Pregnant Women Missing Out On Diabetes Checks

A University of Waikato study has found only 26.4% of
women in the Waikato region are screened for diabetes during
pregnancy as per the national guidelines. Even worse, just
17.5% of Māori women receive the recommended checks,
despite being at higher risk of diabetes than

During pregnancy, a woman needs two to
three times as much insulin (the hormone which controls
blood sugar) as when she is not pregnant. If her body cannot
produce this, she will experience diabetes.

complication usually only lasts during pregnancy; however it
can be dangerous (even fatal) for mums and babies, so early
diagnosis and appropriate management are key. In New
Zealand, diabetes affects 810% of pregnancies and the
rates are increasing.

The study

Dr Lynne
Chepulis and her team reviewed data on women who gave birth
in hospitals and birth centres in the Waikato from June to
August 2017.

They found that although more than 80% of
the women received some kind of diabetes test, few were
checked in accordance with the Ministry of Health
guidelines. Introduced in 2014, the guidelines recommend
several types of diabetes tests at different points in the

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“The results of our study show many
midwives and obstetricians may not be following the
Ministry’s guidelines for screening pregnant women for
diabetes,” says Dr Chepulis.

“This might be to do
with the guidelines themselves, which some health
professionals consider overcomplicated. It could also be
that some are unaware of the guidelines or need training on
how to implement them.

“And it’s important to note
that women might not have a midwife or obstetrician early on
in their pregnancy, meaning they don’t get screened for
diabetes at all the recommended stages.”

being missed

Using the national average rates of
diabetes in pregnancy, the researchers estimate five Māori
and eight non-Māori women in their study actually had the
illness but were missed due to lack of

“Although we didn’t assess pregnancy
outcomes within this study, we can speculate that these
women and their babies may have been negatively impacted by
this disease, because they weren’t screened and managed
correctly,” Dr Chepulis says.

Next steps

researchers have received funding from the Waikato Medical
Research Foundation to extend their study, looking at all
women who gave birth in the Waikato (excluding home births)
in 2018. Now underway, the larger study includes data from
more than 5000 women and interviews with mothers and
midwives to identify barriers to diabetes

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“I think the results will show that a
review of the national guidelines might be needed, and that
it should consider alternative, woman-centred pathways of
screening for diabetes in pregnancy,” says Dr Chepulis.
“If looking into alternative screening options, we also
need to look at their potential to improve access for

“And if the guidelines do change, this will
need to be carefully communicated with midwives and
obstetricians, with training on offer so they can
confidently put them into action.”

The paper, Ethnic
inequities in screening fordiabetes in pregnancy in New
Zealand—adherence to national guidelines
, was
authored by:

· Lynne Chepulis, University of

· Dr Ryan Paul, University of Waikato,
Waikato District Health Board

· Elizabeth
Lewis-Hills, Waikato District Health Board

· Manjula
Ratnaweera, Waikato District Health Board

· Neve
Mclean, University of Otago

· Louise Wolmarans,
Waikato District Health Board, University of

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· Jade Tamatea, Waikato District Health
Board, University of

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