Background: Women with type 1 diabetes mellitus (T1DM) are at greater risk of maternal and neonatal complications. While efforts have been made to improve pregnancy outcomes for these women, a recent Victorian study found that women with pre-existing diabetes delivering in rural hospitals had poorer outcomes. This highlights the geographical inequality that exists, where patients living rurally have limited access to specialist care and lack the resources to manage their diabetes and prevent complications.
Problem: Albury Wodonga Health (AWH) is a regional centre located on the border of New South Wales and Victoria, with 1,700 births annually and a disproportionately high T1DM prevalence of 0.7%. In 2022, a local audit demonstrated higher rates of special care nursery admission and interventions in women with T1DM. In response, a small local obstetric endocrine clinic was established in June 2023.
Objective: To evaluate the quality of care provided to women with T1DM in pregnancy at AWH and assess neonatal and maternal outcomes.
Methodology: Retrospective clinical audit of women with T1DM who delivered at AWH between 1 January 2021 and 31 December 2025. Researchers extracted clinical data using a standardised proforma, reflecting the current pregnancy clinical guidelines for women with T1DM.
Results and conclusions: 54 women with T1DM delivered at AWH over the five-year period, with 2% stillbirths, 2% neonatal deaths, 16% congenital abnormalities, 79% caesarean or instrumental deliveries, 84% special care nursery admission, and 61% with hypoglycaemia <24h. This highlights the imperative for improved obstetric endocrine management in the region.