Inpatient admission for glycaemic monitoring and management in women with diabetes in pregnancy in the remote Top End — ASN Events
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Inpatient admission for glycaemic monitoring and management in women with diabetes in pregnancy in the remote Top End (#136)

Annee Yogarajah 1 2 , Harshana Munasinghe 1 , Kiarna Brown 1 3 , Sarah Luthy 4 , Winnie Chen 1 5 6 , Genevieve Stawarz 7 , Agatha Kujawa 7 , Matthew Hare 1 8
  1. Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
  2. Flinders University, Darwin, Northern Territory, Australia
  3. Obstetrics and Gynaecology Department, Royal Darwin Hospital , Darwin, Northern Territory, Australia
  4. Katherine Hospital, Katherine, Northern Territory, Australia
  5. Leader Centre for Health Policy , Economics and Data, University of Sydney, Sydney, New South Wales, Australia
  6. Danila Dilba Health Service, Darwin, Northern Territory, Australia
  7. Gove District Hospital, Nhulunbuy, Northern Territory, Australia
  8. Endocrinology Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia

Background: Diabetes in pregnancy (DIP) is common in remote communities of the Northern Territory (NT). Antenatal care for DIP usually occurs predominantly in the outpatient setting. However, where barriers to self-management exist, women may be hospitalised for blood glucose monitoring and treatment optimisation.

Aim: To quantify the burden of antenatal admissions for glycaemia optimisation at two NT remote regional hospitals and describe the characteristics of women admitted and their pregnancy outcomes.

Methods: A retrospective review of medical records for antenatal hospital admissions in 2024 was conducted at Gove District Hospital and Katherine Hospital. Women with any type of DIP hospitalised during pregnancy were identified using ICD-10-AM coding. Hospitalisations for labour and birth were excluded. Data were collected through manual review of electronic medical records. Descriptive statistics were used to summarise admission patterns, indications for admission, and clinical and demographic characteristics.

Results: Over 12 months, 65 women with DIP accounted for 98 antenatal admissions. Among these, 59 (91%) identified as Aboriginal women, median age was 33 years (IQR 25-36), 14 (22%) were nulliparous, 39 (60%) had gestational diabetes, 22 (34%) had type 2 diabetes, and one (2%) had type 1 diabetes. A total of 51 admissions (52%) were primarily for glycaemic optimisation, with glycaemic management a contributing reason for a further 29 admissions (30%). Median length of stay was 2 days (IQR 1-3), and 63 admissions (64%) involved travel from a very remote community. Of all admissions, 15 (15%) included review by a diabetes educator and 20 (20%) by a dietitian. Metformin was used in 45 hospitalisations (46%), and insulin in 21 hospitalisations (21%). Pregnancy outcomes included preterm birth (<37 weeks’) in 24 women (37%), caesarean birth in 31 women (48%), large-for-gestational-age infants in 15 (23%), small-for-gestational-age infants in 9 (14%) and higher level care admission in 20 neonates (31%).

Conclusion: Antenatal hospitalisation for glycaemic monitoring and management remains common in the NT, particularly for Aboriginal women from remote communities. Access to appropriate multidisciplinary care remains limited. These findings will inform future service planning, quality improvement, and development of culturally safe outpatient models of care.