scholarly journals 1013How has change in gestational diabetes diagnosis affected pregnancy outcomes?

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Deborah Randall ◽  
Jonathan Morris ◽  
Patrick Kelly ◽  
Sarah Glastras
Keyword(s):  
Gestational Diabetes ◽  
Diagnostic Criteria ◽  
New South ◽  
Neonatal Morbidity ◽  
Diabetes Diagnosis ◽  
Confidence Bounds ◽  
South Wales ◽  
Improved Outcomes ◽  
Obstetric Intervention ◽  
Poisson Modelling

Abstract Background Gestational diabetes mellitus (GDM) incidence is increasing in Australia, influenced by new diagnostic criteria gradually implemented from 2011. We aimed to identify whether the change was associated with increased obstetric intervention and/or improved outcomes. Methods Linked perinatal, hospital and deaths data from New South Wales identified singleton births, 33-41 weeks, 2006-2015. Adjusted Poisson modelling predicted the GDM incidence trajectory post-2011 without the diagnostic change and estimated the post-2011 “additional GDM” cases. Actual rates of interventions and outcomes for GDM-diagnosed pregnancies were compared with predicted scenarios where the “additional GDM” group was assumed to have the same rate as (ie clinically same as): (A) the “previous GDM” group <2011; (B) the “non-GDM” group <2011; or (C) the “non-GDM” group ≥2011. Results GDM incidence more than doubled over the study period. Actual planned birth, Caesarean and macrosomia rates were consistent with Scenario A, ie higher intervention rates, but lower macrosomia than B and C. Neonatal hypoglycaemia was lower than Scenario A, closer to B and C. Actual perinatal deaths were lower than predicted by all scenarios, showing improvement for all with GDM, not only “additional” cases. Maternal and neonatal morbidity rates were within the confidence bounds for all three predicted scenarios. Conclusions Our study suggests that the widely adopted new diagnostic criteria for GDM are associated with increased obstetric intervention rates and lower macrosomia rates but with no clear impacts on maternal or neonatal morbidity. Key messages A diagnostic criteria change has identified more GDM pregnancies without clear benefit for outcomes.

scholarly journals Are newly introduced criteria for the diagnosis of gestational diabetes mellitus associated with improved pregnancy outcomes and/or increased interventions in New South Wales, Australia? A population-based data linkage study

2021 ◽  
Vol 9 (1) ◽  
pp. e002277
Author(s):  
Deborah A Randall ◽  
Jonathan M Morris ◽  
Patrick Kelly ◽  
Sarah J Glastras
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Diagnostic Criteria ◽  
New South ◽  
New South Wales ◽  
Neonatal Morbidity ◽  
Adverse Outcomes ◽  
Newly Diagnosed ◽  
South Wales

IntroductionThe incidence of gestational diabetes mellitus (GDM) is increasing in Australia, influenced by changed diagnostic criteria. We aimed to identify whether the diagnostic change was associated with improved outcomes and/or increased obstetric interventions using state-wide data in New South Wales (NSW), Australia.Research design and methodsPerinatal and hospital data were linked for singleton births, 33–41 weeks’ gestation, 2006–2015, NSW. An adjusted Poisson model was used to split pregnancies from 2011 onwards into those that would have been diagnosed under the old criteria (‘previous GDM’) and newly diagnosed cases (‘additional GDM’). We compared actual rates of total and early (<39 weeks) planned births, cesareans, and maternal and neonatal adverse outcomes for GDM-diagnosed pregnancies using three predicted scenarios, where the ‘additional GDM’ group was assumed to have the same rates as: the ‘previous GDM’ group <2011 (scenario A); the ‘non-GDM’ group <2011 (scenario B); or the ‘non-GDM’ group ≥2011 (scenario C).ResultsGDM incidence more than doubled over the study period, with an inflection point observed at 2011. For those diagnosed with GDM since 2011, the actual incidence of interventions (planned births and cesareans) and macrosomia was consistent with scenario A, which meant higher intervention rates, but lower rates of macrosomia, than those with no GDM. Incidence of neonatal hypoglycemia was lower than scenario A and closer to the other scenarios. There was a reduction in perinatal deaths among those with GDM, lower than that predicted by all scenarios, indicating an improvement for all with GDM, not only women newly diagnosed. Incidence of maternal and neonatal morbidity indicators was within the confidence bounds for all three predicted scenarios.ConclusionsOur study suggests that the widely adopted new diagnostic criteria for GDM are associated with increased obstetric intervention rates and lower rates of macrosomic babies, but with no clear impacts on maternal or neonatal morbidity.

Rates of neonatal morbidity by maternal region of birth and gestational age in New South Wales, Australia 2003‐2016

2020 ◽  
Author(s):  
Ye’elah Berman ◽  
Ibinabo Ibiebele ◽  
Deborah Randall ◽  
Siranda Torvaldsen ◽  
Tanya A. Nippita ◽  
...  
Keyword(s):  
Gestational Age ◽  
New South ◽  
New South Wales ◽  
Neonatal Morbidity ◽  
South Wales

scholarly journals Urgent Non-Emergency Surgery and Death Attributable to Anaesthetic Factors

1996 ◽  
Vol 24 (6) ◽  
pp. 694-698 ◽  
Author(s):  
B. F. Horan ◽  
J. C. Warden
Keyword(s):  
New South ◽  
Anaesthetic Management ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Emergency Operations ◽  
South Wales ◽  
Improved Outcomes ◽  
Hospital General ◽  
Inappropriate Choice ◽  
Type Of Surgery

The Special Committee Investigating Deaths Under Anaesthesia in New South Wales classified 1503 deaths which occurred in the years 1984 to 1990 during, within 24 hours of, or as a result of anaesthesia. One hundred and seventy-two (11.4%) of these were attributed definitely, probably or jointly to factors under the anaesthetists’ control. One hundred and forty-four (9.6%) of the 1503 deaths classified occurred in patients undergoing urgent non-emergency operations of which 45 (31.3%) were attributed to anaesthetic factors. A specialist anaesthetist either gave the anaesthetic or was present for part or all of it in 35 of these 45 cases. In 22 the hospital was a metropolitan teaching hospital. General anaesthesia was employed in 31 cases and major regional block (10 spinals and 4 epidurals) in the others. The commonest type of surgery was orthopaedic (26 cases), particularly for fractured neck of femur (20 cases). There were no deaths attributed to anaesthetic factors in cases of this degree of urgency in patients less than 16 years old. The factors under the anaesthetists’ control most often identified as contributing to death were inadequate preparation for anaesthesia and surgery (18 cases, 12 of which were jointly attributed to the surgeon); inappropriate choice or application of technique (17); inadequate postoperative care (12 cases); and overdose (11 cases). If improved outcomes are to be achieved for patients having operations of this degree of urgency, greater attention must be paid to these aspects of their anaesthetic management.

scholarly journals Morbilidade Neonatal na Diabetes Gestacional: Coincidência ou Consequência do Consenso de 2011

2017 ◽  
Vol 30 (9) ◽  
pp. 589
Author(s):  
Gabriela Mimoso ◽  
Guiomar Oliveira
Keyword(s):  
Gestational Diabetes ◽  
Scientific Evidence ◽  
Neonatal Morbidity ◽  
Diabetes Diagnosis ◽  
Perinatal Complications ◽  
Before And After ◽  
Short And Long Term ◽  
New Guidelines ◽  
The Impact

Introduction: Gestational diabetes is one of the diseases associated with pregnancy with higher rate of complications. Despite being a transitory condition, short and long term complications related to gestational diabetes have been described. There is scientific evidence to say that good metabolic control decreases perinatal complications. In 2011, new criteria was proposed for its diagnosis, which made possible its diagnosis during the 1st trimester of pregnancy. The aim of this study is to compare neonatal morbidity in two groups of women with gestational diabetes diagnosis before and after the latest Portuguese guidelines for diabetes and pregnancy were published (February 2011).Material and Methods: We included all newborns born in Maternidade Bissaya Barreto whose mother, followed at our maternity between 2008 and 2013, had unifetal pregnancy complicated by diabetes. We used a perinatal database and analysed the impact of the new guidelines in perinatal morbidity over two periods of three years.Results: There were 774 women who met the inclusion criteria. We found that gestational diabetes was diagnosed earlier, insulin therapy was more frequent. Neonatal morbidity was increased, and there were more cases of neonatal hypoglycemia and congenital anomalies, and newborns became smaller for gestational age.Discussion: The increase in neonatal morbidity was associated with early diagnosis and rigorous metabolic control.Conclusion: To analyse national data will be fundamental to understand this unexpected increase in morbidity.

scholarly journals Reporting of gestational diabetes and other maternal medical conditions

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Heather J Baldwin ◽  
Tanya A Nippita ◽  
Kristen Rickard ◽  
Siranda Torvaldsen ◽  
Therese M McGee ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Gestational Diabetes ◽  
Gestational Hypertension ◽  
New South ◽  
Health Planning ◽  
New South Wales ◽  
Chronic Hypertension ◽  
Medical Conditions ◽  
Predictive Values ◽  
South Wales

IntroductionHospital datasets are a valuable resource for examining prevalence and outcomes of medical conditions during pregnancy. To enable effective research and health planning, it is important to determine whether variables are reliably captured. ObjectiveTo examine the reliability of reporting of gestational and pre-existing diabetes, hypertension, thyroid conditions, and morbid obesity in coded hospital records that inform the population-level New South Wales Admitted Patient Data Collection. MethodsCoded hospital admission data from two large tertiary hospitals in New South Wales, from 2011 to 2015, were compared with obstetric data, collected by midwives at outpatient pregnancy booking and in hospital after birth, as the reference standard. Records were deterministically linked and sensitivity, specificity, positive predictive values and negative predictive values for the conditions of interest were obtained. ResultsThere were 36,051 births included in the analysis. Sensitivity was high for gestational diabetes (83.6%, 95% CI 82.4–84.7%), pre-existing diabetes (88.2%, 95% CI 84.1–91.6%), and gestational hypertension (80.1%, 95% CI 78.2–81.9%), moderate for chronic hypertension (53.5%, 95% CI 47.8–59.1%), and low for thyroid conditions (12.9%, 95% CI 11.7–14.2%) and morbid obesity (9.8%, 95% CI 7.6–12.4%). Specificity was high for all conditions (≥97.8%, 95% CI 97.7–98.0) and positive predictive value ranged from 53.2% for chronic hypertension (95% CI 47.5–58.8%) to 92.7% for gestational diabetes (95% CI 91.8–93.5%). ConclusionOur findings suggest that coded hospital data are a reliable source of information for gestational and pre-existing diabetes and gestational hypertension. Chronic hypertension is less consistently reported, which may be remedied by grouping hypertension types. Data on thyroid conditions and morbid obesity should be used with caution, and if possible, other sources of data for those conditions should be sought.

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