Solving the mystery: the true prevalence of gestational diabetes in indigenous women

Saad, Nathalie; Wilson, Don; Donovan, Lois

doi:10.1002/dmrr.2648

Cited by 4 publications

(4 citation statements)

References 21 publications

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“…First Nation ethnicity is an independent predictor for GDM [48]. As noted by Saad, Wilson and Donovan [59], research has not sufficiently evaluated the role of socioeconomic status, a key risk factor for obesity and GDM among Indigenous women [59,[68][69][70][71], and future research should further investigate this critical relationship. Of specific concern noted in the literature is the increased risk of developing T2DM after GDM for both mother [4,34,52,[72][73][74][75] and child [76,77].…”

Section: Gestational Diabetes Mellitus and Intergenerational Riskmentioning

confidence: 99%

“…Chamberlain et al's systematic review [52] reported GDM prevalence rates for Australian Indigenous females ranging from 1.33% to 18.51%, while prevalence rates of GDM in Canada's First Nations population reported 3 times higher than the non-First Nations population [47,51]. GDM screening is important for capturing accurate prevalence rates, and limited/inconsistent screening practices and inconsistent study designs helps to explain the varying rates of GDM noted in the literature [57][58][59]. In Cape York, Australia, a three-fold increase in GDM was observed over a two year period with the introduction of universal screening [58].…”

Section: Gestational Diabetes Mellitus and Intergenerational Riskmentioning

confidence: 99%

“…Pregnancy is considered an optimal time to identify women at greatest risk for developing GDM and T2DM, and subsequent offspring through intergenerational risk [58]. This 'window of opportunity' offers care providers a strategic time to introduce strategies for long term risk reduction for mother and offspring [86]; however systematic care gaps with limited and late screening practices were consistently found in the literature [57][58][59]87]. This highlights the urgent need for screening in early pregnancy, with improved awareness of pre-existing diabetes and effective interventions needed to decrease the risk to mother and offspring [29,48,52,67].…”

Section: Gestational Diabetes Mellitus and Intergenerational Riskmentioning

confidence: 99%

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Call to action: A new path for improving diabetes care for Indigenous peoples, a global review

Harris

Tompkins

TeHiwi

2017

Diabetes Research and Clinical Practice

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Diabetes has reached epidemic proportions in Indigenous populations around the globe, and there is an urgent need to improve the health and health equity of Indigenous peoples with diabetes through timely and appropriate diabetes prevention and management strategies. This review describes the evolution of the diabetes epidemic in Indigenous populations and associated risk factors, highlighting gestational diabetes and intergenerational risk, lifestyle risk factors and social determinants as having particular importance and impact on Indigenous peoples. This review further describes the impact of chronic disease and diabetes on Indigenous peoples and communities, specifically diabetes-related comorbidities and complications. This review provides continued evidence that dramatic changes are necessary to reduce diabetes-related inequities in Indigenous populations, with a call to action to support programmatic primary healthcare transformation capable of empowering Indigenous peoples and communities and improving chronic disease prevention and management. Promising strategies for transforming health services and care for Indigenous peoples include quality improvement initiatives, facilitating diabetes and chronic disease registry and surveillance systems to identify care gaps, and prioritizing evaluation to build the evidence-base necessary to guide future health policy and planning locally and on a global scale.

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Section: Gestational Diabetes Mellitus and Intergenerational Riskmentioning

confidence: 99%

Section: Gestational Diabetes Mellitus and Intergenerational Riskmentioning

confidence: 99%

Section: Gestational Diabetes Mellitus and Intergenerational Riskmentioning

confidence: 99%

See 1 more Smart Citation

Call to action: A new path for improving diabetes care for Indigenous peoples, a global review

Harris

Tompkins

TeHiwi

2017

Diabetes Research and Clinical Practice

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“…Most experts agree that a focus on “ethnicity as a proxy for genetic variation” being a primary determinant of GDM risk diverts attention away from the wider determinants affecting Indigenous peoples’ health [ 30 ]. In fact, the contribution of socioeconomic and psychosocial deprivation to GDM prevalence among Indigenous women has not been adequately evaluated [ 31 ]. The experience of “unequal treatment” [ 29 ] for Indigenous women with GDM also receives little attention, despite several small studies and a recent audit reporting inequities in screening, diagnosis and management of GDM between Māori and non-Māori [ 22 , 32 , 33 ].…”

Section: Introductionmentioning

confidence: 99%

The experience of gestational diabetes for indigenous Māori women living in rural New Zealand: qualitative research informing the development of decolonising interventions

Reid

Anderson

Cormack

et al. 2018

BMC Pregnancy Childbirth

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BackgroundAlthough early detection and management of excess rates of gestational diabetes mellitus (GDM) among Indigenous women can substantially reduce maternal and offspring complications, current interventions seem ineffective for Indigenous women. While undertaking a qualitative study in a rural community in Northland, New Zealand about the complexities of living with diabetes, we observed a common emotional discourse about the burden of diabetic pregnancies. Given the significance of GDM and our commitment to give voice to Indigenous Māori women in ways that could potentially inform solutions, we aimed to explore the phenomenon of GDM among Māori women in a rural context marked by high area-deprivation.MethodA qualitative and Kaupapa Māori methodology was utilised. A sub-sample of women (n = 10) from a broader study designed to improve type 2 diabetes mellitus (T2DM) who had experienced GDM or pre-existing diabetes during pregnancy and/or had been exposed to diabetes in utero were interviewed. Participants in the broader study were recruited via the local primary care clinic. Experiences of GDM, in relation to their current T2DM, was sought. Narrative data was analysed for themes.ResultsIntergenerational experiences informed perceptions that GDM was an inevitable heritable illness that “just runs in the family.” The cumulative effects of deprivation and living with GDM compounded the complexities of participant’ lives including perceptions of powerlessness and mental health deterioration. Missed opportunities for health services to detect and manage diabetes had ongoing health consequences for the women and their offspring. Positive relationships with healthcare providers facilitated management of GDM and helped women engage with self-management.ConclusionMāori women living with T2DM were clear that health providers had failed to intervene in ways that would have potentially slowed or prevented progression of GDM to T2DM. Participants revealed missed opportunities for appropriate diagnostic testing, treatment and health promotion programmes for GDM. Poor collaboration between health services and social services meant psychosocial issues were rarely addressed and the cycle of intergenerational poverty and disadvantage prevailed. These data highlight opportunities for extended case management to include whānau (family) engagement, input from social services, and evidence-based medicine and/or long-term management and prevention of T2DM.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-2103-8) contains supplementary material, which is available to authorized users.

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Ethnic Disparities in Gestational Diabetes

2018

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The global prevalence of GDM has been steadily increasing and estimated to be 16.2% from the International Diabetes Federation extrapolation. Reported prevalence rates may understate the true prevalence, due to factors of access and attitudes to GDM diagnosis and screening in low resource settings for foreign-born women and indigenous populations. Other factors may relate to genes associated with specific ethnicities, obesity, body composition and gestational weight gain. Various factors such as access to screening, body composition, genetics and gestational weight gain may result in ethnic disparities in the prevalence and outcomes of GDM.

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Solving the mystery: the true prevalence of gestational diabetes in indigenous women

Cited by 4 publications

References 21 publications

Call to action: A new path for improving diabetes care for Indigenous peoples, a global review

Call to action: A new path for improving diabetes care for Indigenous peoples, a global review

The experience of gestational diabetes for indigenous Māori women living in rural New Zealand: qualitative research informing the development of decolonising interventions

Ethnic Disparities in Gestational Diabetes

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