title: Diabetes in pregnancy among indigenous women in Australia, Canada, New Zealand, and the United States: a method for systematic review of studies with different designs.
abstract: BACKGROUND
  Diabetes in pregnancy, which includes gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM), is associated with poor outcomes for both mother and infant during pregnancy, at birth and in the longer term. Recent international guidelines recommend changes to the current GDM screening criteria. While some controversy remains, there appears to be consensus that women at high risk of T2DM, including indigenous women, should be offered screening for GDM early in pregnancy, rather than waiting until 24-28 weeks as is current practice. A range of criteria should be considered before changing screening practice in a population sub-group, including: prevalence, current practice, acceptability and whether adequate treatment pathways and follow-up systems are available. There are also specific issues related to screening in pregnancy and indigenous populations. The evidence that these criteria are met for indigenous populations is yet to be reported. A range of study designs can be considered to generate relevant evidence for these issues, including epidemiological, observational, qualitative, and intervention studies, which are not usually included within a single systematic review. The aim of this paper is to describe the methods we used to systematically review studies of different designs and present the evidence in a pragmatic format for policy discussion.
  
  
  METHODS
  The inclusion criteria will be broad to ensure inclusion of the critical perspectives of indigenous women. Abstracts of the search results will be reviewed by two persons; the full texts of all potentially eligible papers will be reviewed by one person, and 10% will be checked by a second person for validation. Data extraction will be standardised, using existing tools to identify risks for bias in intervention, measurement, qualitative studies and reviews; and adapting criteria for appraising risk for bias in descriptive studies. External validity (generalisability) will also be appraised. The main findings will be synthesised according to the criteria for population-based screening and summarised in an adapted "GRADE" tool.
  
  
  CONCLUSIONS
  This will be the first systematic review of all the published literature on diabetes in pregnancy among indigenous women. The method provides a pragmatic approach for synthesizing relevant evidence from a range of study designs to inform the current policy discussion.
authors.affiliation: International Public Health Unit Department of Epidemiology and Preventive Medicine School of Medicine, Nursing and Health Sciences Monash University, Victoria, Australia. Catherine.chamberlain@monash.edu
authors.forename: Catherine
authors.initials: C
authors.lastname: Chamberlain
authors.forename: Daniel
authors.initials: D
authors.lastname: Yore
authors.forename: Hang
authors.initials: H
authors.lastname: Li
authors.forename: Emily
authors.initials: E
authors.lastname: Williams
authors.forename: Brian
authors.initials: B
authors.lastname: Oldenburg
authors.forename: Jeremy
authors.initials: J
authors.lastname: Oats
authors.forename: Bridgette
authors.initials: B
authors.lastname: McNamara
authors.forename: Sandra
authors.initials: S
authors.lastname: Eades
mesh_terms: D005260:Female; D006801:Humans; D011247:Pregnancy; D001315:Australia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D016640:Diabetes, Gestational / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control; D006285:Health Planning; D008427:Maternal Health Services; D008507:Medically Underserved Area; D009520:New Zealand / Q000453:epidemiology; D044382:Population Groups; D011254:Pregnancy in Diabetics / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control; D014481:United States / Q000453:epidemiology; D000078202:Systematic Reviews as Topic