ORCHID Study: Optimisation of screening and management of hyperglycaemia in pregnancy for rural communities

The ORCHID Study is a collaborative research project between the Rural Clinical School of WA and the Kimberley Aboriginal Medical Services, aimed at improving screening for hyperglycaemia (high blood-glucose levels) in pregnancy.

Hyperglycaemia first detected in pregnancy is associated with a range of adverse neonatal and maternal outcomes. Due to the potential to improve birth outcomes, screening for hyperglycaemia is recommended for all women without known diabetes using an oral glucose tolerance test (OGTT) at 24-28 weeks gestation and at first antenatal presentation if risk-factors are present. The OGTT requires women to fast overnight, consume a 75g glucose drink and have three blood samples taken over two hours.

Phase 1 of the ORCHID Study (2015-2018) was funded by a UWA multi-site grant, the Lishman Health Foundation and Diabetes Australia. Recruitment for Phase 1 is now complete. We found that:

• Many rural and remote Australian women decline an OGTT.
• In women who are tested we estimate 62% of gestational diabetes is missed due to OGTT sample instability. Alternative FC collection tubes that stabilise glucose in OGTT samples immediately were implemented in the Kimberley region by Aboriginal Community Controlled Health Organisations in 2019. We are currently evaluating the impact of the change in Phase 2 of the ORCHID study.
• One in five women who probably had gestational diabetes but were not managed had a large baby.
• Women with risk factors for hyperglycaemia in pregnancy were more likely to have a glycated haemoglobin (HbA1c) test, and have it earlier in pregnancy, compared to an early OGTT.
• An early pregnancy HbA1c (<20-weeks gestation) identifies Australian Aboriginal women with high-risk of GDM and large babies. In the Kimberley all Aboriginal women have been offered an early HbA1c at their first antenatal visit since 2017. We are currently looking at outcomes for Kimberley Aboriginal women who delivered their babies between 2018 and 2021. This will give us a larger, more representative of group of Kimberley women to test the early HbA1c ≥5.6% threshold.

Phase 2 of the ORCHID Study (2020-2022) is funded by Diabetes Research WA. We aim to validate thresholds for glycated albumin and HbA1c collected after 24-weeks gestation as alternative tests to the OGTT, when declined. Recruitment is now complete and final analysis will proceed once samples have been batch tested.

Phase 3 of the ORCHID Study (2022-2027), funded by the WA Department of Health and the Medical Research Futures Fund, aims to co-design culturally appropriate management strategies for Aboriginal women with hyperglycaemia detected early in pregnancy, and roll out alternative testing strategies Nation-wide.