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

Jennifer M. Yamamoto, Joanne E. Kellett , Montserrat Balsells, Apolonia García-Patterson, Eran Hadar, Ivan Solà, Ignasi Gich, Eline M. van der Beek, Eurídice Castañeda-Gutiérrez, Seppo Heinonen, Moshe Hod, Kirsi Laitinen, Sjurdur F. Olsen, Lucilla Poston, Ricardo Rueda, Petra Rust, Lilou van Lieshout, Bettina Schelkle, Helen R. Murphy, Rosa Corcoy

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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.
Original languageEnglish
Pages (from-to)346-1361
Number of pages16
JournalDiabetes Care
Issue number7
Early online date22 Jun 2018
Publication statusPublished - 1 Jul 2018

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