MacKay, DianaBoyle, Jacqueline A.Campbell, SandraFreeman, NatashaMcLean, AnnaHampton, DenellaWhitbread, CherieVan Dokkum, PaulaMurtha, KirbyConnors, ChristineMoore, ElizabethSinha, AshimCadet-James, YvonneCardona, SharniOats, JeremyMcIntyre, H. DavidHanley, Anthony J.Brown, AlexShaw, Jonathan E.Kirkham, RenaeMaple-Brown, Louise2025-05-232025-05-23http://www.scopus.com/inward/record.url?scp=86000656032&partnerID=8YFLogxKhttps://hdl.handle.net/1885/733752001Background: Aboriginal and Torres Strait Islander women experience a disproportionate burden of hyperglycaemia in pregnancy. A multi-component health systems intervention aiming to improve antenatal and postpartum care was implemented across Australia's Northern Territory (NT) and Far North Queensland (FNQ) between 2016 and 2019. Components included clinician education, improving recall systems, enhancing policies and guidelines, and embedding Diabetes in Pregnancy (DIP) Clinical Registers in systems of care. This program was evaluated to determine impacts on clinical practice and maternal health. Methods: Data for women with hyperglycaemia in pregnancy from primary care clinical records and the DIP Clinical Registers were analysed to assess changes in: antenatal and postpartum diabetes testing; HbA1c/glucose levels; medication use; weight checks performed, weight and body mass index; and postpartum contraception, smoking and breastfeeding. Findings: Clinical practice in the NT improved, including increased uptake of the recommended first trimester 75 g oral glucose tolerance test among women with hyperglycaemia risk factors (Aboriginal and Torres Strait Islander women 11.7% to 26.5%, p < 0.001; non-Indigenous women 6.2% to 19.3%, p < 0.001). In the NT, postpartum diabetes monitoring (56% to 68%, p = 0.039) and contraceptive use (41% to 60%, p = 0.001) increased among Aboriginal and Torres Strait Islander women. In FNQ, postpartum glucose monitoring increased among women with T2D (26% to 68% Aboriginal and Torres Strait Islander, p = 0.002; 50% to 100% non-Indigenous, p = 0.008), although there were no improvements in antenatal care indicators. Interpretation: Aspects of care for women with hyperglycaemia in pregnancy improved in the NT and FNQ following a multi-component health systems intervention. Funding: This study is funded by the Australian National Health and Medical Research Council (NHMRC) Global Alliance for Chronic Diseases Grant 1092968y.This study is funded by the Australian National Health and Medical Research Council (NHMRC) Global Alliance for Chronic Diseases Grant 1092968.This study is funded by the Australian National Health and Medical Research Council (NHMRC) Global Alliance for Chronic Diseases Grant 1092968, and was independently peer-reviewed by this funding body. DM is supported by NHMRC Postgraduate Scholarship GNT1168668; JB was supported by NHMRC Career Development Fellowship; AB was supported by a Sylvia and Charles Viertel Senior Medical Research Fellowship and NHMRC Research Fellowship 1137563; LMB is supported by NHMRC Investigator Grant 1194698. The Diabetes Across the Lifecourse: Northern Australia Partnership is a collaboration between researchers, policy makers and health organisations committed to using a lifecourse approach to improve care for people across Northern Australia with diabetes, focussing on hyperglycemia in pregnancy and youth diabetes. We gratefully acknowledge all Diabetes Across the Lifecourse: Northern Australia Partnership participants and staff including Vanya Webster, Sian Graham, Chenoa Wapau, Martil Zachariah, Jennifer Barrett, Tara Dias, Kristina Vine, Bronwyn Davis; Partnership investigators; the Partnership Aboriginal and Torres Strait Islander Advisory Group, NT Clinical Reference Group and FNQ Advisory Group; and health professionals across the NT and FNQ from hospitals, primary healthcare and Aboriginal Community Controlled Health Organisations who have contributed to the Partnership activities. Investigators of the Diabetes Across the Lifecourse: Northern Australia Partnership in addition to those named authors are: Chitturi S, Inglis C, Skinner T, O'Dea K, Zimmet P, Barzi F, Davis B, Mein J, Canuto K, Wenitong M. Further information about the Diabetes Across the Lifecourse: Northern Australia Partnership can be obtained by contacting ntdippartnership@menzies.edu.au or dippinq@menzies.edu.au.15en© 2025 The Author(s)Aboriginal and Torres Strait IslanderDiabetes in pregnancyFirst NationsGestational diabetesHealth systemsQuality improvementType 2 diabetes202510.1016/j.lanwpc.2025.10151486000656032