Participant characteristics in the prevention of gestational diabetes as evidence for precision medicine: a systematic review and meta-analysis

doi:10.1038/s43856-023-00366-x

. 2023 Oct 5;3(1):137.

doi: 10.1038/s43856-023-00366-x.

Participant characteristics in the prevention of gestational diabetes as evidence for precision medicine: a systematic review and meta-analysis

Siew Lim¹, Wubet Worku Takele^#², Kimberly K Vesco^#³, Leanne M Redman^#⁴, Wesley Hannah^#^{5

6}, Maxine P Bonham⁷, Mingling Chen⁸, Sian C Chivers⁹, Andrea J Fawcett^{10

11}, Jessica A Grieger¹², Nahal Habibi¹², Gloria K W Leung⁷, Kai Liu⁷, Eskedar Getie Mekonnen¹³, Maleesa Pathirana¹², Alejandra Quinteros¹², Rachael Taylor¹⁴, Gebresilasea G Ukke², Shao J Zhou^{15

16}; ADA/EASD PMDI; Jami Josefson¹⁷

Collaborators, Affiliations

Collaborators

ADA/EASD PMDI:
Deirdre K Tobias, Jordi Merino, Abrar Ahmad, Catherine Aiken, Jamie L Benham, Dhanasekaran Bodhini, Amy L Clark, Kevin Colclough, Rosa Corcoy, Sara J Cromer, Daisy Duan, Jamie L Felton, Ellen C Francis, Pieter Gillard, Véronique Gingras, Romy Gaillard, Eram Haider, Alice Hughes, Jennifer M Ikle, Laura M Jacobsen, Anna R Kahkoska, Jarno L T Kettunen, Raymond J Kreienkamp, Lee-Ling Lim, Jonna M E Männistö, Robert Massey, Niamh-Maire Mclennan, Rachel G Miller, Mario Luca Morieri, Jasper Most, Rochelle N Naylor, Bige Ozkan, Kashyap Amratlal Patel, Scott J Pilla, Katsiaryna Prystupa, Sridharan Raghavan, Mary R Rooney, Martin Schön, Zhila Semnani-Azad, Magdalena Sevilla-Gonzalez, Pernille Svalastoga, Claudia Ha-Ting Tam, Anne Cathrine B Thuesen, Mustafa Tosur, Amelia S Wallace, Caroline C Wang, Jessie J Wong, Jennifer M Yamamoto, Katherine Young, Chloé Amouyal, Mette K Andersen, Maxine P Bonham, Feifei Cheng, Tinashe Chikowore, Christoffer Clemmensen, Dana Dabelea, Adem Y Dawed, Aaron J Deutsch, Laura T Dickens, Linda A DiMeglio, Monika Dudenhöffer-Pfeifer, Carmella Evans-Molina, María Mercè Fernández-Balsells, Hugo Fitipaldi, Stephanie L Fitzpatrick, Stephen E Gitelman, Mark O Goodarzi, Jessica A Grieger, Marta Guasch-Ferré, Nahal Habibi, Torben Hansen, Chuiguo Huang, Arianna Harris-Kawano, Heba M Ismail, Benjamin Hoag, Randi K Johnson, Angus G Jones, Robert W Koivula, Aaron Leong, Gloria K W Leung, Ingrid M Libman, Kai Liu, S Alice Long, William L Lowe Jr, Robert W Morton, Ayesha A Motala, Suna Onengut-Gumuscu, James S Pankow, Maleesa Pathirana, Sofia Pazmino, Dianna Perez, John R Petrie, Camille E Powe, Rashmi Jain, Debashree Ray, Mathias Ried-Larsen, Zeb Saeed, Vanessa Santhakumar, Sarah Kanbour, Sudipa Sarkar, Gabriela S F Monaco, Denise M Scholtens, Elizabeth Selvin, Wayne Huey-Herng Sheu, Cate Speake, Maggie A Stanislawski, Nele Steenackers, Andrea K Steck, Norbert Stefan, Julie Støy, Rachael Taylor, Sok Cin Tye, Gebresilasea Gendisha Ukke, Marzhan Urazbayeva, Bart Van der Schueren, Camille Vatier, John M Wentworth, Wesley Hannah, Sara L White, Gechang Yu, Yingchai Zhang, Shao J Zhou, Jacques Beltrand, Michel Polak, Ingvild Aukrust, Elisa de Franco, Sarah E Flanagan, Kristin A Maloney, Andrew McGovern, Janne Molnes, Mariam Nakabuye, Pål Rasmus Njølstad, Hugo Pomares-Millan, Michele Provenzano, Cécile Saint-Martin, Cuilin Zhang, Yeyi Zhu, Sungyoung Auh, Russell de Souza, Andrea J Fawcett, Chandra Gruber, Eskedar Getie Mekonnen, Emily Mixter, Diana Sherifali, Robert H Eckel, John J Nolan, Louis H Philipson, Rebecca J Brown, Liana K Billings, Kristen Boyle, Tina Costacou, John M Dennis, Jose C Florez, Anna L Gloyn, Maria F Gomez, Peter A Gottlieb, Siri Atma W Greeley, Kurt Griffin, Andrew T Hattersley, Irl B Hirsch, Marie-France Hivert, Korey K Hood, Jami L Josefson, Soo Heon Kwak, Lori M Laffel, Siew S Lim, Ruth J F Loos, Ronald C W Ma, Chantal Mathieu, Nestoras Mathioudakis, James B Meigs, Shivani Misra, Viswanathan Mohan, Rinki Murphy, Richard Oram, Katharine R Owen, Susan E Ozanne, Ewan R Pearson, Wei Perng, Toni I Pollin, Rodica Pop-Busui, Richard E Pratley, Maria J Redondo, Rebecca M Reynolds, Robert K Semple, Jennifer L Sherr, Emily K Sims, Arianne Sweeting, Tiinamaija Tuomi, Miriam S Udler, Kimberly K Vesco, Tina Vilsbøll, Robert Wagner, Stephen S Rich, Paul W Franks

Affiliations

¹ Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia. siew.lim1@monash.edu.
² Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.
³ Kaiser Permanente Northwest, Kaiser Permanente Center for Health Research, Oakland, USA.
⁴ Pennington Biomedical Research Center, Baton Rouge, LA, USA.
⁵ Madras Diabetes Research Foundation Chennai, Chennai, India.
⁶ Deakin University, Melbourne, Australia.
⁷ Department of Nutrition and Dietetics, Monash University, Melbourne, Victoria, Australia.
⁸ Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia.
⁹ Department of Women and Children's Health, King's College London, London, United Kingdom.
¹⁰ Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
¹¹ Department of Clinical & Organizational Development, University of Chicago, Chicago, IL, USA.
¹² Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.
¹³ Global Health Institute, University of Antwerp, Antwerp, Belgium.
¹⁴ School of Health Sciences, University of Newcastle, Newcastle, Australia.
¹⁵ School of Agriculture, Food and Wine, University of Adelaide, Adelaide, Australia.
¹⁶ American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) Precision Medicine in Diabetes Initiative (PMDI) led by Paul Franks, Malmo, Sweden.
¹⁷ Northwestern University/ Lurie Children's Hospital of Chicago, Chicago, USA. JJosefson@luriechildrens.org.

^# Contributed equally.

PMID: 37794119
PMCID: PMC10551015
DOI: 10.1038/s43856-023-00366-x

Participant characteristics in the prevention of gestational diabetes as evidence for precision medicine: a systematic review and meta-analysis

Siew Lim et al. Commun Med (Lond). 2023.

. 2023 Oct 5;3(1):137.

doi: 10.1038/s43856-023-00366-x.

Authors

Collaborators

ADA/EASD PMDI:
Deirdre K Tobias, Jordi Merino, Abrar Ahmad, Catherine Aiken, Jamie L Benham, Dhanasekaran Bodhini, Amy L Clark, Kevin Colclough, Rosa Corcoy, Sara J Cromer, Daisy Duan, Jamie L Felton, Ellen C Francis, Pieter Gillard, Véronique Gingras, Romy Gaillard, Eram Haider, Alice Hughes, Jennifer M Ikle, Laura M Jacobsen, Anna R Kahkoska, Jarno L T Kettunen, Raymond J Kreienkamp, Lee-Ling Lim, Jonna M E Männistö, Robert Massey, Niamh-Maire Mclennan, Rachel G Miller, Mario Luca Morieri, Jasper Most, Rochelle N Naylor, Bige Ozkan, Kashyap Amratlal Patel, Scott J Pilla, Katsiaryna Prystupa, Sridharan Raghavan, Mary R Rooney, Martin Schön, Zhila Semnani-Azad, Magdalena Sevilla-Gonzalez, Pernille Svalastoga, Claudia Ha-Ting Tam, Anne Cathrine B Thuesen, Mustafa Tosur, Amelia S Wallace, Caroline C Wang, Jessie J Wong, Jennifer M Yamamoto, Katherine Young, Chloé Amouyal, Mette K Andersen, Maxine P Bonham, Feifei Cheng, Tinashe Chikowore, Christoffer Clemmensen, Dana Dabelea, Adem Y Dawed, Aaron J Deutsch, Laura T Dickens, Linda A DiMeglio, Monika Dudenhöffer-Pfeifer, Carmella Evans-Molina, María Mercè Fernández-Balsells, Hugo Fitipaldi, Stephanie L Fitzpatrick, Stephen E Gitelman, Mark O Goodarzi, Jessica A Grieger, Marta Guasch-Ferré, Nahal Habibi, Torben Hansen, Chuiguo Huang, Arianna Harris-Kawano, Heba M Ismail, Benjamin Hoag, Randi K Johnson, Angus G Jones, Robert W Koivula, Aaron Leong, Gloria K W Leung, Ingrid M Libman, Kai Liu, S Alice Long, William L Lowe Jr, Robert W Morton, Ayesha A Motala, Suna Onengut-Gumuscu, James S Pankow, Maleesa Pathirana, Sofia Pazmino, Dianna Perez, John R Petrie, Camille E Powe, Rashmi Jain, Debashree Ray, Mathias Ried-Larsen, Zeb Saeed, Vanessa Santhakumar, Sarah Kanbour, Sudipa Sarkar, Gabriela S F Monaco, Denise M Scholtens, Elizabeth Selvin, Wayne Huey-Herng Sheu, Cate Speake, Maggie A Stanislawski, Nele Steenackers, Andrea K Steck, Norbert Stefan, Julie Støy, Rachael Taylor, Sok Cin Tye, Gebresilasea Gendisha Ukke, Marzhan Urazbayeva, Bart Van der Schueren, Camille Vatier, John M Wentworth, Wesley Hannah, Sara L White, Gechang Yu, Yingchai Zhang, Shao J Zhou, Jacques Beltrand, Michel Polak, Ingvild Aukrust, Elisa de Franco, Sarah E Flanagan, Kristin A Maloney, Andrew McGovern, Janne Molnes, Mariam Nakabuye, Pål Rasmus Njølstad, Hugo Pomares-Millan, Michele Provenzano, Cécile Saint-Martin, Cuilin Zhang, Yeyi Zhu, Sungyoung Auh, Russell de Souza, Andrea J Fawcett, Chandra Gruber, Eskedar Getie Mekonnen, Emily Mixter, Diana Sherifali, Robert H Eckel, John J Nolan, Louis H Philipson, Rebecca J Brown, Liana K Billings, Kristen Boyle, Tina Costacou, John M Dennis, Jose C Florez, Anna L Gloyn, Maria F Gomez, Peter A Gottlieb, Siri Atma W Greeley, Kurt Griffin, Andrew T Hattersley, Irl B Hirsch, Marie-France Hivert, Korey K Hood, Jami L Josefson, Soo Heon Kwak, Lori M Laffel, Siew S Lim, Ruth J F Loos, Ronald C W Ma, Chantal Mathieu, Nestoras Mathioudakis, James B Meigs, Shivani Misra, Viswanathan Mohan, Rinki Murphy, Richard Oram, Katharine R Owen, Susan E Ozanne, Ewan R Pearson, Wei Perng, Toni I Pollin, Rodica Pop-Busui, Richard E Pratley, Maria J Redondo, Rebecca M Reynolds, Robert K Semple, Jennifer L Sherr, Emily K Sims, Arianne Sweeting, Tiinamaija Tuomi, Miriam S Udler, Kimberly K Vesco, Tina Vilsbøll, Robert Wagner, Stephen S Rich, Paul W Franks

Affiliations

¹ Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia. siew.lim1@monash.edu.
² Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.
³ Kaiser Permanente Northwest, Kaiser Permanente Center for Health Research, Oakland, USA.
⁴ Pennington Biomedical Research Center, Baton Rouge, LA, USA.
⁵ Madras Diabetes Research Foundation Chennai, Chennai, India.
⁶ Deakin University, Melbourne, Australia.
⁷ Department of Nutrition and Dietetics, Monash University, Melbourne, Victoria, Australia.
⁸ Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia.
⁹ Department of Women and Children's Health, King's College London, London, United Kingdom.
¹⁰ Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
¹¹ Department of Clinical & Organizational Development, University of Chicago, Chicago, IL, USA.
¹² Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.
¹³ Global Health Institute, University of Antwerp, Antwerp, Belgium.
¹⁴ School of Health Sciences, University of Newcastle, Newcastle, Australia.
¹⁵ School of Agriculture, Food and Wine, University of Adelaide, Adelaide, Australia.
¹⁶ American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) Precision Medicine in Diabetes Initiative (PMDI) led by Paul Franks, Malmo, Sweden.
¹⁷ Northwestern University/ Lurie Children's Hospital of Chicago, Chicago, USA. JJosefson@luriechildrens.org.

^# Contributed equally.

PMID: 37794119
PMCID: PMC10551015
DOI: 10.1038/s43856-023-00366-x

Abstract

Background: Precision prevention involves using the unique characteristics of a particular group to determine their responses to preventive interventions. This study aimed to systematically evaluate the participant characteristics associated with responses to interventions in gestational diabetes mellitus (GDM) prevention.

Methods: We searched MEDLINE, EMBASE, and Pubmed to identify lifestyle (diet, physical activity, or both), metformin, myoinositol/inositol and probiotics interventions of GDM prevention published up to May 24, 2022.

Results: From 10347 studies, 116 studies (n = 40940 women) are included. Physical activity results in greater GDM reduction in participants with a normal body mass index (BMI) at baseline compared to obese BMI (risk ratio, 95% confidence interval: 0.06 [0.03, 0.14] vs 0.68 [0.26, 1.60]). Combined diet and physical activity interventions result in greater GDM reduction in participants without polycystic ovary syndrome (PCOS) than those with PCOS (0.62 [0.47, 0.82] vs 1.12 [0.78-1.61]) and in those without a history of GDM than those with unspecified GDM history (0.62 [0.47, 0.81] vs 0.85 [0.76, 0.95]). Metformin interventions are more effective in participants with PCOS than those with unspecified status (0.38 [0.19, 0.74] vs 0.59 [0.25, 1.43]), or when commenced preconception than during pregnancy (0.21 [0.11, 0.40] vs 1.15 [0.86-1.55]). Parity, history of having a large-for-gestational-age infant or family history of diabetes have no effect on intervention responses.

Conclusions: GDM prevention through metformin or lifestyle differs according to some individual characteristics. Future research should include trials commencing preconception and provide results disaggregated by a priori defined participant characteristics including social and environmental factors, clinical traits, and other novel risk factors to predict GDM prevention through interventions.

Plain language summary

An individual’s characteristics, such as medical, biochemical, social, and behavioural may affect their response to interventions aimed at preventing gestational diabetes, which occurs during pregnancy. Here, we evaluated the published literature on interventions such as diet, lifestyle, drug treatment and nutritional supplement and looked at which individual participant characteristics were associated with response to these interventions. Certain participant characteristics were associated with greater prevention of gestational diabetes through particular treatments. Some interventions were more effective when started prior to conception. Future studies should consider individual characteristics when assessing the effects of preventative measures.

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Conflict of interest statement

The authors declare no competing interests.

Figures

**Fig. 1. PRISMA flow diagram.**
Flowchart demonstrating the process of the identifying the papers included in this review. This maps out the number of records identified, included and excluded at each stage of assessment. Reasons for full text exclusions are provided.

See this image and copyright information in PMC

Update of

A systematic review and meta-analysis of participant characteristics in the prevention of gestational diabetes: a summary of evidence for precision medicine.
Lim S, Takele WW, Vesco KK, Redman L; ADA PMDI GDM prevention working group; Josefson J. Lim S, et al. medRxiv [Preprint]. 2023 Apr 17:2023.04.16.23288650. doi: 10.1101/2023.04.16.23288650. medRxiv. 2023. Update in: Commun Med (Lond). 2023 Oct 5;3(1):137. doi: 10.1038/s43856-023-00366-x. PMID: 37131714 Free PMC article. Updated. Preprint.

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References

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[1] Freinkel N. Banting Lecture 1980. Of pregnancy and progeny. Diabetes. 1980;29:1023–1035. doi: 10.2337/diab.29.12.1023. - DOI - PubMed

[2] Freinkel N. Banting Lecture 1980. Of pregnancy and progeny. Diabetes. 1980;29:1023–1035. doi: 10.2337/diab.29.12.1023. - DOI - PubMed

[3] Zhang Y, et al. Factors associated with gestational diabetes mellitus: a meta-analysis. J. Diab. Res. 2021;2021:6692695. - PMC - PubMed

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[5] Habibi N, et al. Maternal metabolic factors and the association with gestational diabetes: A systematic review and meta-analysis. Diabetes Metab. Res. Rev. 2022;38:e3532. doi: 10.1002/dmrr.3532. - DOI - PMC - PubMed

[6] Habibi N, et al. Maternal metabolic factors and the association with gestational diabetes: A systematic review and meta-analysis. Diabetes Metab. Res. Rev. 2022;38:e3532. doi: 10.1002/dmrr.3532. - DOI - PMC - PubMed

[7] Sweeting A, Wong J, Murphy HR, Ross GP. A clinical update on gestational diabetes mellitus. Endocr. Rev. 2022;43:763–793. doi: 10.1210/endrev/bnac003. - DOI - PMC - PubMed

[8] Sweeting A, Wong J, Murphy HR, Ross GP. A clinical update on gestational diabetes mellitus. Endocr. Rev. 2022;43:763–793. doi: 10.1210/endrev/bnac003. - DOI - PMC - PubMed

[9] Lowe WL, Jr., et al. Association of gestational diabetes with maternal disorders of glucose metabolism and childhood adiposity. JAMA. 2018;320:1005–1016,. doi: 10.1001/jama.2018.11628. - DOI - PMC - PubMed

[10] Lowe WL, Jr., et al. Association of gestational diabetes with maternal disorders of glucose metabolism and childhood adiposity. JAMA. 2018;320:1005–1016,. doi: 10.1001/jama.2018.11628. - DOI - PMC - PubMed

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Participant characteristics in the prevention of gestational diabetes as evidence for precision medicine: a systematic review and meta-analysis

Collaborators

Affiliations

Participant characteristics in the prevention of gestational diabetes as evidence for precision medicine: a systematic review and meta-analysis

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Collaborators

Affiliations

Abstract

Plain language summary

Conflict of interest statement

Figures

Update of

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Cited by

References

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Abstract

Plain language summary

Conflict of interest statement

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Cited by

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