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. 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 Lim  1 , Wubet Worku Takele #  2 , Kimberly K Vesco #  3 , Leanne M Redman #  4 , Wesley Hannah #  5   6 , Maxine P Bonham  7 , Mingling Chen  8 , Sian C Chivers  9 , Andrea J Fawcett  10   11 , Jessica A Grieger  12 , Nahal Habibi  12 , Gloria K W Leung  7 , Kai Liu  7 , Eskedar Getie Mekonnen  13 , Maleesa Pathirana  12 , Alejandra Quinteros  12 , Rachael Taylor  14 , Gebresilasea G Ukke  2 , Shao J Zhou  15   16 ; ADA/EASD PMDI; Jami Josefson  17
Collaborators, Affiliations

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). .

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
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

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