Search

Background: There are no contemporary cohorts examining pregnancy outcomes in women with type 2 diabetes (T2D) in Australia. Aim(s): To compare pregnancy outcomes in women with and without T2D, and assess effects of body mass index (BMI) and glycaemic control on outcomes. Material(s) and Method(s): An historical cohort study was conducted of all singleton births > 20 weeks gestation at a specialist maternity network in Australia from 2010 to 2013. Data were extracted from the Birthing Outcomes System database. Multivariable logistic regression analysis was used to examine associations between presence of T2D and pregnancy outcomes. Result(s): Outcomes for 138 pregnancies with T2D and 27 075 pregnancies in women without diabetes were compared (type 1 diabetes and gestational diabetes excluded). Women with T2D were older and more overweight compared to women without diabetes (P < 0.01). Their babies were born earlier (P < 0.01) with increased risk of large for gestational age (adjusted odds ratio 2.13 (95% CI 1.37-3.32)), hypoglycaemia (4.90 (2.79-8.61)), jaundice (2.58 (1.61-4.13)) and shoulder dystocia (2.72 (1.09-6.78)), but not congenital malformations or perinatal death. Women with T2D had a higher risk of induction (4.03 (2.71-5.99)), caesarean section (2.10 (1.44-3.04)), preterm birth (2.74 (1.78-4.24)) and pre-eclampsia (2.75 (1.49-5.10)). An HbA1c >= 6.0% (42 mmol/mol) was associated with increased preterm birth, special care nursery admission, hypoglycaemia and jaundice. Conclusion(s): Despite availability of preconception care, good glycaemic control and specialist management, T2D remains associated with increased adverse obstetric and neonatal outcomes. Further research to examine predictors of adverse outcomes may assist in targeted antenatal surveillance and management.Copyright © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

Background: There are no contemporary cohorts examining pregnancy outcomes in women with type 2 diabetes (T2D) in Australia. Aim(s): To compare pregnancy outcomes in women with and without T2D, and assess effects of body mass index (BMI) and glycaemic control on outcomes. Material(s) and Method(s): An historical cohort study was conducted of all singleton births > 20 weeks gestation at a specialist maternity network in Australia from 2010 to 2013. Data were extracted from the Birthing Outcomes System database. Multivariable logistic regression analysis was used to examine associations between presence of T2D and pregnancy outcomes. Result(s): Outcomes for 138 pregnancies with T2D and 27 075 pregnancies in women without diabetes were compared (type 1 diabetes and gestational diabetes excluded). Women with T2D were older and more overweight compared to women without diabetes (P < 0.01). Their babies were born earlier (P < 0.01) with increased risk of large for gestational age (adjusted odds ratio 2.13 (95% CI 1.37-3.32)), hypoglycaemia (4.90 (2.79-8.61)), jaundice (2.58 (1.61-4.13)) and shoulder dystocia (2.72 (1.09-6.78)), but not congenital malformations or perinatal death. Women with T2D had a higher risk of induction (4.03 (2.71-5.99)), caesarean section (2.10 (1.44-3.04)), preterm birth (2.74 (1.78-4.24)) and pre-eclampsia (2.75 (1.49-5.10)). An HbA1c >= 6.0% (42 mmol/mol) was associated with increased preterm birth, special care nursery admission, hypoglycaemia and jaundice. Conclusion(s): Despite availability of preconception care, good glycaemic control and specialist management, T2D remains associated with increased adverse obstetric and neonatal outcomes. Further research to examine predictors of adverse outcomes may assist in targeted antenatal surveillance and management.Copyright © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

Objective: To compare contemporary pregnancy outcomes in women with and without type 1 diabetes, and to examine the effects of obesity and glycaemic control on these outcomes. Design and setting: Historical cohort study in a specialist diabetes and maternity network in Victoria. Participant(s): All singleton births (at least 20 weeks' gestation), 2010e2013, were analysed: 107 pregnancies to women with type 1 diabetes and 27 075 pregnancies to women without diabetes. Women with type 2 diabetes or gestational diabetes were excluded. Method(s): Data were extracted from the Birthing Outcomes System database; associations between type 1 diabetes and pregnancy outcomes were analysed by multivariable regression. Main Outcome Measure(s): Mode of birth; maternal and neonatal outcomes. Result(s): The mean body mass index was higher for women with type 1 diabetes than for women without diabetes (mean, 27.3 kg/m2 [SD, 5.0] v 25.7 kg/m2 [SD, 5.9]; P = 0.01); the median gestation period for their babies was shorter (median, 37.3 weeks [IQR, 34.6e38.1] v 39.4 weeks [IQR, 38.4e40.4]; P<0.001)and they were more likely to be large for gestational age (LGA) (adjusted odds ratio [aOR], 7.9; 95% CI, 5.3e11.8). Women with type 1 diabetes were more likely to have had labour induced (aOR, 3.0; 95% CI, 2.0e4.5), a caesarean delivery (aOR, 4.6; 95% CI, 3.1e7.0), or a pre-term birth (aOR, 6.7; 95% CI, 4.5e10.0); their babies were more likely to have shoulder dystocia (aOR, 8.2; 95% CI, 3.6e18.7), hypoglycaemia (aOR, 10.3; 95% CI, 6.8e15.6), jaundice (aOR, 5.1; 95% CI, 3.3e7.7), respiratory distress (aOR, 2.5; 95% CI, 1.4e4.4) or to suffer perinatal death (aOR, 4.3; 95% CI, 1.9e9.9). In women with type 1 diabetes, greater obesity was associated with increased odds for an LGA baby or congenital malformation, and increased HbA1c levels were associated with pre-term birth and perinatal death. Conclusion(s): Women with type 1 diabetes, even when managed in a specialist setting, still experience ad

Objective: To compare contemporary pregnancy outcomes in women with and without type 1 diabetes, and to examine the effects of obesity and glycaemic control on these outcomes. Design and setting: Historical cohort study in a specialist diabetes and maternity network in Victoria. Participant(s): All singleton births (at least 20 weeks' gestation), 2010e2013, were analysed: 107 pregnancies to women with type 1 diabetes and 27 075 pregnancies to women without diabetes. Women with type 2 diabetes or gestational diabetes were excluded. Method(s): Data were extracted from the Birthing Outcomes System database; associations between type 1 diabetes and pregnancy outcomes were analysed by multivariable regression. Main Outcome Measure(s): Mode of birth; maternal and neonatal outcomes. Result(s): The mean body mass index was higher for women with type 1 diabetes than for women without diabetes (mean, 27.3 kg/m2 [SD, 5.0] v 25.7 kg/m2 [SD, 5.9]; P = 0.01); the median gestation period for their babies was shorter (median, 37.3 weeks [IQR, 34.6e38.1] v 39.4 weeks [IQR, 38.4e40.4]; P<0.001)and they were more likely to be large for gestational age (LGA) (adjusted odds ratio [aOR], 7.9; 95% CI, 5.3e11.8). Women with type 1 diabetes were more likely to have had labour induced (aOR, 3.0; 95% CI, 2.0e4.5), a caesarean delivery (aOR, 4.6; 95% CI, 3.1e7.0), or a pre-term birth (aOR, 6.7; 95% CI, 4.5e10.0); their babies were more likely to have shoulder dystocia (aOR, 8.2; 95% CI, 3.6e18.7), hypoglycaemia (aOR, 10.3; 95% CI, 6.8e15.6), jaundice (aOR, 5.1; 95% CI, 3.3e7.7), respiratory distress (aOR, 2.5; 95% CI, 1.4e4.4) or to suffer perinatal death (aOR, 4.3; 95% CI, 1.9e9.9). In women with type 1 diabetes, greater obesity was associated with increased odds for an LGA baby or congenital malformation, and increased HbA1c levels were associated with pre-term birth and perinatal death. Conclusion(s): Women with type 1 diabetes, even when managed in a specialist setting, still experience ad

Objective: To determine the prevalence of diabetes in inpatients in Melbourne hospitals. Design(s): Point prevalence survey of all inpatients in each hospital on a single day between 30 November 2010 and 22 November 2012. Setting(s): 11 hospitals in metropolitan Melbourne including community, secondary and tertiary hospitals and one aged care and rehabilitation centre. Participant(s): 2308 adult inpatients in all wards apart from intensive care, emergency, obstetrics and psychiatry. Main Outcome Measure(s): Point prevalence of self-reported diabetes, details of current medication, self-reported frequency of complications. Result(s): Diabetes status was obtained in 2273 of 2308 inpatients (98.5%). Of these, 562 (24.7%) had diabetes (95% CI, 22.9%-26.5%). Diabetes prevalence ranged from 15.7% to 35.1% in diff erent hospitals (P < 0.001). Patients with diabetes were older, heavier and more likely to be taking lipidlowering, antihypertensive and blood-thinning medications. Of 388 patients with complete medication information, 270 (69.6%) were taking oral hypoglycaemic agents alone or in combination with insulin, 158 (40.7%) were treated with insulin (67 [17.3%] with insulin alone) and 51 (13.1%) were not taking medication for diabetes. The frequency of diabetes complications was very high: 207/290 (71.4%) for any microvascular complication, 275/527 (52.2%) for any macrovascular complication and 227/276 (82.2%) for any complication. Conclusion(s): The high burden of diabetes in Melbourne hospital inpatients has major implications for patient health and health care expenditure. Optimising care of these high-risk patients has the potential to decrease inpatient morbidity and length of stay as well as preventing or delaying future complications. A formal Australian national audit of inpatient diabetes would determine its true prevalence and consequences, allowing rational planning to deal with shortcomings in its management.Copyright © MJA 2014, All rights reserved.

Objective: To compare contemporary pregnancy outcomes in women with and without type 1 diabetes, and to examine the effects of obesity and glycaemic control on these outcomes. Design and setting: Historical cohort study in a specialist diabetes and maternity network in Victoria. Participant(s): All singleton births (at least 20 weeks' gestation), 2010e2013, were analysed: 107 pregnancies to women with type 1 diabetes and 27 075 pregnancies to women without diabetes. Women with type 2 diabetes or gestational diabetes were excluded. Method(s): Data were extracted from the Birthing Outcomes System database; associations between type 1 diabetes and pregnancy outcomes were analysed by multivariable regression. Main Outcome Measure(s): Mode of birth; maternal and neonatal outcomes. Result(s): The mean body mass index was higher for women with type 1 diabetes than for women without diabetes (mean, 27.3 kg/m2 [SD, 5.0] v 25.7 kg/m2 [SD, 5.9]; P = 0.01); the median gestation period for their babies was shorter (median, 37.3 weeks [IQR, 34.6e38.1] v 39.4 weeks [IQR, 38.4e40.4]; P<0.001)and they were more likely to be large for gestational age (LGA) (adjusted odds ratio [aOR], 7.9; 95% CI, 5.3e11.8). Women with type 1 diabetes were more likely to have had labour induced (aOR, 3.0; 95% CI, 2.0e4.5), a caesarean delivery (aOR, 4.6; 95% CI, 3.1e7.0), or a pre-term birth (aOR, 6.7; 95% CI, 4.5e10.0); their babies were more likely to have shoulder dystocia (aOR, 8.2; 95% CI, 3.6e18.7), hypoglycaemia (aOR, 10.3; 95% CI, 6.8e15.6), jaundice (aOR, 5.1; 95% CI, 3.3e7.7), respiratory distress (aOR, 2.5; 95% CI, 1.4e4.4) or to suffer perinatal death (aOR, 4.3; 95% CI, 1.9e9.9). In women with type 1 diabetes, greater obesity was associated with increased odds for an LGA baby or congenital malformation, and increased HbA1c levels were associated with pre-term birth and perinatal death. Conclusion(s): Women with type 1 diabetes, even when managed in a specialist setting, still experience ad

Objective: To determine the prevalence of diabetes in inpatients in Melbourne hospitals. Design(s): Point prevalence survey of all inpatients in each hospital on a single day between 30 November 2010 and 22 November 2012. Setting(s): 11 hospitals in metropolitan Melbourne including community, secondary and tertiary hospitals and one aged care and rehabilitation centre. Participant(s): 2308 adult inpatients in all wards apart from intensive care, emergency, obstetrics and psychiatry. Main Outcome Measure(s): Point prevalence of self-reported diabetes, details of current medication, self-reported frequency of complications. Result(s): Diabetes status was obtained in 2273 of 2308 inpatients (98.5%). Of these, 562 (24.7%) had diabetes (95% CI, 22.9%-26.5%). Diabetes prevalence ranged from 15.7% to 35.1% in diff erent hospitals (P < 0.001). Patients with diabetes were older, heavier and more likely to be taking lipidlowering, antihypertensive and blood-thinning medications. Of 388 patients with complete medication information, 270 (69.6%) were taking oral hypoglycaemic agents alone or in combination with insulin, 158 (40.7%) were treated with insulin (67 [17.3%] with insulin alone) and 51 (13.1%) were not taking medication for diabetes. The frequency of diabetes complications was very high: 207/290 (71.4%) for any microvascular complication, 275/527 (52.2%) for any macrovascular complication and 227/276 (82.2%) for any complication. Conclusion(s): The high burden of diabetes in Melbourne hospital inpatients has major implications for patient health and health care expenditure. Optimising care of these high-risk patients has the potential to decrease inpatient morbidity and length of stay as well as preventing or delaying future complications. A formal Australian national audit of inpatient diabetes would determine its true prevalence and consequences, allowing rational planning to deal with shortcomings in its management.Copyright © MJA 2014, All rights reserved.