Gestational diabetes mellitus and its impact on maternal and neonatal outcomes in Indigenous populations: a systematic review and meta-analysis

This systematic review and meta-analysis examined the association between gestational diabetes mellitus (GDM) and adverse pregnancy outcomes among Indigenous populations globally. Pooled risk ratios were calculated using a random-effects model, and study quality was assessed using the Newcastle-Ottawa Scale and the CONSIDER Statement. Twenty studies from Canada, the United States, and Australia were included. Results showed that GDM was associated with increased caesarean section (risk ratio 1.83, 95% confidence interval 1.63 to 2.06), shoulder dystocia (3.21, 2.94 to 3.50), large for gestational age (2.35, 1.46 to 3.77), macrosomia (1.75, 1.48 to 2.07), preterm birth (1.36, 1.09 to 1.69), and hypoglycaemia (8.17, 4.39 to 15.22), but decreased risk of low birth weight (0.80, 0.69 to 0.91) and small for gestational age (0.44, 0.39 to 0.50). Four studies had low or medium risk of bias, only 25% of the studies reported Indigenous involvement in the research process. These findings show that Indigenous women with GDM are at greater risk of perinatal complications than those without GDM. This underscores the need for timely, intensive clinical management of GDM, delivered within culturally safe models of care, to reduce these inequities. In line with calls for action, prioritizing the early prevention of GDM is essential.