Gestational diabetes mellitus (GDM) is impaired glucose tolerance first detected in pregnancy. GDM is associated with a range of adverse neonatal and maternal outcomes. GDM is the commonest maternal antenatal abnormality in Australia. Screening is conducted in order to detect women at risk of disease, facilitating earlier management and treatment. Currently available evidence indicates that treatment of GDM with dietary modifications, glucose monitoring, and metformin and insulin (if needed) can significantly reduce the risk for adverse birth outcomes.
Current screening recommendations are for all pregnant women who are not known to have diabetes or GDM to have an oral glucose tolerance test (OGTT) at 24-28 weeks gestation. Women need to be fasted for this test and blood samples are taken immediately prior to consumption of a 75g glucose drink, and 1 and 2 hours later. Many women decline screening.
Alternative methods for diagnosing GDM or alternative methods for screening that lead to a reduction in the number of OGTTs required need to be found if we are to improve screening rates. We want to see if levels of glycation products such as HbA1c at first and third trimester antenatal visit predict the risk of developing GDM later in pregnancy or can be used instead of OGTT where an OGTT is difficult to achieve or refused by the patient.
The aims of this project are:
- To determine at baseline the number of 24-28 week OGTTs completed on at least 100 antenatal patients in each study region expected to have had an OGTT.
- To determine the relationship between first trimester antenatal information, including glycation products such as HbA1c, blood sugar levels, family history, obesity, maternal age, ethnic background, and 24-28 week glycation products, with 24-28 week OGTT.
- To determine the proportion of women enrolled in the study requiring an OGTT who complete the OGTT at 24-28 weeks gestation.
- To increase research interest and capacity among health service and RCSWA staff and students, and to build skills in rural and remote health service research.
To ensure that the project findings are generalisable to the broader regional, remote primary health care environment, it will be carried out in a range of health care services across Western Australia: Kimberley, Southwest, Greater South, Midwest and Goldfields.
This project is a collaboration between The Rural Clinical School of WA, KAMS, WA Country Health Services – Kimberley, Harry Perkins Institute and is funded in part through an RCSWA Multi-site Project Grant, Lishman Health Foundation grant and Diabetes Australia grant.
Progress to date: We are in the final stages of data analysis.