Maternal medical conditions
The burden of disease – including the prevalence of chronic diseases – is higher for Aboriginal and Torres Strait Islander peoples (AIHW 2020).
Diabetes and hypertension (high blood pressure) are significant sources of maternal illness and death (Marschner et al. 2023). Pregnant women with pre-existing or gestational diabetes or pre-existing or gestational hypertension disorders have increased risk of developing adverse outcomes in pregnancy.
Diabetes affecting pregnancy can be pre-existing (that is, type 1 or type 2) or may arise because of the pregnancy (gestational diabetes).
Box 1: Types of diabetes in pregnancy
- Type 1 diabetes is an autoimmune disease, which destroys the cells in the pancreas. The pancreas produces insulin, and people need insulin replacement to survive. It is usually diagnosed in childhood or early adulthood.
- Type 2 diabetes is the most common form of diabetes at the population level. People with Type 2 diabetes produce insulin, but do not produce enough, and/or cannot use it effectively. It involves a genetic component, but is largely preventable, and associated with a later onset. Modifiable risk factors for type 2 diabetes include physical inactivity, poor diet, being overweight or obese, and tobacco smoking.
- Gestational diabetes is characterised by glucose intolerance of varying severity, which develops or is first recognised during pregnancy, mostly in the second or third trimester. It usually disappears after the baby is born but can recur in later pregnancies (AIHW 2023) (for more information see Gestational diabetes).
The type and severity of complications differs according to the type of diabetes experienced in pregnancy and can have both short-term and long-term implications (AIHW 2023).
In the short-term, diabetes in pregnancy is associated with increased risks of caesarean section birth, induced labour, failed induction of labour, pre-existing hypertension, pre-eclampsia, pre-term birth, stillbirth, low and high birthweight, resuscitation, and special care nursery/ neonatal intensive care unit admission (AIHW 2023; AIHW 2019a). Mothers with gestational diabetes –and their babies – experience complications at a lower rate than mothers with pre-existing diabetes (AIHW 2023).
Long term effects of diabetes in pregnancy include increased future risk of other chronic diseases, such as type 2 diabetes, for both mothers with gestational diabetes during pregnancy and their babies (AIHW 2019a).
Management of diabetes in pregnancy depends on the severity of the disease and can include lifestyle programs, which involve changes to diet and exercise, oral glucose-lowering drugs, non-insulin injectable glucose-lowering medications, insulin injections, or a combination of these methods (AIHW 2019b; Wood et al. 2021).
Aboriginal and Torres Strait Islander women are at increased risk of developing type 2 and recurrence of gestational diabetes and may face structural and practical barriers in preventing and managing diabetes in pregnancy including socioeconomic disadvantage, food insecurity, lack of opportunities and facilities for participating in physical activity and competing priorities such as caring responsibilities (AIHW 2019; Wood et al. 2021).
A recent survey of Aboriginal and Torres Strait Islander women with a history of diabetes in pregnancy, and health professionals, found that women and their care givers preferred diabetes management programs that were co-designed with Aboriginal and Torres Strait Islander peoples, involved connections with community, culture and Country, promoted healthy food options, and acknowledged and advocated for change at the structural level (Wood et al. 2021).
This report shows that Aboriginal and Torres Strait Islander females who gave birth and had pre-existing diabetes were more likely than those who had no diabetes to give birth to a baby who was pre-term, had either low birthweight or high birthweight or were large for gestational age.
Aboriginal and Torres Strait Islander mothers who were diagnosed with gestational diabetes during their pregnancy were also more likely to give birth to a baby who was large for gestational age than mothers who did not have diabetes (for more information on the effect of maternal diabetes see Outcomes for babies of Aboriginal and Torres Strait Islander mothers). In 2020, 0.1% of Aboriginal and Torres Strait Islander females who gave birth had type 1 diabetes, 1.9% had type 2 diabetes and 15% had gestational diabetes (compared with 0.3%, 0.4% and 14%, respectively, of non-Indigenous females).
Between 2014 and 2020 the proportion of Aboriginal and Torres Strait Islander mothers with type 2 diabetes ranged from 1.2% to 1.9%. Over the same period the proportion of Aboriginal and Torres Strait Islander mothers with gestational diabetes has increased (from 9.3% in 2014 to 15% in 2020).
The data visualisation below shows the proportion of Aboriginal and Torres Strait Islander and non-Indigenous females who gave birth by diabetes status, from 2014.
Figure 1: Proportion of Aboriginal and Torres Strait Islander and non-Indigenous females who gave birth by diabetes status from 2014 to 2020