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Hyperglycaemia: A hidden epidemic in pregnancy
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Abstracts / Women and Birth 30(S1) (2017) 1–47
O59 Australian midwives and complementary and alternative medicines: What is the practice out there? Lyndall Mollart 1,2,∗ , Virginia Skinner 3 , Maralyn Foureur 1,2 1 University of Newcastle, New South Wales, Australia 2 Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia 3 Department of Health Northern Territory, Australia
Introduction: Complementary and Alternative Medicines (CAM) have increasingly been used by women and especially pregnant women. There has also been a steady rise in interest in this field by midwives. Literature describing CAM options midwives recommend to women experiencing a post-dates pregnancy is sparse. Aim: This study aimed to investigate if midwives’ personal CAM use impacts on their discussions and recommendations of CAM to pregnant women. Methods: A national survey of Australian College of Midwives (ACM) members (n = 4677) was undertaken at the National ACM conference (October 2015) and via ACM e-bulletins (November 2015 to March 2016) (UTS HREC 2015000614). The selfadministered survey included questions on what CAM and self-help strategies midwives discuss and recommend to women with postdate pregnancy, midwives’ confidence levels on discussing or recommending CAM and midwives’ own personal use of CAM. Results: A total of 571 midwives and 8 student midwives completed the survey (12.76%). Demographics reflected Australian midwives and ACM membership on age, years as a midwife and state of residence. The majority of participants said they discuss (91.2%) and recommend (88.6%) self-help/CAM strategies to women with a post-date pregnancy. Most midwives felt confident in their knowledge to discuss self-help strategies (87.1%) but slightly less so for CAM (68.8%). The top five CAM discussed were Acupuncture (65.5%), Acupressure (58%), Evening primrose oil (52.3%), Massage (39.2%) and Hypnosis/Calmbirthing/Hypnobirthing (35.4%). Midwives were more likely to discuss strategies if they personally used CAM (p < .001), were younger (p < .001) or had worked less years as registered midwives (p = .004). Midwives were more likely to recommend strategies if they used CAM in their own pregnancies (p = .001). Conclusion and implications: This national survey has provided valuable insight into the practices of Australian midwives in relation to CAM discussed/recommended to pregnant women. This study has implications for inclusion of CAM in undergraduate and postgraduate curricula for midwives. http://dx.doi.org/10.1016/j.wombi.2017.08.071 O60 Hyperglycaemia: A hidden epidemic in pregnancy Harriet Kelly Westmead Public Hospital, New South Wales, Australia Introduction: While many pregnant women are diagnosed with gestational diabetes (GDM) during routine screenings at approximately 28 weeks gestation – an equally large amount of women
have elevated blood sugar levels (hyperglycaemia) but fall ‘just short’ of the diagnostic benchmark. Undiagnosed and without specialist management it could be said that these women are at greater risk of developing adverse outcomes. Aim: To raise awareness of the importance for all midwives to remain vigilant for pregnant women whose glucose tolerance test results fall ‘just short’ of the GDM diagnostic benchmark given the relationship between persistent high blood sugars and adverse outcomes. Issue: Routine antenatal blood screening at approximately 24–28 weeks via an ‘oral glucose tolerance test’ (OGTT) is an excellent diagnostic tool which enables those women who exceed the 8.00 mmol/L threshold to be properly diagnosed with GDM and consequently receive additional antenatal care and treatment to prevent and manage the range of symptoms and adverse outcomes associated with this condition. The difficulty with this screening is the arbitrary nature of this ‘cut off’ point which does not take into account a woman’s individual physiology and the fact that the onset of GDM and its precursor hyperglycaemia works on a sliding scale. There is also evidence to support the fact that insulin resistance (exacerbated by further hormonal changes and decreased gastrointestinal mobility) increases as the pregnancy progresses – leaving many women whose 28 week OGTT results are elevated but under the diagnostic benchmark in a concerning medical void. As such, midwives need to be particularly vigilant for these women by considering a number of clinically supported strategies and advice. Several clinical studies concluded that good dietary advice (similar to that provided to GDM women) has been found to be clinically beneficial for those suffering impaired glucose tolerance/hyperglycaemia – particularly in relation to maintaining a diet with low glycaemic (GI) index foods and by increasing wholegrain carbohydrates which slow down digestion thus enabling the body to adjust to the post consumption sugar load. Other clinically supported strategies include ensuring these women remain on folic acid supplementation, that all ultrasounds are attended, remaining vigilant for UTIs and vaginal infections and undertaking regular blood pressure monitoring. Further strategies include keeping mindful of progressive symptoms such as polydipsia, polyuria and abdominal pain. Midwives should also consider repeating the glucose tolerance test in the final trimester. Implications: Pregnant women with impaired glucose tolerance (but below the GDM diagnostic benchmark) should be considered ‘at risk’ by health professionals – particularly as the pregnancy progresses into the final weeks. Such women should warrant medical management (not dissimilar to strategies employed for those with GDM) to prevent all range of conditions associated with elevated blood sugars which can have significant implications for both mother and child. http://dx.doi.org/10.1016/j.wombi.2017.08.072 O61 Born before Arrival in NSW (2000–2011): A linked population data study of incidence, location, associated factors and maternal and neonatal outcomes Hannah Dahlen, Charlene Thornton ∗ School of Nursing and Midwifery, Western Sydney University, New South Wales, Australia Background: There is evidence that the Born Before Arrival (BBA) rate may be increasing within Australia due to the closure of maternity units and geographic distances to places of birth. The BBA rate in New South Wales (NSW) is not known and the associ-
Abstracts / Women and Birth 30(S1) (2017) 1–47
O59 Australian midwives and complementary and alternative medicines: What is the practice out there? Lyndall Mollart 1,2,∗ , Virginia Skinner 3 , Maralyn Foureur 1,2 1 University of Newcastle, New South Wales, Australia 2 Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia 3 Department of Health Northern Territory, Australia
Introduction: Complementary and Alternative Medicines (CAM) have increasingly been used by women and especially pregnant women. There has also been a steady rise in interest in this field by midwives. Literature describing CAM options midwives recommend to women experiencing a post-dates pregnancy is sparse. Aim: This study aimed to investigate if midwives’ personal CAM use impacts on their discussions and recommendations of CAM to pregnant women. Methods: A national survey of Australian College of Midwives (ACM) members (n = 4677) was undertaken at the National ACM conference (October 2015) and via ACM e-bulletins (November 2015 to March 2016) (UTS HREC 2015000614). The selfadministered survey included questions on what CAM and self-help strategies midwives discuss and recommend to women with postdate pregnancy, midwives’ confidence levels on discussing or recommending CAM and midwives’ own personal use of CAM. Results: A total of 571 midwives and 8 student midwives completed the survey (12.76%). Demographics reflected Australian midwives and ACM membership on age, years as a midwife and state of residence. The majority of participants said they discuss (91.2%) and recommend (88.6%) self-help/CAM strategies to women with a post-date pregnancy. Most midwives felt confident in their knowledge to discuss self-help strategies (87.1%) but slightly less so for CAM (68.8%). The top five CAM discussed were Acupuncture (65.5%), Acupressure (58%), Evening primrose oil (52.3%), Massage (39.2%) and Hypnosis/Calmbirthing/Hypnobirthing (35.4%). Midwives were more likely to discuss strategies if they personally used CAM (p < .001), were younger (p < .001) or had worked less years as registered midwives (p = .004). Midwives were more likely to recommend strategies if they used CAM in their own pregnancies (p = .001). Conclusion and implications: This national survey has provided valuable insight into the practices of Australian midwives in relation to CAM discussed/recommended to pregnant women. This study has implications for inclusion of CAM in undergraduate and postgraduate curricula for midwives. http://dx.doi.org/10.1016/j.wombi.2017.08.071 O60 Hyperglycaemia: A hidden epidemic in pregnancy Harriet Kelly Westmead Public Hospital, New South Wales, Australia Introduction: While many pregnant women are diagnosed with gestational diabetes (GDM) during routine screenings at approximately 28 weeks gestation – an equally large amount of women
have elevated blood sugar levels (hyperglycaemia) but fall ‘just short’ of the diagnostic benchmark. Undiagnosed and without specialist management it could be said that these women are at greater risk of developing adverse outcomes. Aim: To raise awareness of the importance for all midwives to remain vigilant for pregnant women whose glucose tolerance test results fall ‘just short’ of the GDM diagnostic benchmark given the relationship between persistent high blood sugars and adverse outcomes. Issue: Routine antenatal blood screening at approximately 24–28 weeks via an ‘oral glucose tolerance test’ (OGTT) is an excellent diagnostic tool which enables those women who exceed the 8.00 mmol/L threshold to be properly diagnosed with GDM and consequently receive additional antenatal care and treatment to prevent and manage the range of symptoms and adverse outcomes associated with this condition. The difficulty with this screening is the arbitrary nature of this ‘cut off’ point which does not take into account a woman’s individual physiology and the fact that the onset of GDM and its precursor hyperglycaemia works on a sliding scale. There is also evidence to support the fact that insulin resistance (exacerbated by further hormonal changes and decreased gastrointestinal mobility) increases as the pregnancy progresses – leaving many women whose 28 week OGTT results are elevated but under the diagnostic benchmark in a concerning medical void. As such, midwives need to be particularly vigilant for these women by considering a number of clinically supported strategies and advice. Several clinical studies concluded that good dietary advice (similar to that provided to GDM women) has been found to be clinically beneficial for those suffering impaired glucose tolerance/hyperglycaemia – particularly in relation to maintaining a diet with low glycaemic (GI) index foods and by increasing wholegrain carbohydrates which slow down digestion thus enabling the body to adjust to the post consumption sugar load. Other clinically supported strategies include ensuring these women remain on folic acid supplementation, that all ultrasounds are attended, remaining vigilant for UTIs and vaginal infections and undertaking regular blood pressure monitoring. Further strategies include keeping mindful of progressive symptoms such as polydipsia, polyuria and abdominal pain. Midwives should also consider repeating the glucose tolerance test in the final trimester. Implications: Pregnant women with impaired glucose tolerance (but below the GDM diagnostic benchmark) should be considered ‘at risk’ by health professionals – particularly as the pregnancy progresses into the final weeks. Such women should warrant medical management (not dissimilar to strategies employed for those with GDM) to prevent all range of conditions associated with elevated blood sugars which can have significant implications for both mother and child. http://dx.doi.org/10.1016/j.wombi.2017.08.072 O61 Born before Arrival in NSW (2000–2011): A linked population data study of incidence, location, associated factors and maternal and neonatal outcomes Hannah Dahlen, Charlene Thornton ∗ School of Nursing and Midwifery, Western Sydney University, New South Wales, Australia Background: There is evidence that the Born Before Arrival (BBA) rate may be increasing within Australia due to the closure of maternity units and geographic distances to places of birth. The BBA rate in New South Wales (NSW) is not known and the associ-