TY - JOUR
T1 - Gestational diabetes mellitus and diet
T2 - A systematic review and meta-analysis of randomized controlled trials examining the impact of modified dietary interventions on maternal glucose control and neonatal birth weight
AU - Yamamoto, Jennifer M.
AU - Kellett, Joanne E.
AU - Balsells, Montserrat
AU - García-Patterson, Apolonia
AU - Hadar, Eran
AU - Solà, Ivan
AU - Gich, Ignasi
AU - Van Der Beek, Eline M.
AU - Castañeda-Gutiérrez, Eurídice
AU - Heinonen, Seppo
AU - Hod, Moshe
AU - Laitinen, Kirsi
AU - Olsen, Sjurdur F.
AU - Poston, Lucilla
AU - Rueda, Ricardo
AU - Rust, Petra
AU - Van Lieshout, Lilou
AU - Schelkle, Bettina
AU - Murphy, Helen R.
AU - Corcoy, Rosa
N1 - Publisher Copyright: © 2018 by the American Diabetes Association.
PY - 2018/7
Y1 - 2018/7
N2 - OBJECTIVE Medical nutrition therapy is a mainstay of gestational diabetes mellitus (GDM) treatment. However, data are limited regarding the optimal diet for achieving euglycemia and improved perinatal outcomes. This study aims to investigate whether modified dietary interventions are associated with improved glycemia and/or improved birth weight outcomes in women with GDM when compared with control dietary interventions. RESEARCH DESIGN AND METHODS Data from published randomized controlled trials that reported on dietary components, maternal glycemia, and birth weight were gathered from 12 databases. Data were extracted in duplicate using prespecified forms. RESULTS From 2,269 records screened, 18 randomized controlled trials involving 1,151 women were included. Pooled analysis demonstrated that for modified dietary interventions when compared with control subjects, there was a larger decrease in fasting and postprandial glucose (24.07 mg/dL [95% CI 27.58, 20.57]; P = 0.02 and 27.78 mg/dL [95% CI 212.27, 23.29]; P = 0.0007, respectively) and a lower need for medication treatment (relative risk 0.65 [95% CI 0.47, 0.88]; P = 0.006). For neonatal outcomes, analysis of 16 randomized controlled trials including 841 participants showed that modified dietary interventions were associated with lower infant birth weight (2170.62 g [95% CI 2333.64, 27.60]; P = 0.04) and less macrosomia (relative risk 0.49 [95% CI 0.27, 0.88]; P = 0.02). The quality of evidence for these outcomes was low to very low. Baseline differences between groups in postprandial glucose may have influenced glucose-related outcomes. As well, relatively small numbers of study participants limit between-diet comparison. CONCLUSIONS Modified dietary interventions favorably influenced outcomes related to maternal glycemia and birth weight. This indicates that there is room for improvement in usual dietary advice for women with GDM.
AB - OBJECTIVE Medical nutrition therapy is a mainstay of gestational diabetes mellitus (GDM) treatment. However, data are limited regarding the optimal diet for achieving euglycemia and improved perinatal outcomes. This study aims to investigate whether modified dietary interventions are associated with improved glycemia and/or improved birth weight outcomes in women with GDM when compared with control dietary interventions. RESEARCH DESIGN AND METHODS Data from published randomized controlled trials that reported on dietary components, maternal glycemia, and birth weight were gathered from 12 databases. Data were extracted in duplicate using prespecified forms. RESULTS From 2,269 records screened, 18 randomized controlled trials involving 1,151 women were included. Pooled analysis demonstrated that for modified dietary interventions when compared with control subjects, there was a larger decrease in fasting and postprandial glucose (24.07 mg/dL [95% CI 27.58, 20.57]; P = 0.02 and 27.78 mg/dL [95% CI 212.27, 23.29]; P = 0.0007, respectively) and a lower need for medication treatment (relative risk 0.65 [95% CI 0.47, 0.88]; P = 0.006). For neonatal outcomes, analysis of 16 randomized controlled trials including 841 participants showed that modified dietary interventions were associated with lower infant birth weight (2170.62 g [95% CI 2333.64, 27.60]; P = 0.04) and less macrosomia (relative risk 0.49 [95% CI 0.27, 0.88]; P = 0.02). The quality of evidence for these outcomes was low to very low. Baseline differences between groups in postprandial glucose may have influenced glucose-related outcomes. As well, relatively small numbers of study participants limit between-diet comparison. CONCLUSIONS Modified dietary interventions favorably influenced outcomes related to maternal glycemia and birth weight. This indicates that there is room for improvement in usual dietary advice for women with GDM.
KW - Gestational diabetes mellitus
KW - pregnancy
KW - complications
U2 - 10.2337/dc18-0102
DO - 10.2337/dc18-0102
M3 - Article
SN - 1935-5548
VL - 41
SP - 1346
EP - 1361
JO - Diabetes Care
JF - Diabetes Care
IS - 7
ER -