Optimisation of rural clinical and haematological indicators of diabetes in pregnancy (ORCHID) to improve detection of risk for adverse birth outcomes: from addressing glycolysis to implementing novel tests for detecting hyperglycaemia in pregnancy
Optimisation of rural clinical and haematological indicators of diabetes in pregnancy (ORCHID) to improve detection of risk for adverse birth outcomes: from addressing glycolysis to implementing novel tests for detecting hyperglycaemia in pregnancy
Pathology
- Author(s): Marley, J. M., Jamieson, E. L., Spry, E. P.
- Published: 2023
- Publisher: Elsevier
- Volume: 55
- ISBN: 0031-3025
Abstract: Background: Hyperglycaemia in pregnancy (HIP) is a significant intergenerational issue. The ORCHID Study aims to improve screening for and management of HIP in regional, rural and remote communities. Methods: 27 clinics recruited 694 pregnant women (39% Aboriginal women) and conducted oral glucose tolerance tests (OGTT), glycated haemoglobin (HbA1c) and albumin tests early in pregnancy and at 24–28 weeks gestation during 2015–2018. Antenatal records from Aboriginal women attending a Kimberley Aboriginal Community Controlled Health Services were audited (2018–2022). Results: Aboriginal women were more likely to do a HbA1c test early in pregnancy compared to an early OGTT. Early pregnancy glycated haemoglobin (HbA1c) ≥5.6% identified women at high-risk for large-gestational-age (LGA) babies. Sixty percent of Aboriginal women did not complete the OGTT at 24–28 weeks gestation. In women who were tested, 62% of HIP is missed due to glycolysis. Undiagnosed HIP leads to missing women at high-risk for LGA babies. Combining HbA1c with glycated albumin at 24–28 weeks gestation can identify women at high-risk for LGA babies earlier than an OGTT. Conclusion: Opportunities for improving HIP screening protocols include lowering the first trimester HbA1c threshold, preventing glycolysis due to pre-analytical handing, and combining HbA1c with glycated albumin at 24-28 gestation screening.