Effects of Dietary Approaches and Exercise Interventions on Gestational Diabetes Mellitus: A Systematic Review and Bayesian Network Meta-analysis

IF 8 1区医学 Q1 NUTRITION & DIETETICS

Advances in Nutrition Pub Date : 2024-10-29 DOI:10.1016/j.advnut.2024.100330

Liang Zhang , Fang Wang , Syoichi Tashiro , Peng Ju Liu

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引用次数: 0

Abstract

Although lifestyle interventions are recommended as the frontline therapeutic strategy for women with gestational diabetes mellitus (GDM), the optimal dietary regimen or form of exercise has yet to be definitively established. We aimed to compare the effectiveness of lifestyle therapies for GDM. Four databases (PubMed, Web of Science, EMBASE, and Cochrane Library) were systematically searched by multiple researchers for randomized controlled trials (RCTs). RCTs comparing lifestyle therapies to treat GDM with control or another treatment were included. Data extraction and synthesis were performed, estimating mean differences (MDs) or relative risk (RR) through pair-wise and network meta-analysis with a randomized or fixed-effects model when appropriate. The primary outcomes were maternal glucose control, birth weight of newborns, macrosomia and preterm birth rate, and rate of need for insulin therapy. In total, 39 trials with information obtained from 2712 women assessed 15 treatments. After sensitivity analysis, we confirmed the dietary approaches to stop hypertension (DASH) diet [MD: −11.52; 95% credible intervals (CrIs): −14.01, −9.07, very low certainty of evidence (CoE)] and low glycemic index (GI) diets (MD: −6.3; 95% CrI: −9.9, −2.7, low CoE) have shown significant advantages in fasting plasma glucose and 2-h postprandial glucose control, respectively. Furthermore, the DASH diet and resistance exercise reduced insulin requirements independently by 71% (95% CrI: 52%, 84%) and 67% (95% CrI: 48%, 85%), respectively. Additionally, both the DASH (MD: −587.6; 95% CrI: −752.12, −421.85, low CoE) and low GI diets (MD: −180.09, 95% CrI: −267.48, −94.65, low CoE) reduced birth weight significantly, with the DASH diet also demonstrating effects in reducing macrosomia by 89% (95% CrI: 53%, 98%) and lowering the cesarean section rate by 46% (95% CI: 27%, 60%). However, exercise did not affect infant outcomes. Our findings suggest that the DASH diet and low GI diet and resistance exercise may be beneficial for maternal outcomes in pregnancies with GDM. The impact on infants is primarily observed through dietary interventions. Future research, characterized by higher quality and evidence grades, is necessary to complement and substantiate our findings.

This study was registered with PROSPERO as CRD 42024527587.

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饮食方法和运动干预对妊娠糖尿病的影响：系统综述和贝叶斯网络荟萃分析。

目的：尽管生活方式干预被推荐为妊娠期糖尿病（GDM）妇女的一线治疗策略，但最佳饮食方案或运动形式尚未明确确定。我们旨在比较生活方式疗法对 GDM 的有效性：多位研究人员对四个数据库（Pubmed、Web of Science、Embase 和 Cochrane Library）进行了系统检索，以寻找随机对照试验（RCT）：研究入选标准：纳入比较生活方式疗法与对照疗法或其他疗法治疗 GDM 的 RCT：方法：进行数据提取和综合，通过配对分析和网络荟萃分析估算平均差（MDs）或相对风险（RR），适当时采用随机或固定效应模型。主要结果包括产妇血糖控制、新生儿出生体重、巨大儿和早产率以及胰岛素治疗需求率。本研究已在 PROSPERO 注册，注册号为 42024527587：39项试验从2712名妇女那里获得了信息，评估了15种治疗方法。经过敏感性分析后，我们证实了高血压饮食疗法（DASH）（MD -11-52，95% 可信区间（CrI）[-14-01，-9-07]，极低 CoE）和低血糖指数饮食疗法（GI）（MD -6-3，95% CrI [-9-9，-2-7]，低证据确凿度（CoE））分别在空腹血浆葡萄糖和餐后 2 小时血糖控制方面具有显著优势。此外，DASH 饮食和抗阻力运动分别将胰岛素需求量独立降低了 71%（95%CrI，[52%，84%]）和 67%（95%CrI，[48%，85%]）。此外，DASH（MD -587-6，95% CrI [-752-12，-421-85]），低 CoE）和低 GI 饮食（MD -180-09，95% CrI [-267-48，-94-65]，低 CoE）都能显著降低出生体重，其中 DASH 饮食还能将巨大儿减少 89%（95%CrI，[53%，98%]），并将剖宫产率降低 46%（95%CI，[27%，60%]）。然而，运动并不影响婴儿的预后：我们的研究结果表明，DASH 饮食和低 GI 饮食以及阻力运动可能对 GDM 孕妇的预后有益。对婴儿的影响主要是通过饮食干预观察到的。今后有必要开展更高质量和证据等级更高的研究，以补充和证实我们的发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Advances in Nutrition 医学-营养学

CiteScore

17.40

自引率

2.20%

发文量

117

审稿时长

56 days

期刊介绍： Advances in Nutrition (AN/Adv Nutr) publishes focused reviews on pivotal findings and recent research across all domains relevant to nutritional scientists and biomedical researchers. This encompasses nutrition-related research spanning biochemical, molecular, and genetic studies using experimental animal models, domestic animals, and human subjects. The journal also emphasizes clinical nutrition, epidemiology and public health, and nutrition education. Review articles concentrate on recent progress rather than broad historical developments. In addition to review articles, AN includes Perspectives, Letters to the Editor, and supplements. Supplement proposals require pre-approval by the editor before submission. The journal features reports and position papers from the American Society for Nutrition, summaries of major government and foundation reports, and Nutrient Information briefs providing crucial details about dietary requirements, food sources, deficiencies, and other essential nutrient information. All submissions with scientific content undergo peer review by the Editors or their designees prior to acceptance for publication.