Introduction:
Management guidelines recommend that women with gestational diabetes (GDM) access a multidisciplinary team for education and care throughout their pregnancy. However, in rural areas, access to such care is often limited.
Aim:
To compare the perinatal outcomes of women with GDM attending rural hospitals with those attending the tertiary hospital in a single health district.
Method:
We conducted a retrospective chart audit of women with GDM mellitus who delivered in the Darling Downs between January 2012 and December 2013.
Results:
During the study period, 447 women with GDM delivered a total of 467 babies. In both groups there were high rates of overweight/obesity (76.9% and 79.9%, p= NS) and equivalent glucose results on OGTT.
Rural women were less likely to receive diabetes education (84.1% vs 94.4%, p<0.001), receive medical treatment (23.9% vs 46.6%, p<0.001), or achieve good glucose control (35.3% vs 57.9%, p<0.001).Â
Overall rates of Caesarean section were comparable for both groups (39.6% vs 41.1%, p= NS), while rural women referred for antenatal care were most likely to undergo an elective Caesarean section (44.8% vs 17.5%, p = 0.004).
There were similar rates of macrosomia (12.9% vs 11.1% p=NS) and hypoglycaemia (40.4% vs 38%, p = NS) in both groups. However, there was a significantly higher rate of shoulder dystocia in rural women (3.5% vs 0.6%, p=0.012).
Rural women were significantly less likely to breastfeed their babies (55.2% vs 77.5%, p <0.001).
Conclusion:
This study highlights the inequity of GDM care experienced by women living in rural Australia. Rural women were less likely to receive education or medical treatment, and less likely to achieve optimal glucose control. While the comparable neonatal outcomes are reassuring, the higher rate of shoulder dystocia and low rates of breastfeeding are concerning for these women.