The perinatal outcomes of women in the Northern Territory with diabetes in pregnancy: The PANDORA Study  — ASN Events
  1. Schedule
  2. ADS Clinical Young Investigator Awards
  3. The perinatal outcomes of women in the Northern Territory with diabetes in pregnancy: The PANDORA Study 

The perinatal outcomes of women in the Northern Territory with diabetes in pregnancy: The PANDORA Study  (#96)

I-Lynn Lee 1 , Alex Brown 2 , Christine Connors 3 , Federica Barzi 1 , Zhong Lu 4 , Cherie Whitbread 1 , Danielle Longmore 1 , Kerin O'Dea 5 , Jeremy Oats 6 , David McIntyre 7 , Jonathan Shaw 8 , Paul Zimmet 8 , Louise Maple-Brown 1
  1. Menzies School of Health Research, Casuarina, NT, Australia
  2. South Australian Health and Medical Research Institute, Adelaide, SA, Australia
  3. NT Department of Health, Darwin, NT, Australia
  4. Melbourne Pathology Services, Melbourne, Victoria, Australia
  5. University of South Australia, Adelaide, SA, Australia
  6. Melbourne School of Population and Global Health, Melbourne, VIC, Australia
  7. Mater Medical Research Institute, Brisbane, QLD, Australia
  8. Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia

Indigenous women have a 10 times higher risk of having type 2 diabetes mellitus (T2DM) in pregnancy than non-Indigenous women.  The PANDORA (Pregnancy and Neonatal Diabetes Outcomes from Remote Australia) study is a prospective birth cohort study recruited from a diabetes in pregnancy (DIP) register in the Northern Territory (NT) where 38% of babies are born to Indigenous mothers.  This study aims to compare the perinatal outcomes by ethnicity of the women.

All NT women with DIP aged 16 years and over are eligible for PANDORA. Information collected included:  antenatal and birth clinical information, cord blood and neonatal anthropometry.  477 mothers with GDM and T2DM had their babies born before July 2014. Only Indigenous (n=187) and Europid women (n=140) were included in this analysis.  C-peptide>90th percentile was defined as >1.7 μg/L as per Hyperglycemic and Adverse Pregnancy Outcome study C-peptide cut-offs.  Data were analysed using t-tests, chi-squared tests; multivariate linear and logistic regression.

Differences in maternal characteristics between Indigenous and Europid mothers were evident for diabetes type (T2DM, 29.4% vs. 3.6%; GDM 70.6% vs. 96.4%), smoking (46.4% vs. 18.3%), nulliparity (15.0% vs. 43.6%) and age (29.9 vs. 31.3 yrs) but not for body mass index (BMI, 29.8 vs. 27.9 kg/m2). On univariate analysis, caesarean section rates (n=327, 53.5 vs. 36.4%, p=0.003), birth weight z-score (n=327, 0.46 vs. 0.17, p=0.05) and C-peptide > 90th percentile (n=197, 35.7% vs. 20.0%, p=0.02) were greater in Indigenous compared with Europid women and their offsprings.  After adjusting for diabetes type, BMI, age and nulliparity, the risk for Indigenous women remained higher for caesarean section (OR 1.80, 1.0-3.1), but not for C-peptide>90th percentile and birth weight z-score.  T2DM was significantly associated with all outcomes on multivariate analyses.

The PANDORA study shows higher rates of caesarean section, birth-weight z-score and C-peptide>90th percentile for Indigenous women.  Indigenous women remained at increased risk of caesarean section after adjusting for diabetes type, BMI, age and nulliparity.  Women with T2DM had increased risk for all adverse perinatal outcomes independent of covariates.