Jennifer M Yamamoto1, Joanne E Kellett2, Montserrat Balsells3, Apolonia García-Patterson4, Eran Hadar5, Ivan Solà4,6,7, Ignasi Gich7,8,9, Eline M van der Beek10,11, Eurídice Castañeda-Gutiérrez12, Seppo Heinonen13,14, Moshe Hod5, Kirsi Laitinen15,16, Sjurdur F Olsen17, Lucilla Poston18, Ricardo Rueda19, Petra Rust20, Lilou van Lieshout21, Bettina Schelkle21, Helen R Murphy22,23,24, Rosa Corcoy25,26,27. 1. Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Canada. 2. Norfolk and Norwich University Hospitals, Norfolk, U.K. 3. Department of Endocrinology and Nutrition, Hospital Mútua de Terrassa, Terrassa, Spain. 4. Institute of Biomedical Research, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 5. Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel. 6. Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 7. CIBER Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain. 8. Department of Epidemiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 9. Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, Spain. 10. Nutricia Research, Utrecht, the Netherlands. 11. Department of Pediatrics, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands. 12. Nestlé Research Center, Lausanne, Switzerland. 13. Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland. 14. Helsinki University Hospital, Helsinki, Finland. 15. Institute of Biomedicine, University of Turku, Turku, Finland. 16. Turku University Hospital, Turku, Finland. 17. Statens Serum Institut, Copenhagen, Denmark. 18. King's College London, London, U.K. 19. Research and Development Department, Abbott Nutrition, Granada, Spain. 20. Department of Nutritional Sciences, University of Vienna, Vienna, Austria. 21. International Life Sciences Institute Europe, Brussels, Belgium. 22. Norfolk and Norwich University Hospitals, Norfolk, U.K. helen.murphy@uea.ac.uk. 23. Cambridge University Hospitals NHS Foundation Trust, Cambridge, U.K. 24. Norwich Medical School, University of East Anglia, Norwich, U.K. 25. Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain. 26. CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Madrid, Spain. 27. Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Abstract
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 (-4.07 mg/dL [95% CI -7.58, -0.57]; P = 0.02 and -7.78 mg/dL [95% CI -12.27, -3.29]; 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 (-170.62 g [95% CI -333.64, -7.60]; 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.
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 (-4.07 mg/dL [95% CI -7.58, -0.57]; P = 0.02 and -7.78 mg/dL [95% CI -12.27, -3.29]; 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 (-170.62 g [95% CI -333.64, -7.60]; 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.
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