The ADIPS pilot national diabetes in pregnancy benchmarking programme

Immanuel, Jincy
Flack, Jeff
Wong, Vincent W.
Yuen, Lili
Eagleton, Carl
Graham, Dorothy
Lagstrom, Janet
Wolmarans, Louise
Martin, Michele
Cheung, Ngai Wah
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Background: To test the feasibility of benchmarking the care of women with pregnancies complicated by hyperglycaemia. Methods: A retrospective audit of volunteer diabetes services in Australia and New Zealand involving singleton pregnancies resulting in live births between 2014 and 2020. Ranges are shown and compared across services. Results: The audit included 10,144 pregnancies (gestational diabetes mellitus (GDM) = 8696; type 1 diabetes (T1D) = 435; type 2 diabetes (T2D) = 1013) from 11 diabetes services. Among women with GDM, diet alone was used in 39.4% (ranging among centres from 28.8–57.3%), metformin alone in 18.8% (0.4–43.7%), and metformin and insulin in 10.1% (1.5–23.4%); when compared between sites, all p < 0.001. Birth was by elective caesarean in 12.1% (3.6–23.7%) or emergency caesarean in 9.5% (3.5–21.2%) (all p < 0.001). Preterm births (<37 weeks) ranged from 3.7% to 9.4% (p < 0.05), large for gestational age 10.3–26.7% (p < 0.001), admission to special care nursery 16.7–25.0% (p < 0.001), and neonatal hypoglycaemia (<2.6 mmol/L) 6.0–27.0% (p < 0.001). Many women with T1D and T2D had limited pregnancy planning including first trimester hyperglycaemia (HbA1c > 6.5% (48 mmol/mol)), 78.4% and 54.6%, respectively (p < 0.001). Conclusion: Management of maternal hyperglycaemia and pregnancy outcomes varied significantly. The maintenance and extension of this benchmarking service provides opportunities to identify policy and clinical approaches to improve pregnancy outcomes among women with hyperglycaemia in pregnancy.

Article originally published in International Journal of Environmental Research and Public Health, 18(9), 4899. English. Published online 2021.
Gestational diabetes mellitus, Healthcare benchmarking, Audit, Pregnancy, Type 1 diabetes mellitus, Type 2 diabetes mellitus, Pregnancy outcomes, HbA1c
This is the published version of an article that is available at: Recommended citation: Immanuel, J., Flack, J., Wong, V. W., Yuen, L., Eagleton, C., Graham, D., Lagstrom, J., Wolmarans, L., Martin, M., Cheung, N. W., Padmanabhan, S., Rudland, V., Ross, G., Moses, R. G., Maple-Brown, L., Fulcher, I., Chemmanam, J., Nolan, C. J., Oats, J. J., … Simmons, D. (2021). The ADIPS pilot national diabetes in pregnancy benchmarking programme. International Journal of Environmental Research and Public Health, 18(9), 4899. This item has been deposited in accordance with publisher copyright and licensing terms and with the author’s permission.