Social Inequities Contributing to Gestational Diabetes in Indigenous Populations in Canada: A Scoping Review


      The prevalence of gestational diabetes mellitus (GDM) is dramatically higher in Indigenous compared with non-Indigenous populations in Canada. In this scoping review, we synthesize the existing literature regarding GDM among Indigenous peoples in Canada, including social and structural determinants that contribute to its higher prevalence in this population. Seven themes related to GDM in Indigenous populations emerged from a synthesis of the 44 included articles. The themes were GDM prevalence and trends; risk factors; screening; diagnosis and treatment; maternal outcomes; child outcomes; systemic barriers; and Indigenous perceptions, concerns and health behaviours. The findings from this review suggest culturally appropriate health care and improved screening practices may help to mitigate the high prevalence and poor health outcomes associated with GDM in Indigenous communities across Canada. More community-driven, participatory research that includes the social determinants of health and a culturally safe lens is required to assess the effects and reduce the impact of GDM in this population.


      La prévalence du diabète sucré gestationnel (DSG) est nettement plus élevée au sein des populations autochtones que des populations non autochtones du Canada. Dans la présente étude de portée, nous avons fait la synthèse de la littérature existante sur le DSG au sein des personnes autochtones du Canada, notamment les déterminants sociaux et structurels qui contribuent à sa plus grande prévalence au sein de cette population. Sept thèmes liés au DSG au sein des populations autochtones sont ressortis de la synthèse des 44 articles retenus. Les thèmes étaient la prévalence et les tendances du DSG; les facteurs de risque; le dépistage; le diagnostic et le traitement; les issues maternelles; les issues de l’enfant; les obstacles systémiques; les perceptions, les préoccupations et les comportements de santé des Autochtones. Les conclusions de cette revue suggèrent que l’adaptation des soins de santé culturellement appropriés à la culture et l’amélioration des pratiques de dépistage peuvent aider à atténuer la forte prévalence et les mauvais résultats cliniques associés au DSG au sein de toutes les communautés autochtones du Canada. Davantage de recherches participatives communautaires qui tiennent compte des déterminants sociaux de la santé et offrent une perspective culturellement sécuritaire sont nécessaires pour évaluer les effets et réduire les répercussions du DSG au sein de cette population.


      Mots clés

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Canadian Journal of Diabetes
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Dyck R.
        • Klomp H.
        • Tan L.K.
        • Turnell R.W.
        • Boctor M.A.
        A comparison of rates, risk factors, and outcomes of gestational diabetes between Aboriginal and non-Aboriginal women in the Saskatoon Health District.
        Diabetes Care. 2002; 25: 487-493
        • Rodrigues S.
        • Robinson E.
        • Gray-Donald K.
        Prevalence of gestational diabetes mellitus among James Bay Cree women in northern Quebec.
        CMAJ. 1999; 160: 1293-1297
      1. Public Health Agency of Canada. Maternal diabetes in Canada. 2014. Accessed June 18, 2021.

        • Farahvar S.
        • Walfisch A.
        • Sheiner E.
        Gestational diabetes risk factors and long-term consequences for both mother and offspring: A literature review.
        Exp Rev Endocrinol Metabol. 2019; 14: 63-74
        • Buchanan T.
        • Xiang A.
        • Page K.
        Gestational diabetes mellitus: Risks and management during and after pregnancy.
        Nat Rev Endocrinol. 2012; 8: 639-649
        • Jacklin K.M.
        • Henderson R.I.
        • Green M.E.
        • Walker L.M.
        • Calam B.
        • Crowshoe L.J.
        Health care experiences of Indigenous people living with type 2 diabetes in Canada.
        CMAJ. 2017; 189: E106-E112
      2. Revised Statutes of Canada (R.S.C) Legislative Services. Consolidated federal laws of Canada, Indian Act 2019. Accessed June 23, 2021.

      3. Loppie Reading C, Wien F. Health inequalities and social determinants of Aboriginal Peoples’ Health, 2009.

        • Morisset A.-S.
        • St-Yves A.
        • Veillette J.
        • Weisnagel S.J.
        • Tchernof A.
        • Robitaille J.
        Prevention of gestational diabetes mellitus: A review of studies on weight management.
        Diabetes Metab Res Rev. 2010; 26: 17-25
        • Feig D.S.
        • Berger H.
        • Donovan L.
        • et al.
        Diabetes and pregnancy.
        Can J Diabetes. 2018; 42: S255-S282
        • Earle L.
        Traditional Aboriginal Diets and Health.
        National Collaborating Center for Aboriginal Health, Prince George, BC2013
        • Crowshoe L.
        • Dannenbaum D.
        • Green M.
        • Henderson R.
        • Hayward M.N.
        • Toth E.
        Type 2 diabetes and Indigenous peoples.
        Can J Diabetes. 2018; 42: S296-306
      4. Office of the Auditor General of Canada. Report 4---Access to health services for remote First Nations communities, 2015.

      5. Rotenberg C. Social determinants of health for the off-reserve First Nations population, 15 years of age and older, 2012. Statistics Canada. 2016. Accessed February 23, 2021.

        • Tompkins J.W.
        • Mequanint S.
        • Edward Barre D.
        • et al.
        National survey of Indigenous primary healthcare capacity and delivery models in Canada: The TransFORmation of IndiGEnous PrimAry HEAlthcare delivery (FORGE AHEAD) community profile survey.
        BMC Health Serv Res. 2018; 1
      6. Indigenous Services Canada. Working as a nurse in a remote or isolated community. 2020. Accessed April 26, 2021.

      7. Statistics Canada. Data tables, 2016 Census. 2017. Accessed June 23, 2021.

        • Maar M.A.
        • Manitowabi D.
        • Gzik D.
        • McGregor L.
        • Corbiere C.
        Serious complications for patients, care providers and policy makers: Tackling the structural violence of First Nations people living with diabetes in Canada.
        Int Indigenous Policy J. 2011; 2
        • Kulhawy-Wibe S.
        • King-Shier K.M.
        • Barnabe C.
        • Manns B.J.
        • Hemmelgarn B.R.
        • Campbell D.J.T.
        Exploring structural barriers to diabetes self-management in Alberta First Nations communities.
        Diabetol Metab Syndr. 2018; 10: 87
        • Adelson N.
        The embodiment of inequity: Health disparities in Aboriginal Canada.
        Can J Public Health. 2005; 96: S45-61
        • Aljohani N.
        • Rempel B.M.
        • Ludwig S.
        • et al.
        Gestational diabetes in Manitoba during a twenty-year period.
        Clin Invest Med. 2008; 31: E131-E137
        • Arksey H.
        • O’Malley L.
        Scoping studies: Towards a methodological framework.
        Int J Social Res Methodol. 2005; 8: 19-32
        • Campbell S.
        • Dorgan M.
        • Tjosvold L.
        Filter to retrieve studies related to Indigenous People of Canada the EBSCO CINAHL database.
        John W. Scott Health Sciences Library, University of Alberta, 2013
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • PRISMA Group
        Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.
        PLoS Med. 2009; 6e1000097
        • Johnson S.
        • Martin D.
        • Sarin C.
        Diabetes mellitus in the First Nations population of British Columbia, Canada. Part 3. Prevalence of diagnosed cases.
        Int J Circumpolar Health. 2002; 61: 260-264
        • Brennand E.A.
        • Dannenbaum D.
        • Willows N.D.
        Pregnancy outcomes of First Nations women in relation to pregravid weight and pregnancy weight gain.
        J Obstet Gynaecol Can. 2005; 27: 936-944
        • Poirier J.
        • Kattini R.
        • Kelly L.
        • et al.
        Screening for gestational diabetes in pregnancy in Northwestern Ontario.
        Can J Rural Med. 2020; 25: 61-66
        • Hummelen R.
        • Kattini R.
        • Poirier J.
        • et al.
        Demographics, prevalence and outcomes of diabetes in pregnancy in NW Ontario.
        Can J Rural Med. 2020; 25: 99
        • Sellers E.A.C.
        • Dean H.J.
        • Shafer L.A.
        • et al.
        Exposure to gestational diabetes mellitus: Impact on the development of early-onset type 2 diabetes in Canadian First Nations and non-First Nations offspring.
        Diabetes Care. 2016; 39: 2240-2246
        • Shen G.X.
        • Shafer L.A.
        • Martens P.J.
        • et al.
        Does First Nations ancestry modify the association between gestational diabetes and subsequent diabetes: A historical prospective cohort study among women in Manitoba, Canada.
        Diabet Med. 2016; 33: 1245-1252
        • Oster R.T.
        • Toth E.L.
        Differences in the prevalence of diabetes risk-factors among First Nation, Métis and non-Aboriginal adults attending screening clinics in rural Alberta, Canada.
        Rural Remote Health. 2009; 9: 1170
        • Dyck R.F.
        • Karunanayake C.
        • Pahwa P.
        • Stang M.
        • Osgood N.D.
        Epidemiology of diabetes in pregnancy among First Nations and non-First Nations women in Saskatchewan, 1980‒2013. Part 2: Predictors and early complications; Results from the DIP: ORRIIGENSS Project.
        Can J Diabetes. 2020; 44: 605-614
        • Godwin M.
        • Muirhead M.
        • Huynh J.
        • Helt B.
        • Grimmer J.
        Prevalence of gestational diabetes mellitus among Swampy Cree women in Moose Factory, James Bay.
        CMAJ. 1999; 160: 1299-1302
        • Harris S.B.
        • Caulfield L.E.
        • Sugamori M.E.
        • Whalen E.A.
        • Henning B.
        The epidemiology of diabetes in pregnant Native Canadians. A risk profile.
        Diabetes Care. 1997; 20: 1422-1425
        • Oster R.
        • Mayan M.
        • Toth E.
        Diabetes in pregnancy among First Nations women.
        Qualitative Health Res. 2014; 24
        • Rodrigues S.
        • Robinson E.J.
        • Ghezzo H.
        • Gray-Donald K.
        Interaction of body weight and ethnicity on risk of gestational diabetes mellitus.
        Am J Clin Nutr. 1999; 70: 1083-1089
        • Aljohani N.
        • Rempel B.M.
        • Ludwig S.
        • et al.
        Impact of diabetes on maternal-fetal outcomes in Manitoba: Relationship with ethnic and environmental factors.
        Clin Invest Med. 2008; 31: E338-E345
        • Oster R.T.
        • King M.
        • Morrish D.W.
        • Mayan M.J.
        • Toth E.L.
        Diabetes in pregnancy among First Nations women in Alberta, Canada: A retrospective analysis.
        BMC Pregnancy Childbirth. 2014; 14: 136
        • Dyck R.F.
        • Karunanayake C.
        • Pahwa P.
        • Osgood N.D.
        The hefty fetal phenotype hypothesis revisited: High birth weight, type 2 diabetes and gestational diabetes in a Saskatchewan cohort of First Nations and non-First Nations women.
        J Dev Orig Health Dis. 2019; 10: 48-54
        • Mohamed N.
        • Dooley J.
        Gestational diabetes and subsequent development of NIDDM in aboriginal women of northwestern Ontario.
        Int J Circumpolar Health. 1998; 57: 355-358
        • Chamberlain C.
        • McNamara B.
        • Williams E.D.
        • et al.
        Diabetes in pregnancy among Indigenous women in Australia, Canada, New Zealand and the United States: A systematic review of the evidence for screening in early pregnancy.
        Diabetes Metab Res Rev. 2013; 29: 241-256
        • Neufeld H.T.
        Food perceptions and concerns of Aboriginal women coping with gestational diabetes in Winnipeg, Manitoba.
        J Nutr Educ Behav. 2011; 43: 482-491
        • Toth E.L.
        • Keith K.-L.
        • Littlechild R.
        • et al.
        High frequency of pre-existing type 2 diabetes in a series of pregnant women referred for “gestational diabetes” in a large Canadian Indigenous community.
        Can J Diabetes. 2016; 40: 487-489
        • Dyck R.F.
        • Karunanayake C.
        • Pahwa P.
        • Stang M.
        • Osgood N.D.
        Epidemiology of diabetes in pregnancy among First Nations and non-First Nations women in Saskatchewan, 1980‒2013. Part 1: Populations, methodology and frequencies (1980‒2009); Results from the DIP: ORRIIGENSS project.
        Can J Diabetes. 2020; 44: 597-604
        • Caulfield L.E.
        • Harris S.B.
        • Whalen E.A.
        • Sugamori M.E.
        Maternal nutritional status, diabetes and risk of macrosomia among Native Canadian women.
        Early Hum Dev. 1998; 50: 293-303
        • Oster R.T.
        • Toth E.L.
        Longitudinal rates and risk factors for adverse birth weight among First Nations pregnancies in Alberta.
        J Obstet Gynaecol Can. 2016; 38: 29-34
        • Rodrigues S.
        • Robinson E.J.
        • Kramer M.S.
        • Gray-Donald K.
        High rates of infant macrosomia: A comparison of a Canadian native and a non-native population.
        J Nutr. 2000; 130: 806-812
        • Willows N.D.
        • Sanou D.
        • Bell R.C.
        Assessment of Canadian Cree infants’ birth size using the WHO child growth standards.
        Am J Hum Biol. 2011; 23: 126-131
        • Osgood N.D.
        • Dyck R.F.
        • Grassmann W.K.
        The inter- and intragenerational impact of gestational diabetes on the epidemic of type 2 diabetes.
        Am J Public Health. 2011; 101: 173-179
        • Wicklow B.A.
        • Sellers E.A.C.
        • Sharma A.K.
        • et al.
        Association of gestational diabetes and type 2 diabetes exposure in utero with the development of type 2 diabetes in First Nations and non-First Nations offspring.
        JAMA Pediatr. 2018; 172: 724-731
        • Young T.K.
        • Martens P.J.
        • Taback S.P.
        • et al.
        Type 2 diabetes mellitus in children: Prenatal and early infancy risk factors among Native Canadians.
        Arch Pediatr Adolesc Med. 2002; 156: 651-655
        • Chen L.
        • Wang W.-J.
        • Auger N.
        • et al.
        Diabetes in pregnancy in associations with perinatal and postneonatal mortality in First Nations and non-Indigenous populations in Quebec, Canada: Population-based linked birth cohort study.
        BMJ Open. 2019; 9e025084
        • Kattini R.
        • Poirier J.N.
        • Kelly L.F.
        • et al.
        Outcomes of pregnancies affected by gestational diabetes and type 2 diabetes in a rural First Nations obstetrical program in northwest Ontario.
        Can J Diabetes. 2020; 44: 624-627
      8. Whitty-Rogers JP. Exploring Mi’kmaq women’s experiences with gestational diabetes mellitus. Doctoral dissertation, University of Alberta, Calgary, Alberta, Canada, 2013.

        • Darroch F.E.
        • Giles A.R.
        A postcolonial feminist discourse analysis of urban Aboriginal women’s description of pregnancy-related weight gain and physical activity.
        Women Birth. 2016; 29: e23-32
        • Locke S.R.
        • Dix G.
        • Te Hiwi B.
        • et al.
        Improving diabetes care in the British Columbia southern interior: Developing community‒university initiatives to address service gaps.
        Can J Diabetes. 2021; 45: 5-14.e2
        • Cleary E.
        • Ludwig S.
        • Riese N.
        • Grant L.
        Educational strategies to improve screening for gestational diabetes mellitus in Aboriginal women in a remote northern community.
        Can J Diabetes. 2006; 30: 264-268
        • Gaudreau S.
        • Michaud C.
        Cultural factors related to the maintenance of health behaviours in Algonquin women with a history of gestational diabetes.
        Chronic Dis Inj Can. 2012; 32: 140-148
        • Pace R.
        • Loon O.
        • Chan D.
        • et al.
        Preventing diabetes after pregnancy with gestational diabetes in a Cree community: An inductive thematic analysis.
        BMJ Open Diabetes Res Care. 2020; 8e001286
        • Back L.
        • Hui A.
        • Reid A.
        • et al.
        Comparison of physical activity and nutritional intake in First Nations pregnant women in remote communities and urban-living pregnant women.
        Can J Diabetes. 2012; 36: 64-67
        • Gray-Donald K.
        • Robinson E.
        • Collier A.
        • David K.
        • Renaud L.
        • Rodrigues S.
        Intervening to reduce weight gain in pregnancy and gestational diabetes mellitus in Cree communities: An evaluation.
        CMAJ. 2000; 163: 1247-1251
        • Klomp H.
        • Dyck R.
        • Sheppard S.
        Description and evaluation of a prenatal exercise program for urban Aboriginal women.
        Can J Diabetes. 2003; 27: 231-238
        • Oster R.T.
        • Grier A.
        • Lightning R.
        • Mayan M.J.
        • Toth E.L.
        Cultural continuity, traditional Indigenous language, and diabetes in Alberta First Nations: A mixed methods study.
        Int J Equity Health. 2014; 13: 92
        • Di Lallo S.
        Prenatal care through the eyes of Canadian Aboriginal women.
        Nurs Womens Health. 2014; 18: 38-46
        • McConkey S.R.
        The Indigenous determinants of health as predictors for diabetes and unmet health needs among urban Indigenous people: A respondent-driven sampling study in Toronto, Ontario.
        ([Master's thesis]) University of Western Ontario, 2018
      9. Public Health Agency of Canada. Chapter 6: Diabetes in Canada: Facts and figures from a public health perspective---First Nations, Inuit, and Métis. Government of Canada. 2011. Accessed May 29, 2021.

        • Singer J.
        • Putulik Kidlapik C.
        • Martin B.
        • Dean H.J.
        • Trepman E.
        • Embil J.M.
        Food consumption, obesity and abnormal glycaemic control in a Canadian Inuit community.
        Clin Obes. 2014; 4: 316-323
        • McIntyre H.D.
        • Catalano P.
        • Zhang C.
        • Desoye G.
        • Mathiesen E.R.
        • Damm P.
        Gestational diabetes mellitus.
        Nat Rev Dis Primers. 2019; 5: 47
        • Zhang C.
        • Ning Y.
        Effect of dietary and lifestyle factors on the risk of gestational diabetes: Review of epidemiologic evidence.
        Am J Clin Nutr. 2011; 94: 1975S-1979S
        • Ismaili M’hamdi H.
        • de Beaufort I.
        • Jack B.
        • Steegers E.A.P.
        Responsibility in the age of Developmental Origins of Health and Disease (DOHaD) and epigenetics.
        J Dev Orig Health Dis. 2018; 9: 58-62
        • Heaman M.I.
        • Gupton A.L.
        • Moffatt M.E.K.
        Prevalence and predictors of inadequate prenatal care: A comparison of Aboriginal and non-Aboriginal women in Manitoba.
        J Obstet Gynaecol Canada. 2005; 27: 237-248
        • Wilson D.
        • de la Ronde S.
        • Brascoupé S.
        • et al.
        First Nations, Inuit, and Métis maternal health.
        J Obstet Gynaecol Canada. 2013; 35: S33-S36
        • Hackett F.J.P.
        • Abonyi S.
        • Dyck R.F.
        Anthropometric indices of First Nations children and youth on first entry to Manitoba/Saskatchewan residential schools---1919 to 1953.
        Int J Circumpolar Health. 2016; 7530734
      10. Truth and Reconciliation Commission of Canada. Honouring the truth, reconciling for the future: Summary of the final report of the Truth and Reconciliation Commission of Canada. 2015. Accessed May 31, 2021.

        • Mosby I.
        • Galloway T.
        ‘The abiding condition was hunger’: Assessing the long-term biological and health effects of malnutrition and hunger in Canada’s residential schools.
        Br J Can Studies. 2017; 30: 147-163
        • Kuhnlein H.V.
        • Receveur O.
        • Soueida R.
        • Egeland G.M.
        Arctic Indigenous Peoples experience the nutrition transition with changing dietary patterns and obesity.
        Commun Int Nutr. 2004; 7