Epidemiology of Diabetes in Pregnancy among Indigenous Women: Insights into the Global Indigenous and Métis Specific Contexts

• Author / Creator

  Voaklander, Britt

• Diabetes in pregnancy has been found to be more prevalent among Indigenous women in many countries. It is not clear whether Indigenous women with similar colonial histories have a greater prevalence of both pre-existing diabetes mellitus (pre-existing DM) and gestational diabetes mellitus (GDM) compared to non-Indigenous women. This thesis includes a systematic review of the literature that examined the prevalence of both pre-existing DM and GDM among Indigenous women in Australia, Canada, New Zealand, and the USA. The systematic review identified that Indigenous women living in countries with similar histories of colonialism have a higher prevalence of pre-existing DM (pooled odds ratios (OR) by country ranging from 1.81 (95% confidence interval [CI]:1.53, 2.13) to 3.20 (95%CI: 2.04, 5.03) and GDM (pooled ORs by country ranging from 1.41 (95%CI: 1.22, 1.63) to 2.04 (95%CI: 1.46, 2.84) compared to non-Indigenous women. This thesis also includes a retrospective cohort study of all singleton births in Alberta from 2006-2016 that evaluated the prevalence of pre-existing DM, GDM, and maternal and neonatal outcomes among Métis women compared to non-Métis women in Alberta. Results from the retrospective cohort study demonstrate that Métis women have an increased risk for both pre-existing DM (adjusted OR [aOR]:1.74, 95%CI: 1.18, 2.58) and GDM (aOR:1.30, 95%CI: 1.08, 1.55) after accounting for important clinical and sociodemographic factors, including material and social deprivation. Births to Métis women with GDM have increased odds of having a baby that is large for gestational age (aOR: 1.48, 95%CI: 1.00, 2.19). Results of both studies suggest that risk for diabetes in pregnancy among Indigenous women is substantial and may be due to structural determinants of health. Implications of study results for clinicians and public health are discussed, and future research directions are suggested.

• Subjects / Keywords

  • Indigenous
  • Métis
  • Gestational Diabetes
  • Diabetes in Pregnancy
  • Epidemiology

• Graduation date

  Spring 2020

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/r3-8w4m-js53

• License

  Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.