Gestational Diabetes Mellitus and Diet: 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
Por:
Yamamoto, JM, Kellett, JE, Balsells, M, Garcia-Patterson, A, Hadar, E, Sola, I, Gich, I, van der Beek, EM, Castaneda-Gutierrez, E, Heinonen, S, Hod, M, Laitinen, K, Olsen, SF, Poston, L, Rueda, R, Rust, P, van Lieshout, L, Schelkle, B, Murphy, HR, Corcoy, R
Publicada:
1 jul 2018
Resumen:
OBJECTIVEMedical 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 METHODSData 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.RESULTSFrom 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.CONCLUSIONSModified 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.
Filiaciones:
Yamamoto, JM:
Univ Calgary, Div Endocrinol & Metab, Dept Med, Calgary, AB, Canada
Kellett, JE:
Norfolk & Norwich Univ Hosp, Norwich, Norfolk, England
Balsells, M:
Hosp Mutua Terrassa, Dept Endocrinol & Nutr, Terrassa, Spain
Garcia-Patterson, A:
Hosp Santa Creu & Sant Pau, Inst Biomed Res, Barcelona, Spain
Hadar, E:
Tel Aviv Univ, Rabin Med Ctr, Tel Aviv, Israel
Sola, I:
Hosp Santa Creu & Sant Pau, Inst Biomed Res, Barcelona, Spain
Hosp Santa Creu & Sant Pau, Iberoamer Cochrane Ctr, Barcelona, Spain
Inst Salud Carlos III, CIBER Epidemiol & Salud Publ, Madrid, Spain
Gich, I:
Inst Salud Carlos III, CIBER Epidemiol & Salud Publ, Madrid, Spain
Hosp Santa Creu & Sant Pau, Dept Epidemiol, Barcelona, Spain
Univ Autonoma Barcelona, Dept Pharmacol Therapeut & Toxicol, Bellaterra, Spain
van der Beek, EM:
Nutr Res, Utrecht, Netherlands
Univ Groningen, Univ Med Ctr Groningen, Dept Pediat, Groningen, Netherlands
Castaneda-Gutierrez, E:
Nestle Res Ctr, Lausanne, Switzerland
Heinonen, S:
Univ Helsinki, Dept Obstet & Gynecol, Helsinki, Finland
Helsinki Univ Hosp, Helsinki, Finland
Hod, M:
Tel Aviv Univ, Rabin Med Ctr, Tel Aviv, Israel
Laitinen, K:
Univ Turku, Inst Biomed, Turku, Finland
Turku Univ Hosp, Turku, Finland
Olsen, SF:
Statens Serum Inst, Copenhagen, Denmark
Poston, L:
Kings Coll London, London, England
Rueda, R:
Abbott Nutr, Dept Res & Dev, Granada, Spain
Rust, P:
Univ Vienna, Dept Nutr Sci, Vienna, Austria
van Lieshout, L:
Int Life Sci Inst Europe, Brussels, Belgium
Schelkle, B:
Int Life Sci Inst Europe, Brussels, Belgium
Murphy, HR:
Norfolk & Norwich Univ Hosp, Norwich, Norfolk, England
Cambridge Univ Hosp NHS Fdn Trust, Cambridge, England
Univ East Anglia, Norwich Med Sch, Norwich, Norfolk, England
Corcoy, R:
Univ Autonoma Barcelona, Dept Med, Bellaterra, Spain
Inst Salud Carlos III, CIBER Bioengn Biomat & Nanotechnol, Madrid, Spain
Hosp Santa Creu & Sant Pau, Dept Endocrinol & Nutr, Barcelona, Spain
Green Accepted, Bronze
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