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 non-Māori.
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.
The 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 8‒10% of pregnancies and the rates are increasing.
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 pregnancy.
“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.”
Women 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 testing.
“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.
The 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 screening.
“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 Māori.
“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 for diabetes in pregnancy in New Zealand—adherence to national guidelines, was authored by:
- Lynne Chepulis, University of Waikato
- 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 Auckland
- Jade Tamatea, Waikato District Health Board, University of Auckland