Problems with the pregnancy sugar drink test in rural and remote Australia

What is it about?

Gestational diabetes mellitus (GDM) means high blood sugar in pregnancy. A lot of women find the sugar drink test for GDM hard to do and many do not want to do it. In the ORCHID Study we wanted to see if we could make it easier to check for GDM. During the study we discovered that there are problems with the way the blood sample tubes are stored before they are tested. To get correct sugar results, the blood tubes need to be put straight on ice in an esky until they are tested. Testing needs to happen within one hour of the last blood sample being taken. This is not part of usual practice in Australia. Instead blood samples are put in tubes that contain an additive (fluoride) to stop cells in the blood sample from using sugar. However, this takes four hours to work, so when the blood gets tested there is less sugar. We wanted to explore this further to see if usual practice effects sugar results and if we are missing women with GDM. How was this study done? • 600 of 694 (39% Aboriginal) women from 27 clinics across regional, rural and remote WA completed the ORCHID study and delivered their babies after 30 weeks gestation. Most of the blood sample tubes took over four hours to get to the lab for testing. • We found out how much the sugar result dropped by getting women to give blood samples that could get tested quickly. We kept blood sample tubes from these women at room temperature (usual clinic practice), on ice (research grade), and in a different blood sample tube that is better at keeping sugar stable (FC Mix tubes). What does this research show? • We think that we missed 2 out of 3 women who had GDM due to the drop in sugar results. • Sugar results did not change in blood samples put in FC Mix tubes. This would mean more women would be told they had GDM.

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Photo by Heather Mount on Unsplash

Photo by Heather Mount on Unsplash

Why is it important?

Changes to clinical practice: FC Mix tubes are easier to use than putting samples on ice to stop sugar results from dropping. While more women might be told they have GDM when we use these blood tubes, this will allow the clinic to help look after the woman with a care plan that includes a special diet, exercise, and more regular checking of sugar results. More education programs and resources are needed about the effects of too much sugar. Kimberley Aboriginal Community Controlled Health Organisations are now using FC Mix tubes and Pathwest will accept these tubes for sugar testing. We plan to meet with the Royal College of Pathologists of Australasia (RCPA), to discuss updating their guidelines for blood sample collection for sugar testing.