Nutritional manipulation for the primary prevention of gestational diabetes mellitus: a meta-analysis of randomised studies

Ewelina Rogozińska, Monica Chamillard, Graham A Hitman, Khalid S Khan, Shakila Thangaratinam, Ewelina Rogozińska, Monica Chamillard, Graham A Hitman, Khalid S Khan, Shakila Thangaratinam

Abstract

Introduction: The rise in gestational diabetes (GDM), defined as first onset or diagnosis of diabetes in pregnancy, is a global problem. GDM is often associated with unhealthy diet and is a major contributor to adverse outcomes maternal and fetal outcomes. Manipulation of nutrition has the potential to prevent GDM.

Methods: We assessed the effects of nutritional manipulation in pregnancy on GDM and relevant maternal and fetal outcomes by a systematic review of the literature. We searched MEDLINE, EMBASE, and Cochrane Database from inception to March 2014 without any language restrictions. Randomised controlled trials (RCT) of nutritional manipulation to prevent GDM were included. We summarised dichotomous data as relative risk (RR) and continuous data as standardised mean difference (SMD) with 95% confidence interval (CI).

Results: From 1761 citations, 20 RCTs (6,444 women) met the inclusion criteria. We identified the following interventions: diet-based (n = 6), mixed approach (diet and lifestyle) interventions (n = 13), and nutritional supplements (myo-inositol n = 1, diet with probiotics n = 1). Diet based interventions reduced the risk of GDM by 33% (RR 0.67; 95% CI 0.39, 1.15). Mixed approach interventions based on diet and lifestyle had no effect on GDM (RR 0.95; 95% CI 0.89, 1.22). Nutritional supplements probiotics combined with diet (RR 0.40; 95% CI 0.20, 0.78) and myo-inositol (RR 0.40; 95% CI 0.16, 0.99) were assessed in one trial each and showed a beneficial effect. We observed a significant interaction between the groups based on BMI for diet-based intervention. The risk of GDM was reduced in obese and overweight pregnant women for GDM (RR 0.40, 95% CI 0.18, 0.86).

Conclusions: Nutritional manipulation in pregnancy based on diet or mixed approach do not appear to reduce the risk of GDM. Nutritional supplements show potential as agents for primary prevention of GDM.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. PRISMA flow diagram outlining study…
Fig 1. PRISMA flow diagram outlining study selection in the systematic review on nutritional manipulation in the prevention of gestational diabetes.
Fig 2. Quality assessment of the meta-analysed…
Fig 2. Quality assessment of the meta-analysed RCTs with a) diet based interventions, and b) mixed approach (diet and lifestyle) reporting rates of gestation diabetes (GDM).
Fig 3. Forest plot of the meta-analysed…
Fig 3. Forest plot of the meta-analysed RCTs with a) diet interventions, b) mixed approach (diet and lifestyle), and c) nutritional supplements reporting rates of gestation diabetes (GDM).

References

    1. Ferrara A (2007) Increasing Prevalence of Gestational Diabetes Mellitus: A public health perspective. Diabetes Care 30(Supplement 2):S141–S146.
    1. Jovanovic L, P DJ (2001) Gestational diabetes mellitus. JAMA 286(20):2516–8.
    1. Kim C, Newton KM, Knopp RH (2002) Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care 25(10):1862–8.
    1. Buchanan TA, Xiang AH, Page KA (2012) Gestational diabetes mellitus: risks and management during and after pregnancy. Nat Rev Endocrinol 8(11):639–49. 10.1038/nrendo.2012.96
    1. Coustan DR (2013) Can a dietary supplement prevent gestational diabetes mellitus? Diabetes Care 36(4):777–9. 10.2337/dc12-2505
    1. Gillies CL, Abrams KR, Lambert PC, Cooper NJ, Sutton AJ, et al. (2007) Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. BMJ 334(7588):299
    1. Kalergis M, Leung Yinko SS, Nedelcu R (2013) Dairy products and prevention of type 2 diabetes: implications for research and practice. Front Endocrinol (Lausanne) 4:90 10.3389/fendo.2013.00090
    1. Weickert MO, Pfeiffer AF (2008) Metabolic effects of dietary fiber consumption and prevention of diabetes. J Nutr 138(3):439–42.
    1. Oostdam N, van Poppel MN, Wouters MG, van MW (2011) Interventions for preventing gestational diabetes mellitus: a systematic review and meta-analysis. J Womens Health (Larchmt) 20(10):1551–63. 10.1089/jwh.2010.2703
    1. Tieu J, Crowther CA, Middleton P (2008) Dietary advice in pregnancy for preventing gestational diabetes mellitus. Cochrane Database Syst Rev (2):CD006674 10.1002/14651858.CD006674.pub2
    1. Thangaratinam S, Rogozinska E, Jolly K, Glinkowski S, Roseboom T, et al. (2012) Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. BMJ 344:e2088 10.1136/bmj.e2088
    1. Luoto R, Kinnunen TI, Aittasalo M, Kolu P, Raitanen J, et al. (2011) Primary prevention of gestational diabetes mellitus and large-for-gestational-age newborns by lifestyle counseling: a cluster-randomized controlled trial. PLoS Med 8(5):e1001036 10.1371/journal.pmed.1001036
    1. Khan KS, ter Riet G, Glanville J, Sowden AJ, Kleijnen J (2001) Undertaking Systematic Reviews of Research on Effectiveness. CRD's Guidance for Carrying Out or Commissioning Reviews. NHS Centre for Reviews and Dissemination, University of York. Report No.: 4 (2nd edition).
    1. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, et al. (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100 10.1371/journal.pmed.1000100
    1. Walker JD (2008) NICE guidance on diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. NICE clinical guideline 63. London, March 2008. Diabet Med 25(9):1025–7. 10.1111/j.1464-5491.2008.02532.x
    1. Higgins JPT, Green Se. Cochrane Reviewers Handbook 5.1.0. Available: . 2011 Mar.
    1. Harbord RM, Egger M, Sterne JA (2006) A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints. Stat Med 25(20):3443–57.
    1. Bogaerts A, Devlieger R, Nuyts E, Witters I, Gyselaers W, et al. (2013) Effects of lifestyle intervention in obese pregnant women on gestational weight gain and mental health: A randomized controlled trial. Int J Obes 37(6):814–21. 10.1038/ijo.2012.162
    1. D'Anna R, Scilipoti A, Giordano D, Caruso C, Cannata ML, et al. (2013) Myo-inositol supplementation and onset of gestational diabetes mellitus in pregnant women with a family history of type 2 diabetes: A prospective, randomized, placebo-controlled study. Diabetes Care 36(4):854–7. 10.2337/dc12-1371
    1. Dodd JM, Turnbull D, McPhee AJ, Deussen AR, Grivell RM, et al. (2014) Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial. BMJ 348:doi: 10.1136/bmj.g1285.
    1. Guelinckx I, Devlieger R, Mullie P, Vansant G (2010) Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: A randomized controlled trial. Am J Clin Nutr 91(2):373–80. 10.3945/ajcn.2009.28166
    1. Harrison CL, Lombard CB, Gibson-Helm M, Deeks A, Teede HJ (2011) Limiting excess weight gain in high-risk pregnancies: A randomized controlled trial. Endocr Rev 32(3). 10.1210/er.2011-0001
    1. Hui A, Back L, Ludwig S, Gardiner P, Sevenhuysen G, et al. (2011) Lifestyle intervention on diet and exercise reduced excessive gestational weight gain in pregnant women under a randomised controlled trial. BJOG Int J Obstet Gynaecol 119(1):70–7.
    1. Jeffries K, Shub A, Walker SP, Hiscock R, Permezel M (2009) Reducing excessive weight gain in pregnancy: a randomised controlled trial. Med J Aust 191(8):429–33.
    1. Korpi-Hyovalti E, Schwab U, Laaksonen DE, Linjama H, Heinonen S, et al. (2012) Effect of intensive counselling on the quality of dietary fats in pregnant women at high risk of gestational diabetes mellitus. Br J Nutr 108(5):910–7. 10.1017/S0007114511006118
    1. Luoto R, Laitinen K, Nermes M, Isolauri E, Luoto R, et al. (2010) Impact of maternal probiotic-supplemented dietary counselling on pregnancy outcome and prenatal and postnatal growth: a double-blind, placebo-controlled study. Br J Nutr 103(12):1792–9. 10.1017/S0007114509993898
    1. Petrella E, Malavolti M, Bertarini V, Pignatti L, Neri I, et al. (2013) Gestational weight gain in overweight and obese women enrolled in a healthy lifestyle and eating habits program. J Matern Fetal Neonatal Med November 25.
    1. Phelan S, Phipps MG, Abrams B, Darroch F, Schaffner A, et al. (2011) Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery Study. Am J Clin Nutr 93(4):772–9. 10.3945/ajcn.110.005306
    1. Polley BA, Wing RR, Sims CJ (2002) Randomized controlled trial to prevent excessive weight gain in pregnant women. Int J Obes Relat Metab Disord 26(11):1494–502.
    1. Poston L, Briley AL, Barr S, Bell R, Croker H, et al. (2013) Developing a complex intervention for diet and activity behaviour change in obese pregnant women (the UPBEAT trial); Assessment of behavioural change and process evaluation in a pilot randomised controlled trial. BMC Pregnancy Childbirth 13.
    1. Quinlivan J, Lam LT, Fisher J (2011) A randomised trial of a four-step multidisciplinary approach to the antenatal care of obese pregnant women. Australian & New Zealand Journal of Obstetrics & Gynaecology 51(2):141–6.
    1. Renault KM, Norgaard K, Nilas L, Carlsen EM, Cortes D, et al. (2014) The Treatment of Obese Pregnant Women (TOP) study: a randomized controlled trial of the effect of physical activity intervention assessed by pedometer with or without dietary intervention in obese pregnant women. Am J Obstet Gynecol 210(2):134–9. 10.1016/j.ajog.2013.09.029
    1. Thornton YS, Smarkola C, Kopacz SM, Ishoof SB (2009) Perinatal outcomes in nutritionally monitored obese pregnant women: a randomized clinical trial. J Natl Med Assoc 101(6):569–77.
    1. Vesco K, Leo M, Gillman M, King J, McEvoy C, et al. (2013) Impact of a weight management intervention on pregnancy outcomes among obese women: The Healthy Moms Trial. Am J Obstet Gynecol 208(1):S352.
    1. Vinter C, Jensen DM, Ovesen P, Beck-Nielsen H, Jorgensen JS (2011) The LiP (Lifestyle in Pregnancy) study: a randomized controlled trial of lifestyle intervention in 360 obese pregnant women. Diabetes Care 34(12):2502–7. 10.2337/dc11-1150
    1. Walsh J, McGowan CA, Mahony R, Foley ME, McAuliffe FM (2012) Low glycaemic index diet in pregnancy to prevent macrosomia (ROLO study): randomised control trial. BMJ 345:e5605 10.1136/bmj.e5605
    1. Wolff S, Legarth J, Vangsgaard K, Toubro S, Astrup A (2008) A randomized trial of the effects of dietary counseling on gestational weight gain and glucose metabolism in obese pregnant women. Int J Obes (Lond) 32(3):495–501. 10.1038/sj.ijo.0803710
    1. Barrett HL, Callaway LK, Nitert MD (2012) Probiotics: a potential role in the prevention of gestational diabetes? Acta Diabetol 49 Suppl 1:S1–13. 10.1007/s00592-012-0444-8
    1. Fraser RB, Ford FA, Lawrence GF (1988) Insulin sensitivity in third trimester pregnancy. A randomized study of dietary effects. Br J Obstet Gynaecol 95[3], 223–229.
    1. Zhang C, Liu S, Solomon CG, Hu FB (2006) Dietary fiber intake, dietary glycemic load, and the risk for gestational diabetes mellitus. Diabetes Care 29(10):2223–30.
    1. Qiu C, Williams MA, Vadachkoria S, Frederick IO, Luthy DA (2004) Increased maternal plasma leptin in early pregnancy and risk of gestational diabetes mellitus. Obstet Gynecol 103(3):519–25.
    1. Pirc LK, Owens JA, Crowther CA, Willson K, De Blasio MJ, et al. (2007) Mild gestational diabetes in pregnancy and the adipoinsular axis in babies born to mothers in the ACHOIS randomised controlled trial. BMC Pediatr 7:18
    1. Han S, Middleton P, Crowther CA (2012) Exercise for pregnant women for preventing gestational diabetes mellitus. Cochrane Database Syst Rev 7:CD009021 10.1002/14651858.CD009021.pub2
    1. Genazzani AD, Lanzoni C, Ricchieri F, Jasonni VM (2008) Myo-inositol administration positively affects hyperinsulinemia and hormonal parameters in overweight patients with polycystic ovary syndrome. Gynecol Endocrinol 24(3):139–44. 10.1080/09513590801893232
    1. Cogram P, Tesh S, Tesh J, Wade A, Allan G, et al. (2002) D-chiro-inositol is more effective than myo-inositol in preventing folate-resistant mouse neural tube defects. Hum Reprod 17(9):2451–8.
    1. Shang M, Lin L (2014) IADPSG criteria for diagnosing gestational diabetes mellitus and predicting adverse pregnancy outcomes. J Perinatol 34(2):100–4. 10.1038/jp.2013.143
    1. Hex N, Bartlett C, Wright D, Taylor M, Varley D (2012) Estimating the current and future costs of Type 1 and Type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabet Med 29(7):855–62. 10.1111/j.1464-5491.2012.03698.x

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する