Chepulis Lynne, Paul Ryan, Lewis-Hills Elizabeth, Ratnaweera Manjula, Mclean Neve, Wolmarans Louise, Tamatea Jade
Medical Research Centre, University of Waikato, Hamilton.
Medical Research Centre, University of Waikato, Hamilton; Waikato Regional Diabetes Service, Waikato District Health Board, Hamilton.
N Z Med J. 2020 Nov 20;133(1525):106-113.
The aim of this study was to assess adherence to the 2014 Ministry of Health (MoH) screening guidelines for diabetes in pregnancy (DiP) by Māori and non-Māori in the Waikato region.
Clinical records were reviewed for women without known diabetes before pregnancy who delivered in hospitals or community birth centres in the Waikato region during June-August 2017. Screening rates for DiP were assessed using HbA1c, glucose challenge and/or glucose tolerance tests.
Of a total of 807 women, 94% received some form of screening for DiP; 527 (65.3%) underwent HbA1c screening at <20 weeks and 267 (33.1%) underwent testing for gestational diabetes at 24-28 weeks' gestation. However, only 213 (26.4%) received all screening as per the MoH guideline. HbA1c testing was the most common screening performed (83.9% of all pregnancies), and three quarters of women had a glucose load screen at some point during pregnancy. In all measures, screening rates were lower in Māori, with only 17.5% (46 of 263 women) receiving both HbA1c and further glucose load screening in the recommended gestation windows (versus 31.6% (171 of 541) for non-Māori; P<0.0005).
Adherence to screening guidelines for DiP was poor with a marked ethnic inequity. Further work is needed to investigate the barriers to care that drive these differences.
本研究旨在评估怀卡托地区毛利族和非毛利族对2014年卫生部妊娠糖尿病（DiP）筛查指南的遵循情况。
对2017年6月至8月在怀卡托地区医院或社区分娩中心分娩的孕前无已知糖尿病的妇女的临床记录进行回顾。使用糖化血红蛋白（HbA1c）、葡萄糖耐量试验和/或葡萄糖耐量测试评估DiP的筛查率。
在总共807名妇女中，94%接受了某种形式的DiP筛查；527名（65.3%）在孕20周前进行了HbA1c筛查，267名（33.1%）在妊娠24 - 28周时进行了妊娠期糖尿病检测。然而，只有213名（26.4%）按照卫生部指南接受了所有筛查。HbA1c检测是最常见的筛查项目（占所有妊娠的83.9%），四分之三的妇女在孕期的某个阶段进行了葡萄糖负荷筛查。在所有指标中，毛利族的筛查率较低，只有17.5%（263名妇女中的46名）在推荐的孕周窗口接受了HbA1c和进一步的葡萄糖负荷筛查（非毛利族为31.6%（541名中的171名）；P<0.0005）。
对DiP筛查指南的遵循情况较差，且存在明显的种族不平等。需要进一步开展工作，调查导致这些差异的护理障碍。
