The burden of diabetes mellitus during pregnancy in low- and middle-income countries: a systematic review

Abstract

Background: Little is known about the burden of diabetes mellitus (DM) in pregnancy in low- and middle-income countries despite high prevalence and mortality rates being observed in these countries.

Objective: To investigate the prevalence and geographical patterns of DM in pregnancy up to 1 year post-delivery in low- and middle-income countries.

Search strategy: Medline, Embase, Cochrane (Central), Cinahl and CAB databases were searched with no date restrictions.

Selection criteria: Articles assessing the prevalence of gestational diabetes mellitus (GDM), and types 1 and 2 DM were sought.

Data collection and analysis: Articles were independently screened by at least two reviewers. Forest plots were used to present prevalence rates and linear trends calculated by linear regression where appropriate.

Main results: A total of 45 articles were included. The prevalence of GDM varied. Diagnosis was made by the American Diabetes Association criteria (1.50-15.5%), the Australian Diabetes in Pregnancy Society criteria (20.8%), the Diabetes in Pregnancy Study Group India criteria (13.4%), the European Association for the Study of Diabetes criteria (1.6%), the International Association of Diabetes and Pregnancy Study Groups criteria (8.9-20.4%), the National Diabetes Data Group criteria (0.56-6.30%) and the World Health Organization criteria (0.4-24.3%). Vietnam, India and Cuba had the highest prevalence rates. Types 1 and 2 DM were less often reported. Reports of maternal mortality due to DM were not found. No geographical patterns of the prevalence of GDM could be confirmed but data from Africa is particularly limited.

Conclusion: Existing published data are insufficient to build a clear picture of the burden and distribution of DM in pregnancy in low- and middle-income countries. Consensus on a common diagnostic criterion for GDM is needed. Type 1 and 2 DM in pregnancy and postpartum DM are other neglected areas.

Keywords: diabetes mellitus; gestational diabetes mellitus; non-communicable diseases; pregnancy; prevalence.

Fig. 1

Flow chart of study selection. In general, studies were excluded based on participants (if it included women who were not pregnant or those beyond 1 year in the postpartum period), study design (if these were commentaries, letters of correspondence, systematic reviews), outcome measure (if it did not include relevant outcomes sought) and was not a low- and middle-income country as defined by the World Bank.

Fig. 2

DGM prevalence and confidence intervals (CI).

Fig. 3

Prevalence of gestational diabetes mellitus against gross national income per capita in thousands (US$).

Fig. 4

Risk of bias summary (bias considerations vs. proportion of studies).