Gestational Diabetes Mellitus in Southeast Asia: A Scoping Review

Abstract

A rapid increase in the prevalence of gestational diabetes mellitus (GDM) has been associated with various factors such as urbanization, lifestyle changes, adverse hyperglycemic intrauterine environment, and the resulting epigenetic changes. Despite this, the burden of GDM has not been well-assessed in Southeast Asia. We comprehensively reviewed published Southeast Asian studies to identify the current research trend in GDM in this region. Joanna Briggs Institute's methodology was used to guide the scoping review. The synthesis of literature findings demonstrates almost comparable clinical evidence in terms of risk factors and complications, challenges presented in diagnosing GDM, and its disease management, given the similarities of the underlying population characteristics in Southeast Asia. Evidence suggests that a large proportion of GDM risk in women may be preventable by lifestyle modifications. However, the GDM burden across countries is expected to rise, given the heterogeneity in screening approaches and diagnostic criteria, mainly influenced by economic status. There is an urgent need for concerted efforts by government and nongovernmental sectors to implement national programs to prevent, manage, and monitor the disease.

Keywords: Southeast Asia; complications; gestational diabetes mellitus; management; risk-factors; screening.

Figure 1

PRISMA flow chart of the article selection process.

Figure 2

Distribution of articles by year of publication.

Figure 3

Distribution of articles by geographic location.

Figure 4

(a) Southeast Asian prevalence of GDM in 2010–2020. Note: Median (interquartile range) prevalence (%) of gestational diabetes mellitus (GDM) in 2010–2020. A literature search was conducted for eligible studies on the prevalence of GDM from 1 January 2010 to 25 May 2020 to capture the contemporary burden of GDM. Among the eligible studies that met the search criteria, data from countries reported in the studies were included to derive country-specific estimates for GDM prevalence. The country-specific prevalence of GDM was estimated by calculating the median prevalence of country-specific estimates within each country. (b) Country-specific prevalence of GDM according to different diagnostic criteria. Note: Graph of the prevalence of gestational diabetes mellitus (GDM) in selected countries according to the Carpenter–Coustan criteria (C&C), International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, National Diabetes Data Group (NDDG) criteria, WHO 1999/2013 criteria, and International Classification of Diseases codes and local guidelines or criteria (other). A literature search was conducted for eligible studies on the prevalence of GDM from 1 January 2010 to 25 May 2020 to capture the recent burden of GDM. Among the eligible studies that met the search criteria, data from countries reported in the studies were included to derive country-specific GDM prevalence estimates based on different diagnostic criteria. The median of all available source data was used if more than one estimate of GDM prevalence was available for a country.

Figure 5

Studied risk factors of GDM in Southeast Asian countries. BMI: body mass index and IVF: in vitro fertilization.

Figure 6

Factors associated with the complication of GDM. Note: Several influencing factors were studied under the subdomains of maternal outcomes (a), neonatal outcomes (b), postpartum diabetes (c), and other complications (d). Dec: decreased risk/incidence of complications, Inc.: increased risk/incidence of complications, and Equ: equivocal/no association. HbA1c: glycated hemoglobin, PIH: pregnancy-induced hypertension, UTI: urinary tract infection, NICU: neonatal intensive care unit, Index FPG: index fasting plasma glucose, BV dysfunction: blood vessel dysfunction, and OGTT: Oral Glucose Tolerance Test.

Figure 7

Number of articles assessing the management of GDM among Southeast Asian women. Note: SMBG; Self- monitoring blood glucose.