(Pregnancy and Neonatal Diabetes Outcomes in Remote Australia)
PANDORA is a longitudinal birth cohort study of mothers and their children that will assess outcomes of diabetes in pregnancy (DIP) in the Northern Territory, including high-risk Aboriginal women and their children. The results of this study will contribute to policy and clinical practice guidelines on the management of diabetes in pregnancy and follow-up of mother and baby.
The study will also inform the design of further work to reduce risk of future obesity, diabetes and cardiovascular disease in both the mothers and children.
PANDORA Baseline (2012 – 2017)
Recruitment commenced in 2012 and was completed in February 2017. Over 1100 women and their babies, with and without diabetes in pregnancy, were recruited during pregnancy across all NT regions. Participants included women with any type of diabetes in pregnancy (type 1 diabetes, type 2 diabetes, gestational diabetes mellitus) and women without diabetes in pregnancy and their children. Approximately 50% of PANDORA women are Aboriginal and/or Torres Strait Islander women. Our cohort is unique for the high proportion of mothers with pre-existing type 2 diabetes in pregnancy.
The baseline study involved the collection of pregnancy and birth information, and undertaking measurements including cord blood and detailed neonatal body fat assessments.
PANDORA Wave 1 (2016 – 2018)
PANDORA Wave 1 involved follow-up clinical assessments ~2-4 years after baseline of a sub-group of Aboriginal and Europid PANDORA mothers and their babies’. Participants were eligible for Wave 1 if at baseline the PANDORA mother had type 2 diabetes, gestational diabetes mellitus or no DIP, and 415 mothers and 423 babies participated.
PANDORA Wave1 aims to examine cardio-metabolic risk factors in these mothers and their infants in order to identify predictors of chronic disease such as obesity, diabetes and heart disease later in life. Data from Wave 1 will permit exploration of the maternal and infant consequences of diabetes in pregnancy to inform the timing and types of interventions to prevent the development of later chronic conditions.
The Wave 1 study involved detailed assessments of both the mother and her child which included: measurements of body size and blood pressure, collection of blood to measure glucose, cholesterol levels markers of inflammation and assessment of epigenetics. Additional assessments for the child included: ultrasound of the aorta blood vessel, body fat measurements (bioimpedance and skin folds), and a developmental assessment. The mothers also completed questionnaires about her and her child including demographics, smoking and alcohol use, nutrition, physical and mental health, and about her child’s development and well-being.
PANDORA Wave 2 (2019 – 2023)
PANDORA Wave 2 is the next follow-up phase of the PANDORA cohort, where all mothers and children 6-10 years of age/post-partum will be invited to participate in a health examination. The cohort will also be broadened to include a group of brothers and sisters (6-16 years) of Aboriginal PANDORA children who will be invited to participate.
Study assessment will commence in late 2019 and continue until March 2023, to cover the 5 year age range of the cohort.
Ethics approval has been received for both Top End and Central Australia committees.
The Partnership has received letters of support from Aboriginal Medical Services Alliance Northern Territory and the two largest Aboriginal controlled urban health services; Danila Dilba Health Services and Central Australian Aboriginal Congress. We are in the process of contacting other NT Aboriginal Community Controlled Health Organisations to discuss the study and request their support.
We have approval from the NT Government Health Services to work with remote clinics in both Top End and Central Australia and the hospitals for access to medical records.
This sub-study involving PANDORA mothers was completed in 2016. It assessed whether enhanced post-pregnancy support for Aboriginal and Torres Strait Islander women with diabetes in pregnancy improved uptake of recommended health checks post-partum. The study also identified the enablers and barriers to undertaking the recommended post-pregnancy health checks. Results have been published (see publications Kirkham el at ANZJOG 2019).
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