为孕期及产后出现高血糖并发症的女性提供的护理：多组分卫生系统干预措施的影响

Care provided to women during and after a pregnancy complicated by hyperglycaemia: the impacts of a multi-component health systems intervention.

作者信息

MacKay Diana, Boyle Jacqueline A, Campbell Sandra, Freeman Natasha, McLean Anna, Hampton Denella, Whitbread Cherie, Van Dokkum Paula, Murtha Kirby, Connors Christine, Moore Elizabeth, Sinha Ashim, Cadet-James Yvonne, Cardona Sharni, Oats Jeremy, McIntyre H David, Hanley Anthony J, Brown Alex, Shaw Jonathan E, Kirkham Renae, Maple-Brown Louise

机构信息

Menzies School of Health Research, Charles Darwin University, Darwin, Australia.

Department of Endocrinology, Royal Darwin Hospital, Darwin, Australia.

出版信息

Lancet Reg Health West Pac. 2025 Mar 13;57:101514. doi: 10.1016/j.lanwpc.2025.101514. eCollection 2025 Apr.

DOI:10.1016/j.lanwpc.2025.101514

PMID:40162037

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11952800/

Abstract

BACKGROUND

Aboriginal and Torres Strait Islander women experience a disproportionate burden of hyperglycaemia in pregnancy. A multi-component health systems intervention aiming to improve antenatal and postpartum care was implemented across Australia's Northern Territory (NT) and Far North Queensland (FNQ) between 2016 and 2019. Components included clinician education, improving recall systems, enhancing policies and guidelines, and embedding Diabetes in Pregnancy (DIP) Clinical Registers in systems of care. This program was evaluated to determine impacts on clinical practice and maternal health.

METHODS

Data for women with hyperglycaemia in pregnancy from primary care clinical records and the DIP Clinical Registers were analysed to assess changes in: antenatal and postpartum diabetes testing; HbA1c/glucose levels; medication use; weight checks performed, weight and body mass index; and postpartum contraception, smoking and breastfeeding.

FINDINGS

Clinical practice in the NT improved, including increased uptake of the recommended first trimester 75 g oral glucose tolerance test among women with hyperglycaemia risk factors (Aboriginal and Torres Strait Islander women 11.7% to 26.5%, p < 0.001; non-Indigenous women 6.2% to 19.3%, p < 0.001). In the NT, postpartum diabetes monitoring (56% to 68%, p = 0.039) and contraceptive use (41% to 60%, p = 0.001) increased among Aboriginal and Torres Strait Islander women. In FNQ, postpartum glucose monitoring increased among women with T2D (26% to 68% Aboriginal and Torres Strait Islander, p = 0.002; 50% to 100% non-Indigenous, p = 0.008), although there were no improvements in antenatal care indicators.

INTERPRETATION

Aspects of care for women with hyperglycaemia in pregnancy improved in the NT and FNQ following a multi-component health systems intervention.

FUNDING

This study is funded by the Australian National Health and Medical Research Council (NHMRC) Global Alliance for Chronic Diseases Grant 1092968.

摘要

背景

澳大利亚原住民和托雷斯海峡岛民妇女在孕期面临着不成比例的高血糖负担。2016年至2019年期间，澳大利亚北领地（NT）和远北昆士兰（FNQ）实施了一项旨在改善产前和产后护理的多成分卫生系统干预措施。干预措施包括临床医生教育、改进召回系统、加强政策和指南，以及将妊娠糖尿病（DIP）临床登记纳入护理系统。对该项目进行了评估，以确定其对临床实践和孕产妇健康的影响。

方法

分析初级保健临床记录和DIP临床登记中孕期高血糖妇女的数据，以评估以下方面的变化：产前和产后糖尿病检测；糖化血红蛋白/血糖水平；药物使用；体重检查、体重和体重指数；以及产后避孕、吸烟和母乳喂养情况。

结果

北领地的临床实践得到改善，包括有高血糖风险因素的妇女（原住民和托雷斯海峡岛民妇女从11.7%增至26.5%，p<0.001；非原住民妇女从6.2%增至19.3%，p<0.001）中推荐的孕早期75克口服葡萄糖耐量试验的接受率增加。在北领地，原住民和托雷斯海峡岛民妇女的产后糖尿病监测（从56%增至68%，p=0.039）和避孕措施使用（从41%增至60%，p=0.001）有所增加。在远北昆士兰，2型糖尿病妇女的产后血糖监测有所增加（原住民和托雷斯海峡岛民从26%增至68%，p=0.002；非原住民从50%增至100%，p=0.008），尽管产前护理指标没有改善。