Purpose: To examine the state of the science concerning racial and ethnic disparities and social determinants of health, perinatal care, and maternal and infant health outcomes in pregnant women with diabetes.
Method: PubMed, Scopus, CINAHL, and EMBASE databases were searched using the PRISMA guidelines. The inclusion criteria were original qualitative or quantitative manuscripts published in English from January 1, 2009, to May 31, 2020. Consensus statements were excluded.
Results: This review included 16 manuscripts of women with gestational diabetes mellitus and pregestational diabetes mellitus living in the United States. This synthesis demonstrated the differences in maternal economic stability, education, and health and health care. Non-Hispanic Black, Hispanic, and Asian women had significantly higher odds of experiencing preeclampsia, spontaneous preterm, and postpartum readmission than non-Hispanic White women. Non-Hispanic Black infants had the highest hypoglycemia and intensive care unit admission rates, while Hispanic infants were more likely to have macrosomia than non-Hispanic White infants.
Discussion: Evidence highlights disproportion in maternal social determinants of health and health outcomes. Additional research is needed in disadvantaged groups who are less likely to utilize perinatal care services and be screened for type 2 diabetes after pregnancy. Little is known about the direct and indirect pathway between racial discrimination and maternal and infant health, specifically through chronic stress to glycemic control. Infants exposed to hyperglycemia in pregnancy need closer attention from infancy in assessment and management to prevent diabetes later in life.
Conclusion: There is an urgent need to improve the quality of care for women with diabetes. Health care providers should implement tailored interventions that target racial and ethnic disparities and promote health equity in pregnant women with diabetes and their offspring.
R. Phonyiam: None. D. C. Berry: None.