MacKay, Diana

Boyle, Jacqueline A

Campbell, Sandra

Freeman, Natasha

McLean, Anna

Hampton, Denella

Whitbread, Cherie

Van Dokkum, Paula

Murtha, Kirby

Connors, Christine

Moore, Elizabeth

Sinha, Ashim

Cadet-James, Yvonne

Cardona, Sharni

Oats, Jeremy

McIntyre, H David

Hanley, Anthony J

Brown, Alex

Shaw, Jonathan E

Kirkham, Renae

Maple-Brown, Louise

2025-03-13

Aboriginal and Torres Strait Islander women experience a disproportionate burden of hyperglycaemia in pregnancy. A multi-component health systems intervention aiming to improve antenatal and postpartum care was implemented across Australia's Northern Territory (NT) and Far North Queensland (FNQ) between 2016 and 2019. Components included clinician education, improving recall systems, enhancing policies and guidelines, and embedding Diabetes in Pregnancy (DIP) Clinical Registers in systems of care. This program was evaluated to determine impacts on clinical practice and maternal health.Data for women with hyperglycaemia in pregnancy from primary care clinical records and the DIP Clinical Registers were analysed to assess changes in: antenatal and postpartum diabetes testing; HbA1c/glucose levels; medication use; weight checks performed, weight and body mass index; and postpartum contraception, smoking and breastfeeding.Clinical practice in the NT improved, including increased uptake of the recommended first trimester 75 g oral glucose tolerance test among women with hyperglycaemia risk factors (Aboriginal and Torres Strait Islander women 11.7% to 26.5%, p < 0.001; non-Indigenous women 6.2% to 19.3%, p < 0.001). In the NT, postpartum diabetes monitoring (56% to 68%, p = 0.039) and contraceptive use (41% to 60%, p = 0.001) increased among Aboriginal and Torres Strait Islander women. In FNQ, postpartum glucose monitoring increased among women with T2D (26% to 68% Aboriginal and Torres Strait Islander, p = 0.002; 50% to 100% non-Indigenous, p = 0.008), although there were no improvements in antenatal care indicators.Aspects of care for women with hyperglycaemia in pregnancy improved in the NT and FNQ following a multi-component health systems intervention.This study is funded by the Australian National Health and Medical Research Council (NHMRC) Global Alliance for Chronic Diseases Grant 1092968.

Menzies School of Health Research, Charles Darwin University, Darwin, Australia.

Department of Endocrinology, Royal Darwin Hospital, Darwin, Australia.

Eastern Health Clinical School, Monash University, Melbourne, Australia.

Jawun Research Centre, School of Health, Medical and Applied Sciences, Central Queensland University, Cairns, Australia.

Menzies School of Health Research, Charles Darwin University, Darwin, Australia.

Menzies School of Health Research, Charles Darwin University, Darwin, Australia.

Department of Diabetes and Endocrinology, Cairns and Hinterland Hospital and Health Service, Cairns, Australia.

Central Australian Aboriginal Congress, Alice Springs, Australia.

Aboriginal and Torres Strait Islander Advisory Group, Diabetes Across the Lifecourse: Northern Australia Partnership, Northern Territory, Australia.

Menzies School of Health Research, Charles Darwin University, Darwin, Australia.

Department of Diabetes, Royal Darwin Hospital, Darwin, Australia.

Alice Springs Hospital, Alice Springs, Australia.

Baker Heart and Diabetes Institute, Alice Springs, Australia.

Menzies School of Health Research, Charles Darwin University, Darwin, Australia.

Health and Wellbeing Queensland, Cairns, Australia.

Northern Territory Department of Health, Darwin, Australia.

Public Health Unit, Aboriginal Medical Services Alliance of Northern Territory, Darwin, Australia.

Department of Diabetes and Endocrinology, Cairns and Hinterland Hospital and Health Service, Cairns, Australia.

Apunipima Cape York Health Council, Bungalow, Australia.

Danila Dilba Health Service, Darwin, Australia.

Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.

Mater Research, The University of Queensland, Brisbane, Australia.

Department of Nutritional Sciences, Dalla Lana School of Public Health, University of Toronto, and Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada.

Telethon Kids Institute, Adelaide, Australia.

National Centre for Indigenous Genomics, Australian National University, Adelaide, Australia.

Clinical and Population Health, Baker Heart and Diabetes Institute, Melbourne, Australia.

Menzies School of Health Research, Charles Darwin University, Darwin, Australia.

Menzies School of Health Research, Charles Darwin University, Darwin, Australia.

Department of Endocrinology, Royal Darwin Hospital, Darwin, Australia.

Lancet Reg Health West Pac . 2025 Mar 13:57:101514. doi: 10.1016/j.lanwpc.2025.101514. eCollection 2025 Apr.

2666-6065

https://pubmed.ncbi.nlm.nih.gov/40162037/?otool=iaurydwlib

https://hdl.handle.net/10137/14220

Aboriginal and Torres Strait Islander

Diabetes in pregnancy

First Nations

Gestational diabetes

Health systems

Quality improvement

Type 2 diabetes

Care provided to women during and after a pregnancy complicated by hyperglycaemia: the impacts of a multi-component health systems intervention.

Journal Article

Publication