Lifestyle Interventions for the Treatment of Women with Gestational Diabetes

Summary

A meta-analysis and meta-regression 2 included 24 RCTs with a total of 3477 participants. Exercise lowered fasting blood glucose (FBG) (SMD -1.69, I²=96 %, p < 0.0001), 2-h postprandial blood glucose (2-hPBG) (SMD -2.10, I²=96 %, p < 0.0001), and glycated hemoglobin (MD -0.95, I²=98 %, p < 0.0001), although with high heterogeneity. Exercise reduced the risk of gestational hypertension (RR 0.24, I²=0 %, p < 0.0001), caesarean section (RR 0.71, I²=53 %, p = 0.0005), preterm birth (RR 0.51, I²=31 %, p = 0.002), macrosomia (RR 0.40, I²=19 %, p < 0.0001), and neonatal hypoglycemia (RR 0.49, I²=0 %, p = 0.03). Subgroup analyses indicated that moderate combined aerobic and resistance exercise improved FBG, 2-hPBG and the risks of cesarean section, preterm birth, and macrosomia. There was a significant dose-response relationship between exercise volume and 2-hPBG. The analysis found improvements, when exercise lasted at least 30 min per session, more than 3 times per week, for at least 6 weeks. All types of exercise were effective but combined aerobic and resistance exercise produced the greatest effect size.

A systematic review and Bayesian network meta-analysis 3 included 39 RCTs with information obtained from 2712 women assessing 15 treatments. Dietary approaches to stop hypertension (DASH) diet emphasizes the consumption of fruits, vegetables, whole grains, legumes, nuts, lean protein, and low-fat dairy products. The DASH diet and resistance exercise reduced insulin requirements independently by 71% (95% credible intervals [CrI] 52% to 84%) and 67% (95% CrI 48% to 85%), respectively. Both the DASH (MD -587.6; 95% CrI: -752.12 to -421.85) and low glycaemic index diets (MD -180.09, 95% CrI: -267.48 to -94.65) reduced birth weight (low evidence). The DASH diet reduced macrosomia by 89% (95% CrI: 53% to 98%) and lowered the caesarean section rate by 46% (95% CI: 27% to , 60%).

A systematic review and meta-analysis 4 included 17 studies (15 RCTs, 2 cohort studies). Exercise reduced the risk of adverse neonatal outcomes: Cesarean delivery (OR 0.91, 95% CI 0.88 to 0.94), premature birth (OR 0.49, 95% CI 0.27 to 0.90), macrosomia (OR 0.58, 95% CI 0.40 to 0.83), fetal growth restriction (OR 0.21, 95% CI 0.08 to 0.52), and birth trauma (OR 0.26, 95% CI 0.13 to 0.54).

A Cochrane review [Abstract] 1 included 15 studies with a total of 4501 women and 3768 infants. The lifestyle interventions included a wide variety of components such as education, diet, and exercise. There was no clear evidence of a difference between lifestyle intervention and control groups (usual care or diet alone) for the risk of hypertensive disorders of pregnancy (pre-eclampsia), caesarean section, development of type 2 diabetes, perineal trauma/tearing, or induction of labour T1. More women in the lifestyle intervention group had met postpartum weight goals one year after birth than in the control group T1. Lifestyle interventions were associated with a reduction in the risk of being born large-for-gestational age (LGA) T2. There was a trend for lower birthweight, neonatal fat mass, and the incidence of macrosomia in the lifestyle intervention group T2.