Abstract：
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.
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.
摘要：
这项研究的目的是评估怀卡托地区毛利人和非毛利人对2014年卫生部（MoH）妊娠糖尿病筛查指南（DiP）的遵守情况。
2017年6月至8月在怀卡托地区的医院或社区分娩中心分娩的妊娠前无已知糖尿病妇女的临床记录进行了审查。使用HbA1c评估DiP的筛查率，葡萄糖挑战和/或葡萄糖耐量试验。
总共807名女性中,94%接受了某种形式的DiP筛查；527(65.3%)在<20周时接受了HbA1c筛查，267(33.1%)在24-28周时接受了妊娠糖尿病检测。然而,只有213例(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（占所有妊娠的83.9%）。四分之三的女性在怀孕期间的某个时候有葡萄糖负荷筛查。在所有措施中，毛利人的筛查率较低，只有17.5%(263名女性中的46名)在推荐的妊娠窗口中同时接受HbA1c和进一步的葡萄糖负荷筛查(非毛利人为31.6%(541名女性中的171名);P<0.0005).
对DiP筛查指南的依从性较差，存在明显的种族不平等。需要进一步的工作来调查导致这些差异的护理障碍。
2017年6月至8月在怀卡托地区的医院或社区分娩中心分娩的妊娠前无已知糖尿病妇女的临床记录进行了审查。使用HbA1c评估DiP的筛查率，葡萄糖挑战和/或葡萄糖耐量试验。
总共807名女性中,94%接受了某种形式的DiP筛查；527(65.3%)在<20周时接受了HbA1c筛查，267(33.1%)在24-28周时接受了妊娠糖尿病检测。然而,只有213例(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（占所有妊娠的83.9%）。四分之三的女性在怀孕期间的某个时候有葡萄糖负荷筛查。在所有措施中，毛利人的筛查率较低，只有17.5%(263名女性中的46名)在推荐的妊娠窗口中同时接受HbA1c和进一步的葡萄糖负荷筛查(非毛利人为31.6%(541名女性中的171名);P<0.0005).
对DiP筛查指南的依从性较差，存在明显的种族不平等。需要进一步的工作来调查导致这些差异的护理障碍。
