Abstract
Background Optimal adherence to prescribed medications in women with gestational diabetes is relevant for perinatal outcomes. Objective To summarize available information on the prevalence and factors contributing to medication adherence in women with gestational diabetes from the biological and psychosocial perspectives. Methods A literature search on adherence in gestational diabetes was conducted in PubMed/MEDLINE, CINAHL, Scopus, and the Directory of Open Access Journals for studies published on the topic. The Arksey and O'Malley framework for scoping reviews was used to explore and summarize the evidence. Results A total of 2395 studies were retrieved of which 13 fully met the eligibility criteria. The studies were reported in Zimbabwe (n = 5), Iran (n = 1), Mexico (n = 1), South India (n = 1), the United States of America (n = 4), and one multinational study covering Australia, Europe, North and South America. The main types of antidiabetic medications used were insulin (n = 6), metformin (n = 4), and glyburide (n = 2). The prevalence of adherence ranged from 35.6% to 97%, with the assessment tool being self-report measures (n = 8). The main factors associated with nonadherence included worsening pregnancy symptoms, side effects of medications, perceived risks, mental health symptoms, poor social support, and socioeconomic status. Recommendations that evolved from the studies to improve adherence included education, counselling, improved support networks, and social interventions, while the main reported interventional study employed continuous education on the impact of adherence on perinatal outcomes. Conclusion Medication nonadherence in gestational diabetes seems to be influenced by multiple factors with some educational interventions positively impacting adherence behaviours. Thus, future research in women with gestational diabetes could consider interventions from a multifactorial perspective to improve therapeutic outcomes.
Highlights
Gestational diabetes is defined as the onset of glucose intolerance during the period of pregnancy [1]
A scoping review was conducted following the framework by Arksey and O’Malley, to explore and summarize evidence on medication adherence in gestational diabetes [15]
The scoping review focused on identifying the area of adherence-related issues in the management of gestational diabetes and was guided by the research question, “What is known about medication adherence and associated factors in women with gestational diabetes?”
Summary
Gestational diabetes is defined as the onset of glucose intolerance during the period of pregnancy [1]. Research on gestational diabetes suggests a longer-term risk of developing Type II diabetes in mothers compared with those without pregnancy-related blood glucose problems [3]. Despite the effects on the mother, gestational diabetes is associated with adverse outcomes for the baby including neonatal hypoglycemia, jaundice, and Journal of Diabetes Research respiratory distress syndrome with long-term effects on their health [5]. Optimal adherence to prescribed medications in women with gestational diabetes is relevant for perinatal outcomes. To summarize available information on the prevalence and factors contributing to medication adherence in women with gestational diabetes from the biological and psychosocial perspectives. The main factors associated with nonadherence included worsening pregnancy symptoms, side effects of medications, perceived risks, mental health symptoms, poor social support, and socioeconomic status. Future research in women with gestational diabetes could consider interventions from a multifactorial perspective to improve therapeutic outcomes
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