Pregnancy and Neonatal Diabetes Outcomes in Remote Australia: The PANDORA study - An observational birth cohort

Louise Maple-Brown, I. Lynn Lee, Danielle Longmore, Federica Barzi, Christine Connors, Jacqueline A. Boyle, Elizabeth Moore, Cherie Whitbread, Marie Kirkwood, Sian Graham, Vanya Hampton, Alison Simmonds, Paula Van Dokkum, Joanna Kelaart, Sujatha Thomas, Shridhar Chitturi, Sandra Eades, Sumaria Corpus, Michael Lynch, Zhong X. Lu & 7 others Kerin O'Dea, Paul Zimmet, Jeremy Oats, Harold D. McIntyre, Alex D.H. Brown, Jonathan E. Shaw, on behalf of the PANDORA study research team

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Abstract

Background In Australia's Northern Territory, 33% of babies are born to Indigenous mothers, who experience high rates of hyperglycemia in pregnancy. We aimed to determine the extent to which pregnancy outcomes for Indigenous Australian women are explained by relative frequencies of diabetes type [type 2 diabetes (T2DM) and gestational diabetes (GDM)]. Methods This prospective birth cohort study examined participants recruited from a hyperglycemia in pregnancy register. Baseline data collected were antenatal and perinatal clinical information, cord blood and neonatal anthropometry. Of 1135 women (48% Indigenous), 900 had diabetes: 175 T2DM, 86 newly diagnosed diabetes in pregnancy (DIP) and 639 had GDM. A group of 235 women without hyperglycemia in pregnancy was also recruited. Results Diabetes type differed for Indigenous and non-Indigenous women (T2DM, 36 vs 5%; DIP, 15 vs 7%; GDM, 49 vs 88%, p < 0.001). Within each diabetes type, Indigenous women were younger and had higher smoking rates. Among women with GDM/DIP, Indigenous women demonstrated poorer birth outcomes than non-Indigenous women: large for gestational age, 19 vs 11%, p = 0·002; neonatal fat 11.3 vs 10.2%, p < 0.001. In the full cohort, on multivariate regression, T2DM and DIP were independently associated (and Indigenous ethnicity was not) with pregnancy outcomes. Conclusions Higher rates of T2DM among Indigenous women predominantly contribute to absolute poorer pregnancy outcomes among Indigenous women with hyperglycemia. As with Indigenous and minority populations globally, prevention or delay of type 2 diabetes in younger women is vital to improve pregnancy outcomes and possibly to improve the long-term health of their offspring.

Original languageEnglish
Pages (from-to)307-318
Number of pages12
JournalInternational Journal of Epidemiology
Volume48
Issue number1
DOIs
Publication statusPublished - 1 Feb 2019

Keywords

  • Aboriginal
  • birth cohort
  • diabetes in pregnancy
  • gestational diabetes
  • hyperglycemia in pregnancy
  • Indigenous Australian
  • type 2 diabetes in pregnancy

Cite this

Maple-Brown, L., Lee, I. L., Longmore, D., Barzi, F., Connors, C., Boyle, J. A., ... on behalf of the PANDORA study research team (2019). Pregnancy and Neonatal Diabetes Outcomes in Remote Australia: The PANDORA study - An observational birth cohort. International Journal of Epidemiology, 48(1), 307-318. https://doi.org/10.1093/ije/dyy245
Maple-Brown, Louise ; Lee, I. Lynn ; Longmore, Danielle ; Barzi, Federica ; Connors, Christine ; Boyle, Jacqueline A. ; Moore, Elizabeth ; Whitbread, Cherie ; Kirkwood, Marie ; Graham, Sian ; Hampton, Vanya ; Simmonds, Alison ; Van Dokkum, Paula ; Kelaart, Joanna ; Thomas, Sujatha ; Chitturi, Shridhar ; Eades, Sandra ; Corpus, Sumaria ; Lynch, Michael ; Lu, Zhong X. ; O'Dea, Kerin ; Zimmet, Paul ; Oats, Jeremy ; McIntyre, Harold D. ; Brown, Alex D.H. ; Shaw, Jonathan E. ; on behalf of the PANDORA study research team. / Pregnancy and Neonatal Diabetes Outcomes in Remote Australia : The PANDORA study - An observational birth cohort. In: International Journal of Epidemiology. 2019 ; Vol. 48, No. 1. pp. 307-318.
@article{5abe53fae47a4600ad2ee1ee3bcbef1b,
title = "Pregnancy and Neonatal Diabetes Outcomes in Remote Australia: The PANDORA study - An observational birth cohort",
abstract = "Background In Australia's Northern Territory, 33{\%} of babies are born to Indigenous mothers, who experience high rates of hyperglycemia in pregnancy. We aimed to determine the extent to which pregnancy outcomes for Indigenous Australian women are explained by relative frequencies of diabetes type [type 2 diabetes (T2DM) and gestational diabetes (GDM)]. Methods This prospective birth cohort study examined participants recruited from a hyperglycemia in pregnancy register. Baseline data collected were antenatal and perinatal clinical information, cord blood and neonatal anthropometry. Of 1135 women (48{\%} Indigenous), 900 had diabetes: 175 T2DM, 86 newly diagnosed diabetes in pregnancy (DIP) and 639 had GDM. A group of 235 women without hyperglycemia in pregnancy was also recruited. Results Diabetes type differed for Indigenous and non-Indigenous women (T2DM, 36 vs 5{\%}; DIP, 15 vs 7{\%}; GDM, 49 vs 88{\%}, p < 0.001). Within each diabetes type, Indigenous women were younger and had higher smoking rates. Among women with GDM/DIP, Indigenous women demonstrated poorer birth outcomes than non-Indigenous women: large for gestational age, 19 vs 11{\%}, p = 0·002; neonatal fat 11.3 vs 10.2{\%}, p < 0.001. In the full cohort, on multivariate regression, T2DM and DIP were independently associated (and Indigenous ethnicity was not) with pregnancy outcomes. Conclusions Higher rates of T2DM among Indigenous women predominantly contribute to absolute poorer pregnancy outcomes among Indigenous women with hyperglycemia. As with Indigenous and minority populations globally, prevention or delay of type 2 diabetes in younger women is vital to improve pregnancy outcomes and possibly to improve the long-term health of their offspring.",
keywords = "Aboriginal, birth cohort, diabetes in pregnancy, gestational diabetes, hyperglycemia in pregnancy, Indigenous Australian, type 2 diabetes in pregnancy",
author = "Louise Maple-Brown and Lee, {I. Lynn} and Danielle Longmore and Federica Barzi and Christine Connors and Boyle, {Jacqueline A.} and Elizabeth Moore and Cherie Whitbread and Marie Kirkwood and Sian Graham and Vanya Hampton and Alison Simmonds and {Van Dokkum}, Paula and Joanna Kelaart and Sujatha Thomas and Shridhar Chitturi and Sandra Eades and Sumaria Corpus and Michael Lynch and Lu, {Zhong X.} and Kerin O'Dea and Paul Zimmet and Jeremy Oats and McIntyre, {Harold D.} and Brown, {Alex D.H.} and Shaw, {Jonathan E.} and {on behalf of the PANDORA study research team}",
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Maple-Brown, L, Lee, IL, Longmore, D, Barzi, F, Connors, C, Boyle, JA, Moore, E, Whitbread, C, Kirkwood, M, Graham, S, Hampton, V, Simmonds, A, Van Dokkum, P, Kelaart, J, Thomas, S, Chitturi, S, Eades, S, Corpus, S, Lynch, M, Lu, ZX, O'Dea, K, Zimmet, P, Oats, J, McIntyre, HD, Brown, ADH, Shaw, JE & on behalf of the PANDORA study research team 2019, 'Pregnancy and Neonatal Diabetes Outcomes in Remote Australia: The PANDORA study - An observational birth cohort' International Journal of Epidemiology, vol. 48, no. 1, pp. 307-318. https://doi.org/10.1093/ije/dyy245

Pregnancy and Neonatal Diabetes Outcomes in Remote Australia : The PANDORA study - An observational birth cohort. / Maple-Brown, Louise; Lee, I. Lynn; Longmore, Danielle; Barzi, Federica; Connors, Christine; Boyle, Jacqueline A.; Moore, Elizabeth; Whitbread, Cherie; Kirkwood, Marie; Graham, Sian; Hampton, Vanya; Simmonds, Alison; Van Dokkum, Paula; Kelaart, Joanna; Thomas, Sujatha; Chitturi, Shridhar; Eades, Sandra; Corpus, Sumaria; Lynch, Michael; Lu, Zhong X.; O'Dea, Kerin; Zimmet, Paul; Oats, Jeremy; McIntyre, Harold D.; Brown, Alex D.H.; Shaw, Jonathan E.; on behalf of the PANDORA study research team.

In: International Journal of Epidemiology, Vol. 48, No. 1, 01.02.2019, p. 307-318.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Pregnancy and Neonatal Diabetes Outcomes in Remote Australia

T2 - The PANDORA study - An observational birth cohort

AU - Maple-Brown, Louise

AU - Lee, I. Lynn

AU - Longmore, Danielle

AU - Barzi, Federica

AU - Connors, Christine

AU - Boyle, Jacqueline A.

AU - Moore, Elizabeth

AU - Whitbread, Cherie

AU - Kirkwood, Marie

AU - Graham, Sian

AU - Hampton, Vanya

AU - Simmonds, Alison

AU - Van Dokkum, Paula

AU - Kelaart, Joanna

AU - Thomas, Sujatha

AU - Chitturi, Shridhar

AU - Eades, Sandra

AU - Corpus, Sumaria

AU - Lynch, Michael

AU - Lu, Zhong X.

AU - O'Dea, Kerin

AU - Zimmet, Paul

AU - Oats, Jeremy

AU - McIntyre, Harold D.

AU - Brown, Alex D.H.

AU - Shaw, Jonathan E.

AU - on behalf of the PANDORA study research team

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Background In Australia's Northern Territory, 33% of babies are born to Indigenous mothers, who experience high rates of hyperglycemia in pregnancy. We aimed to determine the extent to which pregnancy outcomes for Indigenous Australian women are explained by relative frequencies of diabetes type [type 2 diabetes (T2DM) and gestational diabetes (GDM)]. Methods This prospective birth cohort study examined participants recruited from a hyperglycemia in pregnancy register. Baseline data collected were antenatal and perinatal clinical information, cord blood and neonatal anthropometry. Of 1135 women (48% Indigenous), 900 had diabetes: 175 T2DM, 86 newly diagnosed diabetes in pregnancy (DIP) and 639 had GDM. A group of 235 women without hyperglycemia in pregnancy was also recruited. Results Diabetes type differed for Indigenous and non-Indigenous women (T2DM, 36 vs 5%; DIP, 15 vs 7%; GDM, 49 vs 88%, p < 0.001). Within each diabetes type, Indigenous women were younger and had higher smoking rates. Among women with GDM/DIP, Indigenous women demonstrated poorer birth outcomes than non-Indigenous women: large for gestational age, 19 vs 11%, p = 0·002; neonatal fat 11.3 vs 10.2%, p < 0.001. In the full cohort, on multivariate regression, T2DM and DIP were independently associated (and Indigenous ethnicity was not) with pregnancy outcomes. Conclusions Higher rates of T2DM among Indigenous women predominantly contribute to absolute poorer pregnancy outcomes among Indigenous women with hyperglycemia. As with Indigenous and minority populations globally, prevention or delay of type 2 diabetes in younger women is vital to improve pregnancy outcomes and possibly to improve the long-term health of their offspring.

AB - Background In Australia's Northern Territory, 33% of babies are born to Indigenous mothers, who experience high rates of hyperglycemia in pregnancy. We aimed to determine the extent to which pregnancy outcomes for Indigenous Australian women are explained by relative frequencies of diabetes type [type 2 diabetes (T2DM) and gestational diabetes (GDM)]. Methods This prospective birth cohort study examined participants recruited from a hyperglycemia in pregnancy register. Baseline data collected were antenatal and perinatal clinical information, cord blood and neonatal anthropometry. Of 1135 women (48% Indigenous), 900 had diabetes: 175 T2DM, 86 newly diagnosed diabetes in pregnancy (DIP) and 639 had GDM. A group of 235 women without hyperglycemia in pregnancy was also recruited. Results Diabetes type differed for Indigenous and non-Indigenous women (T2DM, 36 vs 5%; DIP, 15 vs 7%; GDM, 49 vs 88%, p < 0.001). Within each diabetes type, Indigenous women were younger and had higher smoking rates. Among women with GDM/DIP, Indigenous women demonstrated poorer birth outcomes than non-Indigenous women: large for gestational age, 19 vs 11%, p = 0·002; neonatal fat 11.3 vs 10.2%, p < 0.001. In the full cohort, on multivariate regression, T2DM and DIP were independently associated (and Indigenous ethnicity was not) with pregnancy outcomes. Conclusions Higher rates of T2DM among Indigenous women predominantly contribute to absolute poorer pregnancy outcomes among Indigenous women with hyperglycemia. As with Indigenous and minority populations globally, prevention or delay of type 2 diabetes in younger women is vital to improve pregnancy outcomes and possibly to improve the long-term health of their offspring.

KW - Aboriginal

KW - birth cohort

KW - diabetes in pregnancy

KW - gestational diabetes

KW - hyperglycemia in pregnancy

KW - Indigenous Australian

KW - type 2 diabetes in pregnancy

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U2 - 10.1093/ije/dyy245

DO - 10.1093/ije/dyy245

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JO - International Journal of Epidemiology

JF - International Journal of Epidemiology

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