Diabetes in pregnancy

Transcription

1 Diabetes in pregnancy NDSS initiatives to support women before, during and after pregnancy Melinda Morrison, NDSS Diabetes in Pregnancy Priority Area Leader and the NDSS Diabetes in Pregnancy Expert Reference Group The National Diabetes Services Scheme is an initiative of the Australian Government administered with the assistance of Diabetes Australia. The Commonwealth is not responsible for any recommendations, views, ideas or techniques expressed in this presentation.

2 2 NDSS Diabetes in Pregnancy Expert Reference Group 2018 Assoc Prof Glynis Ross (chair) Endocrinologist Royal Prince Alfred Hospital Sydney Assoc Prof Alison Nankervis Endocrinologist Royal Women s Hospital Melbourne Assoc Prof Ralph Audehm General Practitioner Carlton Family Medical Melbourne Dr Christel Hendrieckx Clinical Psychologist Senior Researcher ACBRD Renza Scibilia Manager Type 1 Diabetes & Consumer Voice Diabetes Australia Alison Barry CDE/Midwife Mater Mother s Hospital Brisbane Dr Cindy Porter APD/CDE Geraldton Diabetes Clinic Geraldton Kaye Farrell Effie Houvardas

3 3 Diabetes during childbearing years NDSS engages with women living with different types of diabetes during pregnancy: Pre-existing type 1 or type 2 diabetes Gestational diabetes mellitus (GDM)

4 Pregnancy in women with type 1 or type 2 diabetes 4

5 Australia s Mothers and Babies per 1000 women have pre-existing type 1 or type 2 diabetes during pregnancy 1

6 WA Mothers and Babies % of pregnant women had pre-existing diabetes 2 Aboriginal women 4 x more likely to have diabetes (2.5%) Obese women 3 x more likely to have diabetes (1.4%)

7 Diabetes in pregnancy is increasing 7 NSW data shows increase from 0.6% in 2011 to ~1.5% pregnancies (n=1398) in Prevalence of T2DM in pregnant women is expected to increase with older maternal age, obesity and an ethnically diverse population 4

8 NDSS pregnancy and diabetes priority area 8 Funded as an NDSS National Development Programme Priority area supported by a multidisciplinary expert reference group Aim: To provide information and support to encourage women with type 1 or type 2 diabetes to plan & prepare for pregnancy and promote optimal diabetes management during pregnancy Diabetes in pregnancy (DIP) continues to be an NDSS priority area

9 Pregnancy in women with diabetes 9 Type 1 and type 2 diabetes pose additional risks during pregnancy 4,5 Miscarriage Congenital abnormalities Pre-term delivery Delivery interventions Stillbirth Maternal complications e.g. pre-eclampsia Planning and preparing for pregnancy and optimal diabetes management have been shown to reduce the risk of adverse outcomes 6,7

10 Improving pregnancy outcomes 10

11 Preconception counselling 11 Key messages Risks associated with pregnancy for women with diabetes Potential consequences of unplanned pregnancy The need for effective contraception to prevent unplanned pregnancy Benefits of diabetes specific pre-pregnancy care prior to conception 11

12 Preconception counselling 12

13 13 93,977 women aged years with type 1 or type 2 diabetes are currently registered with the NDSS 22,534 women with type 1 diabetes 71,443 women with type 2 diabetes Data sourced from the National Diabetes Services Scheme.

14 14 9,824 women in WESTERN AUSTRALIA aged years with diabetes are currently registered with the NDSS 2,384 women with type 1 diabetes 7,440 women with type 2 diabetes Data sourced from the National Diabetes Services Scheme.

15 Preconception counselling 15 Women who are encouraged by their health care provider to seek diabetes specific care prior to pregnancy are 3 x more likely to attend 12 Exposure to a greater number of cues (e.g. education, health messages) is a significant predictor of participation in pre-pregnancy care 13 Encouraging and reassuring messages about pregnancy and diabetes are important Women with diabetes can have a healthy baby

16 Pre-pregnancy care 16 ADIPS (2005) 10 and NHMRC (2011) 14 Safe and effective contraception prior to planning a pregnancy Achieving target blood glucose levels before conception and throughout pregnancy High dose (5mg) folic acid supplementation Review of all existing medications Diabetes complication screening prior to conception

17 A team approach to pre-pregnancy care 17 A team approach is recommenced to optimise prepregnancy care and provide the best outcomes in all aspects of pregnancy and diabetes. This may include: local health professionals with expertise in pregnancy and diabetes referral to a diabetes in pregnancy clinic at a tertiary centre shared care between local services and a diabetes in pregnancy team in a major hospital or telehealth

18 Pre-pregnancy care 18 Diabetes specific pre-pregnancy care has been demonstrated to 6 : first trimester HbA1c (av. 26mmol/mol or 2.4%) congenital malformations (RR 0.25) perinatal mortality (RR 0.35)

19 The pregnancy journey 19 Have the conversation Awareness of the need to plan for pregnancy Contraception until ready to conceive Information and support before pregnancy Diabetes specific pre-pregnancy care Pregnancy planned and best possible diabetes management Healthy pregnancy and healthy baby

20 Planning and preparing for pregnancy 20 Low rates of pregnancy planning and attendance at pre-pregnancy care reported nationally and internationally Zhu et al (2012) reported that 45% of pregnancies among women with diabetes attending a tertiary service in WA were unplanned 15 McElduff et al (2005) found that PPC was documented in only 20% of women with diabetes 28% T1DM & 12% T2DM 16

21 NDSS information and resources 21 Following an extensive consumer and health professional consultation process, a suite of NDSS resources were developed for women with type 1 or type 2 diabetes and their health professionals to support planning and preparing for pregnancy

22 Having a healthy baby booklets 22

23 pregnancyanddiabetes.com.au

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25 Pregnancy planning checklist 25

26 NDSS pregnancy and diabetes factsheets 26

27 Plan for the best start e-newsletter 27

28 28

29 Pregnancy and diabetes seminars 29

30 Health professional e-learning modules 30

31 Ongoing NDSS DIP activities 31 Information dissemination and communications Maintaining and updating resources websites, publications, e-newsletter Promoting health professional CPD Addressing gaps in information and support Building NDSS pathways for national consistency

32 32 Supporting women to plan and prepare for pregnancy at a local level Raising awareness about pregnancy and diabetes among health professionals - especially in primary care Incorporating contraception and pregnancy into annual review for women with diabetes of childbearing age Upskilling of other health professionals to ensure consistent messages about pregnancy and diabetes Ensuring local pathways are in place for diabetes specific PPC Increasing awareness among women with diabetes of available information and resources

33 Gestational diabetes 33

34 In ,171 women with GDM were registered with the NDSS 34 6,504 were registered with a repeat GDM diagnosis 105 women with GDM were registered every day 3212 WA women registered with GDM Data sourced from the National Diabetes Services Scheme.

35 In % Language spoken of women with GDM were overseas born 3% were of Aboriginal or Torres Strait Islander background Women with GDM by aged Age of women group with GDM registered in Data sourced from the National Diabetes Services Scheme.

36 Number of registrants with gestational diabetes Number of registrants with gestational diabetes Data sourced from the National Diabetes Services Scheme.

37 37 Gestational diabetes is the fastest growing type of diabetes in Australia Data sourced from the National Diabetes Services Scheme.

38 The GDM pregnancy journey 38 Universal testing at weeks (earlier if high risk) Early access to information and support NDSS registration and access to supplies Diabetes and obstetric care (ongoing) GDM self-management (ongoing) Healthy pregnancy and healthy baby Oral glucose tolerance test 6-12 weeks Information and support to reduce risk of future Routine diabetes screening every Ongoing healthy lifestyle for mother postpartum type 2 diabetes 1-3 years and offspring

39 How does the NDSS support women on this journey? 39 National Gestational Diabetes Register (NGDR) Access and assistance Information and resources Online and enabled Education and support

40 National Gestational Diabetes Register 40 A register of women with GDM within the NDSS Women diagnosed with GDM registered on the NDSS are automatically included in the NGDR A schedule of reminders are sent to women on the NGDR and their nominated GP Established in 2011 The NGDR was established to provide long term follow-up of women who have had GDM and remind them to have regular diabetes screening.

41 The NGDR offers a unique OPPORTUNITY for early detection and prevention of TYPE 2 DIABETES in a high risk group 41 As of December ,136 women with GDM were registered on the NGDR Data sourced from the National Diabetes Services Scheme.

42 National Gestational Diabetes Register 42 At GDM diagnosis NDSS registration and National Gestational Diabetes Register GDM starter pack Access to diabetes supplies for selfmanagement

43 National Gestational Diabetes Register 43 After the birth of the baby Reminder to have a postnatal oral glucose tolerance test (OGTT) Life after gestational diabetes booklet Annual reminders for diabetes screening sent to woman and GP

44 44 NDSS information and support NDSS Helpline - telephone support Gestational diabetes webpage Understanding gestational diabetes factsheet Translated factsheets Understanding gestational diabetes DVD/clips

45 Ongoing NDSS GDM activities 45 NDSS GDM resource reviews and updates Caring for yourself and your baby booklet Life after gestational diabetes booklet Translated information NDSS GD website and online information Understanding gestational diabetes DVD review

46 Ongoing NDSS GDM activities 46 Evaluation of the National Gestational Diabetes Register Registrant survey and interviews Primary health care consultation and engagement Development of strategies for improving GDM postnatal follow-up and increasing access to healthy lifestyle information Implementation of a service pathways approach to delivery of NDSS services for women with GDM

47 47 Acknowledgments NDSS Diabetes in Pregnancy Expert Reference Group The women living with diabetes and health professionals who participated in the consultation process and provided feedback and input into the development of the NDSS resources References available on request