Conclusion: There is currently a need for an international study of Indigenous women with diabetes in pregnancy to determine accurately gestational diabetes mellitus and preexisting diabetes prevalence rates. Health service planning and service provision of antenatal care for women with diabetes in pregnancy, are based on prevalence rates determined from research, yet for Indigenous women the research has many limitations...
Original languageEnglish
QualificationDoctor of Philosophy
StateUnpublished - 2013


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