Diabetes in pregnancy among indigenous women in Australia, Canada, New Zealand and the United States: a systematic review of the evidence for screening in early pregnancy

Abstract

Recently proposed international guidelines for screening for gestational diabetes mellitus (GDM) recommend additional screening in early pregnancy for sub-populations at a high risk of type 2 diabetes mellitus (T2DM), such as indigenous women. However, there are criteria that should be met to ensure the benefits outweigh the risks of population-based screening. This review examines the published evidence for early screening for indigenous women as related to these criteria. Any publications were included that referred to diabetes in pregnancy among indigenous women in Australia, Canada, New Zealand and the United States (n = 145). The risk of bias was appraised. There is sufficient evidence describing the epidemiology of diabetes in pregnancy, demonstrating that it imposes a significant disease burden on indigenous women and their infants at birth and across the lifecourse (n = 120 studies). Women with pre-existing T2DM have a higher risk than women who develop GDM during pregnancy. However, there was insufficient evidence to address the remaining five criteria, including the following: understanding current screening practice and rates (n = 7); acceptability of GDM screening (n = 0); efficacy and cost of screening for GDM (n = 3); availability of effective treatment after diagnosis (n = 6); and effective systems for follow-up after pregnancy (n = 5). Given the impact of diabetes in pregnancy, particularly undiagnosed T2DM, GDM screening in early pregnancy offers potential benefits for indigenous women. However, researchers, policy makers and clinicians must work together with communities to develop effective strategies for implementation and minimizing the potential risks. Evidence of effective strategies for primary prevention, GDM treatment and follow-up after pregnancy are urgently needed. Copyright © 2013 John Wiley & Sons, Ltd.

Low Rates of Postpartum Glucose Screening Among Indigenous and non-Indigenous Women in Australia with Gestational Diabetes

“…Despite the clear evidence of an increased risk of developing type 2 diabetes [5,12,22], few studies have investigated rates of postpartum glucose screening for Indigenous women with gestational diabetes [21], which has been identified as a 'high priority research need for gestational diabetes' [23]. In Far North Queensland, Australia, there have been a number of initiatives introduced to improve care for women with gestational diabetes [24], including protocols [25][26][27] which recommend all women with gestational diabetes are offered postpartum glucose testing.…”

“…Essential criteria when introducing population-based screening include ensuring that adequate and acceptable treatment, prevention and 'ongoing management' postpartum are provided, and that 'equity and access is provided' [18,19]. There currently is limited evidence that these criteria are met [20], particularly for Indigenous women [21].…”

The early life origin theory in the development of cardiovascular disease and type 2 diabetes

“…In particular focus, the theory has examined the correlations between low birth weight and adult onset of these diseases. Evidence produced has been compelling with a large number of studies across the globe revealing similar results, including the original studies in England [4,5], comprehensive cohort studies in the Nordic countries [6][7][8][9], and more recent studies in non-western countries such as China [10] and also indigenous populations [11,12]. Studies have generally correlated low birth weight, as a result of slowed foetal growth, to be an important indicator in the development of CVD and T2DM.…”

“…DNA methylation occurs via DNA methyltransferses (DNMT) which utilises S-adenosyl Lmethionine (SAM) as the methyl donor, mostly at CpG sites to convert cytosine to 5-methylcytosine have also examined the role of both under and over nutrition in the context of foetal development, and have identified a large range of mechanisms correlating to birth weight which produces the effects of the developmental origins theory for both CVD and T2DM [8,30,[35][36][37]. In addition, birth weight and diabetes risk within aboriginal populations have been examined and have highlighted the importance of nutritional intervention in influencing the foetal development risk [11,12]. The role of maternal diabetes status has also been correlated to the risk of development of T2DM and CVD for both small and large for gestational age (SGA and LGA) children representing an important area for public health interventions [38].…”

Ultrasound diagnosis of diabetic fetopathy

“…Риск развития ДФ имеется при любой форме СД во время беременности, включая ГСД, СД 2-го типа и СД 1-го типа [6,7]. У большинства беременных с СД без лече-ния выявляется ДФ.…”