Abstract
Around the world, 60 million women of reproductive age have type 2 diabetes and 15% of the pregnant women have gestational diabetes mellitus (GDM). GDM accounts for 90% of all cases of diabetes in pregnancy, and if left unrecognized pose a higher risk of morbidity for mother and the fetus. Although GDM is a temporary phenomenon for the pregnant woman, but 5–10% of women with GDM develop type 2 diabetes after delivery and more than 50% within 5–10 years of delivery. However, the prevalence critically depends on the diagnostic methods and criteria. This review has undertaken an in-depth analysis to systematically assess the risk factors and interventions for screening, detection, prevention and management of pre-pregnancy obesity, pre-diabetes and diabetes at different levels of care (community, outreach, facility) and to draw research gaps and recommendations particularly for low- and middle-income countries.
Acknowledgements
The support from Novo Nordisk Changing Future Health Initiative in the scoping and conduct of this systematic review is gratefully acknowledged.
Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.
No writing assistance was utilized in the production of this manuscript.
Key issues
• Pre-pregnancy overweight approximately doubles the risk for hypertensive disorders of pregnancy, preeclampsia and gestational diabetes mellitus (GDM).
• Women who delay childbearing are at an increased risk of GDM, hypertensive disorders, preeclampsia, Cesarean delivery and face a higher risk of stillbirths, perinatal death, preterm births and low birth weight babies.
• Diet and exercise and diet (calorie-restricted) alone are successful interventions for weight loss in women (including postpartum). Interventions are more effective when they are more intensified and women must make bigger behavioral changes, and when they have a support group.
• Preconception care of women with diabetes led to an overall 70% reduction in congenital malformations as compared with children born to women receiving standard antenatal care. Preconception care also led to a 69% reduction in the occurrence of perinatal mortality associated with pre-existing diabetes.
• Early detection and management of gestational diabetes leads to less incidence of GDM in pregnancy and perinatal deaths.
• There is, however, very limited evidence to support the use of one particular form of insulin administration regimen over another for pregnant women with diabetes.
• Packaged treatment of GDM (dietary advice, glucose monitoring and insulin) had a significant positive impact on antenatal preeclampsia, neonatal convulsions, Cesarean section and birth weight >4000 g.