Rural healthcare delivery and maternal and infant outcomes for diabetes in pregnancy: A systematic review

Abstract

Aim: The aim of this systematic review was to examine the literature regarding rural healthcare delivery for women with any type of diabetes in pregnancy, and subsequent maternal and infant outcomes. Methods: Eight databases were searched in September 2020, including Medline, EMCare, CINAHL, EMBASE, Maternity and Infant Care, Cochrane, Rural and Remote Health and Aboriginal and Torres Strait Islander Health bibliography. Studies from high-income countries in rural, regional or remote areas with interventions conducted during the antenatal period were included. Intervention details were reported using the template for intervention description and replication template. Two reviewers independently assessed for risk of bias using the RoB2 and ROBINS I tools. Results: Three articles met the inclusion criteria: two conducted in Australia and one in the United States. A multidisciplinary approach was reported in two of the included studies, which were modified specifically for their respective rural settings. All three studies reported rates of caesarean section, birthweight (grams) and gestational age at birth as maternal and infant outcomes. One study was considered at moderate risk of bias, and two studies were at serious risk of bias. Conclusion:There is a significant gap in research relating to healthcare delivery for women with diabetes in pregnancy in rural areas. This lack of research is concerning given that 19% of individuals in high-income countries reside rurally. Further research is required to understand the implications of healthcare delivery models for diabetes in pregnancy in rural areas.PROSPERO registration details: CRD42020209956.

Rural–urban disparities in pregestational and gestational diabetes in pregnancy: Serial, cross‐sectional analysis of over 12 million pregnancies

“…The persistent rural–urban disparity in the rate of DM and increasing disparity in the rate of GDM among pregnant women is consistent with emerging data with regards to rural–urban disparities in adverse pregnancy outcomes, severe maternal morbidity and mortality, as well as access to high‐quality clinical and obstetric care services during pregnancy in the USA, 18,37 as well as other high‐income countries, such as Canada and Australia 21,22 . Whether the risk of adverse outcomes is higher among pregnant women with diabetes in rural versus urban areas requires further study.…”

“…Increasing population‐level data in the USA demonstrate that rising rates of severe maternal morbidity and mortality, 18 hypertensive disorders of pregnancy, 19 and chronic hypertension, 20 have been of greater magnitude in rural compared with urban communities. Similarly, outside the USA, rural–urban disparities in diabetes care and adverse outcomes in pregnancy exist in other high‐income countries, including Canada and Australia, where nearly one‐fifth of individuals reside in rural communities 21,22 …”

“…Similarly, outside the USA, rural-urban disparities in diabetes care and adverse outcomes in pregnancy exist in other high-income countries, including Canada and Australia, where nearly one-fifth of individuals reside in rural communities. 21,22 There remains limited information about rural-urban disparities in diabetes in pregnancy over time using population-level US data. Whether rural residence may intersect with other disparities, inclusive of racial and ethnic and geographic identities, to reinforce and even increase persistent disparities in diabetes in pregnancy remains to be investigated.…”

Rural nutrition and dietetics research—Future directions

“…These reviews published between 2020 and 2023 (including 94 unique studies) together, highlight significant gaps in rural nutrition and dietetics research to date in Australia and generate extensive data to inform considerations for future research. 4,6,[10][11][12][13] Specifically, there has been a lack of dietary intervention research in rural Australian communities 11 or in rural communities globally, 14 incomplete dietary intake data collected in these populations, a lack of exploration on how environmental sustainability could impact rural nutrition, as well as an under-utilisation of rural dieticians in this research. 11,12 Further, minimal food environment interventions specific to rural areas have been conducted either in Australia or globally 15 despite the evidence that rural food environments are less healthy and have minimal promotion of healthy foods.…”

Contemporary syntheses in nutrition and dietetics

“…The scoping review prepared by Shi et al 9 on the effects of the COVID‐19 pandemic on food security in Australia further highlights some systemic problems within the food supply chain, but indeed considers other social issues that have emerged and been highlighted over the past 2 years. The review of Payne et al 10 considers rural healthcare delivery and maternal and infant outcomes for diabetes in pregnancy, whilst the review led by Du et al 11 examines the effects of macronutrient intake on sleep duration and quality.…”