Detection and Management of Diabetes during Pregnancy in Low Resource Settings: Insights into Past and Present Clinical Practices.

Bettina Utz,Alexandre Delamou,Loubna Belaid,Vincent De Brouwere

doi:10.1155/2016/3217098

Abstract

Background. Timely and adequate treatment is important to limit complications of diabetes affecting pregnancy, but there is a lack of knowledge on how these women are managed in low resource settings. Objective. To identify modalities of gestational diabetes detection and management in low and lower middle income countries. Methods. We conducted a scoping review of published literature and searched the databases PubMed, Web of Science, Embase, and African Index Medicus. We included all articles published until April 24, 2016, containing information on clinical practices of detection and management of gestational diabetes irrespective of publication date or language. Results. We identified 23 articles mainly from Asia and sub-Saharan Africa. The majority of studies were conducted in large tertiary care centers and hospital admission was reported in a third of publications. Ambulatory follow-up was generally done by weekly to fortnightly visits, whereas self-monitoring of blood glucose was not the norm. The cesarean section rate for pregnancies affected by diabetes ranged between 20% and 89%. Referral of newborns to special care units was common. Conclusion. The variety of reported provider practices underlines the importance of promoting latest consensus guidelines on GDM screening and management and the dissemination of information regarding their implementation.

Highlights

The prevalence of diabetes in women of reproductive age is growing in developing countries, where changes in lifestyle are largely accountable for this increase [1]
Despite a higher risk of affected women to develop direct obstetric complications such as preeclampsia and prolonged labor due to macrosomic babies [3], the attention paid to gestational diabetes (GDM) in low resource countries remains negligible, and not much is yet known about the burden of GDM in these contexts
Eight papers originated from Sub-Saharan Africa with one publication from South Africa [20], three from Nigeria [15, 23, 34], and one from Kenya [14], Tanzania [16], Ivory Coast [18], and Sudan [21]

Summary

Introduction

The prevalence of diabetes in women of reproductive age is growing in developing countries, where changes in lifestyle are largely accountable for this increase [1]. Despite a higher risk of affected women to develop direct obstetric complications such as preeclampsia and prolonged labor due to macrosomic babies [3], the attention paid to gestational diabetes (GDM) in low resource countries remains negligible, and not much is yet known about the burden of GDM in these contexts. And adequate treatment is important to limit complications of diabetes affecting pregnancy, but there is a lack of knowledge on how these women are managed in low resource settings. To identify modalities of gestational diabetes detection and management in low and lower middle income countries. We included all articles published until April 24, 2016, containing information on clinical practices of detection and management of gestational diabetes irrespective of publication date or language. The variety of reported provider practices underlines the importance of promoting latest consensus guidelines on GDM screening and management and the dissemination of information regarding their implementation

Methods

Results

Discussion

Conclusion