Screening for gestational diabetes mellitus in a predominantly Indigenous population in rural New Zealand

Abstract

Screening for Gestational Diabetes Mellitus in a Predominantly Indigenous Population in Rural New Zealand Contact author: Isabel Raiman, RN BSc MSc Nurse Practitioner Diabetes Bay of Plenty District Health Board Private Bag 12024, Tauranga, New Zealand Ph: +6475798765 Fax: +6475710645 Email: Isabel.Raiman@bopdhb.gov.nz Jennifer Goodson RN Clinical Study Coordinator Bay of Plenty District Health Board Dr Barbara Daly RN BSc MHSc PhD Senior Lecturer in Nursing, Faculty of Medical and Health Sciences, University of Auckland. Background: The rates of Gestational Diabetes Mellitus (GDM) have been increasing in New Zealand over the last 5 years with the number of pregnancies associated with GDM rising from 1.3% in 2001 to 4.9% in 2012. Despite this the diabetes team notes a decline in referrals for GDM in a rural area of New Zealand with a predominantly indigenous population. Aims: To identify the screening rate for gestational diabetes mellitus (GDM) in a region of New Zealand with a predominantly indigenous population. Methods: An audit was undertaken of routine hospital data collected from 656 women who gave birth over two six-month periods (July to December in 2013 and 2014) in two small rural hospitals in New Zealand. Results: Of the 656 women who gave birth during this period, only 416 (63%) were screened for GDM. After controlling for age, screening was less common in Māori women (56%), and in Pacific women (50%) when compared with European women, (see Table 1). After adjusting for ethnicity, women aged 35-40 years were more likely to be screened compared with women aged 25-29 years (1.24, 95% CI 1.06-1.47, p=0.02). Screening was associated with longer hospital stays following birth, with screened women more likely to stay >5 days compared with unscreened women <1 day, (1.44, 95% CI 1.25-1.66, p<0.0001). Screening was significantly higher in 2014 than 2013 (1.17 95% CI 1.04-1.32, p=0.008). Conclusion: Results from this study demonstrate a poor uptake of screening for GDM particularly in the indigenous population. A multidisciplinary team initiative based in the maternity clinic in 2014 may explain the improvement in screening that year. However, increased effort is required to improve screening rates, especially for Maori and Pacific women who are at higher risk of developing GDM. Further research will help identify reason for low screening rates in this population.