To undertake a systematic review of diabetes in pregnancy, to determine the prevalence of diabetes in pregnancy and to determine its impact on maternal and child health outcomes for Indigenous and Aboriginal women.
Electronic searches of MEDLINE, Embase, CINAHL, ERIC, DARE, CDSR, CINAHL, PsycINFO, Austhealth and HealthInfoNet were undertaken. Grey literature was sought, along with hand searching of key journals. Due to changes in diagnostic criteria for Gestational Diabetes Mellitus (GDM) and variability in methodology, a qualitative synthesis of the data was undertaken.
From the 142 potential studies identified by searches, 42 peer reviewed journal articles met the inclusion criteria and were included. GDM prevalence in nearly two thirds of the studies was greater for Indigenous and Aboriginal women than for Caucasian comparison groups; Pacific Islander 8.1%, Canadian Aboriginal 11.5%, American Indian 7.9%, Australian Aboriginal 8.4% compared with 2-5% worldwide . For studies reporting outcome variables with diabetes in pregnancy 75% of the studies reported greater than expected prevalence of high birth weight (>4000g), 86% of studies reported more macrosomia and 63% of the studies reported greater stillbirth rates. Alaskan, Australian Aboriginal and Pacific Islander women have GDM prevalence that is both greater and less than the Caucasian comparison group.
DIP and GDM prevalence is not the same for all Indigenous and Aboriginal women. The lack of consistent study design and robust data is interfering with accurate comparison of diabetes in pregnancy for these high risk Indigenous and Aboriginal women. With new international consensus guidelines, there are opportunities for high quality studies of diabetes in pregnancy for Indigenous and Aboriginal women worldwide.