Audit of Diabetes in Pregnancy in CWM Hospital 2009 to 2010

CWM Hospital is the major referral hospital for the Central and Eastern division of the Fiji Islands. The obstetrics unit caters for deliveries in the Suva Sub-division and referrals from the Central and Eastern division. Included are those women with diabetes in pregnancy who are referred for antenatal follow-up and delivery. From 1997 to 2007 round about 5000 to 7000 women delivered at the CWM hospital annually and these figures are expected to increase over the coming years.
Diabetes in pregnancy constitute of pre-existing diabetes which is either type I or type 2 diabetes mellitus and gestational diabetes mellitus. Gestational diabetes occurs in 2-9% of pregnancies. More recently improvements in pregnancy related outcomes have been documented due to better patient care programs such as multidisciplinary approach which includes an obstetrician, internal medicine specialist, dietician and a diabetic nurse educator.
In 2002 a system was adopted whereby high-risk patients were screened with a glucose challenge test and positive cases were then tested with the oral glucose challenge test. This system involves identifying risk markers at booking and those-identified those identified as high risk were selected for the Glucose Challenge test. Those with history of pre-pregnancy diabetes did not need further screening and were admitted for routine four-point blood sugar monitoring. The guidelines for gestational diabetes mellitus by the Australian Diabetes in Pregnancy Society are being used at the
CWM Hospital for screening and diagnosis of diabetes in pregnancy.
The screening risk factors used in C WM hospital for GDM were the following:
Age >30 years
Obesity
Glucosuria
Family history of diabetes
Past history of GDM
Previous history of babies >4kg
Previous adverse pregnancy outcomes
Stillbirths
Neonatal deaths
Fetal abnormalities
Miscarriages