Search

Background: Recent guidelines suggest screening high‐risk women in early pregnancy for gestational diabetes (GDM); however, there is little evidence to support this. Aims: To compare pregnancy outcomes associated with diabetes for women with risk factors for GDM according to gestation of diagnosis. Early GDM was defined as a positive test before 20 weeks gestation, late GDM as a positive test at 20 or more weeks and no GDM when both tests were negative. Materials and methods: Retrospective analysis in an Australian tertiary hospital of women who underwent a glucose tolerance test in pregnancy prior to 20 weeks gestation, and a repeat test after 20 weeks gestation if the initial test was negative. Results were adjusted for maternal demographics. Results: Women with early GDM (n = 170) were no more likely to experience the obstetric composite outcome than women with late GDM (n = 171) or no GDM (n = 547) (early odds ratio (OR) 1.16, 95%CI 0.79–1.71; late OR 0.78, 95%CI 0.53–1.12). Infants of women with early GDM, but not late GDM, were more likely (early OR 1.8, 95%CI 1.15–2.92; late OR 1.4, 95%CI 0.90–2.23) to have the neonatal composite outcome than infants of women without GDM, predominantly due to an increase in neonatal hypoglycaemia. Conclusions: This result may be due to careful management of GDM, or because, after adjustment for maternal demographics, the early diagnosis of GDM does not substantially increase rates of adverse outcomes compared to GDM diagnosed in later pregnancy or no GDM in women with risk factors for GDM. [ABSTRACT FROM AUTHOR]

Background High-quality, evidence-based guidelines can improve the quality of health care and facilitate standardisation of practice within and across healthcare organisations. Limited information is known regarding existing antenatal corticosteroid ( ACS) guideline practices within organisations across Australia and New Zealand. Aims To assess existing ACS clinical practice guidelines ( CPG). To describe current organisational practice related to the production, implementation and renewal of CPG. Design A cross-sectional survey of hospital practice using an online questionnaire. Methods Clinical Managers at 27 secondary and 25 tertiary maternity hospitals, that contribute data to the Australia and New Zealand Neonatal Network, were approached from May to September 2015 and completed the questionnaire on behalf of their organisation. Results Of the hospitals surveyed, 93% reported having a CPG or protocol. Of these, 89% of CPG included recommendations on a single course of ACS, 37% on the use of repeat course/s and 41% on use prior to elective caesarean section at term. Variation in the recommendations provided existed between countries and depending on the level of neonatal care provided. A guideline development group existed in 85% of hospitals. The preferred tools to facilitate implementation of a CPG include: email with a link to the hospital intranet, education sessions and an opinion leader. Only 28% of respondents reported auditing the use of ACS administration. Conclusions There is significant variation in the recommendations provided by current ACS CPGs. Utilisation of a single ACS CPG reflective of the current available evidence base may limit this variation. [ABSTRACT FROM AUTHOR]

Background The Australasian Diabetes in Pregnancy Society ( ADIPS) has recently endorsed the World Health Organization ( WHO) terminology and classification of hyperglycaemia in pregnancy. The prevalence is likely to increase, but no prospective data are available for a representative Australian population. Aims To determine the prevalence of hyperglycaemia in pregnancy ( HIP) using results from both the public and private sectors in a population that has a similar ethnicity to the overall Australian population. Material and Methods The results of all pregnancy oral glucose tolerance tests ( POGTT) in the public sector and by a dominant private pathology provider in a major city have been prospectively collected for a three-year period and analysed using the ADIPS ( WHO) criteria. Results The prevalence of hyperglycaemia in pregnancy ( HIP) was 13.1% with diabetes mellitus in pregnancy ( DIP) being 0.4% and gestational diabetes mellitus ( GDM) being 12.7%. Conclusion The new criteria will diagnose about one-third more women with GDM than the previous ADIPS criteria. This will have resource and health implications. Focussed local health economic data will be important. [ABSTRACT FROM AUTHOR]

Background While weight gain during pregnancy is regarded as important, there has not been a prospective study of measured weight gain in pregnancy in Australia. This study aimed to prospectively evaluate pregnancy-related weight gain against the Institute of Medicine ( IOM) recommendations in women receiving antenatal care in a setting where ongoing weight monitoring is not part of routine clinical practice, to describe women's knowledge of weight gain recommendations and to describe the health professional advice received relating to gestational weight gain ( GWG). Methods Pregnant women were recruited ≤20 weeks of gestation ( n = 664) from a tertiary obstetric hospital between August 2010 to July 2011 for this prospective observational study. Outcome measures were weight gain from pre-pregnancy to 36 weeks of gestation, weight gain knowledge and health professional advice received. Results Thirty-six percent of women gained weight according to guidelines. Twenty-six percent gained inadequate weight, and 38% gained excess weight. Fifty-six percent of overweight women gained weight in excess of the IOM guidelines compared with 30% of those who started with a healthy weight ( P < 0.001). At 16 weeks, 47% of participants were unsure of the weight gain recommendations for them. Sixty-two percent of women reported that the health professionals caring for them during this pregnancy 'never' or 'rarely' offered advice about how much weight to gain. Conclusions The prevalence of inappropriate gestational weight gain in this study was high. The majority of women do not know their recommended weight gain. The advice women received from health professionals relating to healthy weight gain in pregnancy could be improved. [ABSTRACT FROM AUTHOR]

Obesity worsens and modest weight loss improves female fertility. Overweight women were randomised to lifestyle or standard treatment pre- in vitro fertilisation with treatment cessation at embryo transfer. There was a greater reduction in weight ( P < 0.001) for lifestyle treatment (−3.8 ± 3.0 kg, P < 0.001) compared with no changes for standard treatment (−0.5 ± 1.2 kg, P = 0.092). Both the intervention (−5.3 ± 4.6 cm) and control (−3.5 ± 3.5 cm) group had reductions in waist circumference ( P < 0.001) with no differences between the two groups ( P = 0.215). The overall pregnancy rate was 53% (20/38) for the intervention and control group combined. [ABSTRACT FROM AUTHOR]