Connecting hapu mama (pregnant women) early to a lead maternity carer: striving for equity using the Best Start-Pregnancy Tool.

Introduction In Aotearoa New Zealand, lead maternity carers (LMCs) provide maternity care through pregnancy and birth, until 6 weeks' postpartum. An early LMC connection in pregnancy is associated with better maternal and perinatal health outcomes. However, hapu mama (pregnant women) may experience barriers to engaging with LMC, delaying screening, risk assessments, and education. These barriers contribute to inequitable health outcomes for Maori mama and pepi (Maori mothers and babies). A pro-equity approach to maternity care is warranted. Aim To investigate the LMC plan at the first point of contact with a primary care provider once pregnancy is confirmed, as well as selected risk factors to maternal and perinatal health for Maori and non-Maori hapu mama. Methods Data entered by primary care providers into the Best Start-Pregnancy Tool were analysed for 482 pregnant women from November 2020 to December 2021. Results Most hapu mama planned for midwifery care. About one-third of hapu mama had engaged with a midwife before their first GP visit after a confirmed pregnancy. Maori hapu mama were more likely to present with risk factors to maternal and perinatal health than non-Maori hapu mama. Discussion Primary healthcare providers have an expectation to connect hapu mama to a LMC by 10 weeks' gestation. More research is needed to identify how to best support Maori hapu mama to access a LMC early in pregnancy. The Best Start Kowae is an accessible online tool (currently in an implementation phase) for primary care providers and LMCs that promotes equitable health outcomes for Maori mama and pepi.

What protects against pre-diabetes progressing to diabetes? Observational study of integrated health and social data.

AIMS: To examine the incidence of type 2 diabetes in people with newly diagnosed prediabetes and the factors that protect against this progression. METHODS: The study population was 14,043 adults with pre-diabetes enrolled in a primary health organization in the upper North Island of New Zealand. Glycated hemoglobin (HbA1c) and body mass index (BMI) were linked to government health, census and social datasets in the Statistics New Zealand Integrated Data Infrastructure. Adults with a first diagnosis of pre-diabetes between 2009 and 2017 (HbA1c in range 5.9-6.6% [41-49 mmol/mol]) were followed-up for type 2 diabetes incidence. Cox regression was used to examine protective factors and adjust for potential confounding. RESULTS: Cumulative diabetes incidence was 5.0% after three years. Progression was greater in younger adults, men, people with higher HbA1c, greater BMI and a more recent diagnosis. Progression was lower in people treated with metformin, and Indigenous language speakers. Higher progression rates for Maori (Indigenous population) and Pacific peoples (migrants to New Zealand) were related to higher baseline HbA1c. CONCLUSIONS: This is the first study to identify Indigenous language as a protective factor against diabetes, and results confirm obesity as a key target for population prevention. People with identified risk factors should be prioritized for pre-diabetes interventions.