Review
A systematic review of interventions for Hispanic women with or at risk of Gestational diabetes mellitus (GDM)

https://doi.org/10.1016/j.srhc.2017.02.006Get rights and content

Highlights

  • Hispanic women incur high rates of gestational diabetes mellitus.

  • There is limited literature reporting on GDM interventions for this population and limited information to guide health professionals providing care to this group.

  • Culturally tailored interventions offering dietary counselling over a prolonged period may prove effective.

Abstract

Background and objective

Gestational Diabetes Mellitus (GDM) is a serious health concern for pregnant women, with Hispanic women at particular risk for developing the condition. The aim of this review was to critically examine GDM intervention programs for Hispanic women, in the United States of America (US).

Methods

English and Spanish electronic databases were searched for relevant studies published between 1995 and 2015. Eligible study designs included randomized controlled trial, pre/post-test and quasi experimental methods.

Results

Findings indicated that there was a dearth of literature reporting on GDM interventions for Hispanic women and just seven papers met inclusion criteria. These seven studies were included in the review and they reported on interventions for: (1) pregnant women at high risk of developing GDM; (2) pregnant women with GDM. Results suggest that a combination of intensive counselling over a prolonged period of time, together with a low calorie, possibly low glycemic index diet, produces best results.

Conclusion

The review found that intensive nutritional counselling approaches which promote low calorie/low GI diets appear to be most effective in BGL management in this population. Interventions that are delivered in Spanish and culturally tailored may be more acceptable to participants. More research is needed to develop suitable interventions to improve GDM management among Hispanic women.

Introduction

Gestational diabetes mellitus (GDM) is a serious health challenge for pregnant women [1] with increased risk for caesarean birth and hypertensive disorders [2]. For infants, GDM is linked to increased mortality and morbidity including respiratory distress, macrosomia and special care admission [3]. Longer term, GDM increases women’s risk for type 2 diabetes, and their infants’ risk for obesity, type 2 diabetes and cardiovascular disease [2]. Recent research indicates that high glucose levels or over nutrition during pregnancy can result in a ‘metabolic programming’ effect on the fetus, predisposing the child to early onset diabetes and obesity [4].

Rates of GDM are increasing dramatically in the United States [1], [5] with a 10–100% increase in some ethnic groups in the past 2 decades [5]. Hispanic women are at particularly high risk [6] and in a recent US study, Hispanics had considerably higher rates of GDM (12.1%) compared to non-Hispanic whites (6.8%) [7]. The risk for recurrence of GDM in subsequent pregnancies is also significantly higher amongst Hispanic women [8]. This is of particular concern as Hispanics are the largest minority group in the US, representing approximately 17% of the total population [9] and have higher than average birthrates [9].

Hispanic women incur a disproportionate risk for GDM as they possess additional risk factors that are associated with poor pregnancy outcomes, including; birth outside the US [10]; and overweight/obesity [11]. Cavicchi et al. [11], for example, found that a BMI (Body Mass Index) of 25–29 kg/m2 was associated with 14.4% of GDM cases among Hispanic women, compared to White (8.8%) and Black (7.8%) women while Hedderson et al. [12] suggested that BMI > 25 kg/m2 was attributable to 61.2% of GDM cases among Hispanics. Low levels of education and low socio-economic factors, which are associated with a calorie dense diet and minimal fruit/vegetables [13], may also contribute to this problem [14].

Although GDM poses serious health risks, careful management, which aims to maintain blood glucose levels (BGLs) within normal ranges, mitigates some of these risks. Recommended approaches include: gestational weight gain counselling, nutrition and exercise intervention and pharmacological approaches (oral hypoglycemics or insulin). Most studies evaluating interventions consider their approach to be successful: at reducing insulin requirements; macrosomia and hypertensive disorders, and improving knowledge and pregnancy outcomes [15]. Studies evaluating interventions for GDM that are specifically tailored to cultural groups have shown significant improvements in GDM management behaviours and health outcomes [16], [17]. Nonetheless, a systematic review of nutrition interventions tailored to Asian women with GDM found limited effects on glycemic control and overall pregnancy outcome, however diet changes made in early pregnancy were associated with reduced neonatal birthweight [18]. These findings demonstrate the inconsistencies in this area of research, and it is not clear how existing interventions address the needs of Hispanic women with GDM.

Thus, the aim of this systematic review was to critically examine existing gestational diabetes mellitus (GDM) programs for Hispanic women of Mexican origin. It was intended that the insights gained would inform the development of a GDM intervention for Hispanic Mexican women in US Border regions.

Section snippets

Methods

A systematic review approach was chosen for this project, using Uman’s guidelines [19], p. 57–5919:

  • Formulating the review question/s

  • Data searching using key search terms

  • Study selection using defined inclusion/exclusion criteria

  • Data extraction and quality assessment

  • Results (Analysis and interpretation of findings)

Results of the search

The literature search took place in Melbourne, Australia and El Paso Texas and was conducted by (MCO, MDG, JL) in January-May 2015. A total of 189 citations were retrieved from electronic databases and hand searches (Fig. 1). After reviewing abstracts and full articles, 22 unique publications related to interventions for the management or prevention of GDM were located. A further four articles were identified when the search criteria was broadened to include studies located in Mexico. After

Discussion

Our goal was to evaluate interventions to assist Hispanic women manage their GDM. However, there is a dearth of studies aimed at this population, and limited consensus as to which approach is most likely to be successful at reducing GDM rates or improving perinatal outcomes. This is concerning as Hispanic populations incur high rates of GDM [30] and they and their infants are at greater risk of adverse perinatal outcomes.

Overall, findings suggest that: (1) intensive nutritional counselling over

Limitations

Limited available literature resulted in a broadening of the original search to include GDM interventions in Mexican settings. Other limitations include the quality of the studies, heterogeneity of study methods, sample size, intervention approaches, all of which limit possible comparison between studies. Variability in GDM diagnosis is a further limitation and three studies that tested for GDM did not describe GDM diagnostic criteria (22, 25, 26). Efforts were made to contact these authors to

Implications and conclusion

Our understanding that Spanish language approaches produce the best results is consistent with the literature [31], [40] and research suggests that language and culturally adapted interventions are more effective for ethnic minorities [41]. Our review indicates not only a dearth of research on GDM interventions for Hispanic women but also few culturally adapted interventions. This is an area that requires much greater attention in the future.

Overall, this review has highlighted a lack of

References (41)

  • D. Dabelea et al.

    Increasing prevalence of gestational diabetes mellitus (GDM) over time and by birth cohort: Kaiser Permanente of Colorado GDM screening program

    Diabetes Care

    (2005)
  • M.G. Ross et al.

    Developmental programming of offspring obesity, adipogenesis, and appetite

    Clin Obstet Gynecol

    (2013)
  • A. Ferrara

    Increasing prevalence of gestational diabetes mellitus: a public health perspective

    Diabetes Care

    (2007)
  • L.M. Chasan-Taber et al.

    Estudio Parto: postpartum diabetes prevention program for hispanic women with abnormal glucose tolerance in pregnancy: a randomised controlled trial – study protocol

    BMC Preg Childbirth

    (2014)
  • C. DeSisto et al.

    Prevalence estimates of gestational diabetes mellitus in the United States, pregnancy risk assessment monitoring system (PRAMS), 2007–2010

    Preventing Chron Dis

    (2014)
  • Gonzalez-Barrera A, Lopez MH. A demographic portrait of Mexican-Origin Hispanics in the United States; 2013 [cited 2015...
  • A. Braun et al.

    Effect of maternal birthplace on gestational diabetes prevalence in Colorado hispanics

    J Immigrant Minority Health

    (2011)
  • P.P. Cavicchia et al.

    Proportion of gestational diabetes mellitus attributable to overweight and obesity among non-Hispanic Black, non-Hispanic White, and Hispanic Women in South Carolina

    Mat Child Health J

    (2014)
  • M. Hedderson et al.

    Racial/ethnic disparities in the prevalence of gestational diabetes mellitus by BMI

    Diabetes Care

    (2012)
  • I. Boumtje et al.

    Dietary habits, demographics, and the development of overweight and obesity among children in the United States

    Food Pol

    (2005)
  • Cited by (8)

    • Allied health professionals: A promising ally in the work against health inequalities- A rapid review

      2022, Public Health in Practice
      Citation Excerpt :

      Interventions to tackle stereotyping and discriminatory treatment (e.g., rude behaviour) include the use of inclusive language, relevant cultural education pre- and post-qualification, and building an affirming health care environment [34]. Additionally, studies highlight the importance of culturally tailored interventions for ethnic minority groups as they seem to be more effective than usual care [35,36]. Evidence suggests that shifting away from western cultural assumptions facilitates the cultivation of reciprocal relationships and an affirming environment [37], while tailoring involves much more elements than language.

    View all citing articles on Scopus
    View full text