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. 2024 Apr 20;4(1):75.
doi: 10.1038/s43856-024-00491-1.

Effective interventions in preventing gestational diabetes mellitus: A systematic review and meta-analysis

Wubet Worku Takele  1 , Kimberly K Vesco  2 , Jami Josefson  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 G Mekonnen  13 , Maleesa Pathirana  12 , Alejandra Quinteros  12 , Rachael Taylor  14 , Gebresilasea G Ukke  1 , Shao J Zhou  15 ; ADA/EASD PMDI; Siew Lim  16
Collaborators, Affiliations

Effective interventions in preventing gestational diabetes mellitus: A systematic review and meta-analysis

Wubet Worku Takele et al. Commun Med (Lond). .

Abstract

Background: Lifestyle choices, metformin, and dietary supplements may prevent GDM, but the effect of intervention characteristics has not been identified. This review evaluated intervention characteristics to inform the implementation of GDM prevention interventions.

Methods: Ovid, MEDLINE/PubMed, and EMBASE databases were searched. The Template for Intervention Description and Replication (TIDieR) framework was used to examine intervention characteristics (who, what, when, where, and how). Subgroup analysis was performed by intervention characteristics.

Results: 116 studies involving 40,940 participants are included. Group-based physical activity interventions (RR 0.66; 95% CI 0.46, 0.95) reduce the incidence of GDM compared with individual or mixed (individual and group) delivery format (subgroup p-value = 0.04). Physical activity interventions delivered at healthcare facilities reduce the risk of GDM (RR 0.59; 95% CI 0.49, 0.72) compared with home-based interventions (subgroup p-value = 0.03). No other intervention characteristics impact the effectiveness of all other interventions.

Conclusions: Dietary, physical activity, diet plus physical activity, metformin, and myoinositol interventions reduce the incidence of GDM compared with control interventions. Group and healthcare facility-based physical activity interventions show better effectiveness in preventing GDM than individual and community-based interventions. Other intervention characteristics (e.g. utilization of e-health) don't impact the effectiveness of lifestyle interventions, and thus, interventions may require consideration of the local context.

Plain language summary

The effect of any given intervention to prevent gestational diabetes (high blood sugar levels that arise during pregnancy) may depend on the way it is delivered (how, when, what, etc). This study reviewed published literature to investigate if the effects of interventions (diet, exercise, metformin, probiotics, myoinositol) to prevent gestational diabetes differ according to the way it is being delivered (e.g., online vs in-person, by health professionals or others, etc.). Exercise delivered to group settings, or those delivered at a healthcare facility worked better to prevent gestational diabetes. Although we did not observe any differences with other delivery characteristics (e.g., online vs in-person), it does not mean they are always equally effective, it is important to consider individual situations when prescribing or developing interventions.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. PRISMA flow diagram of the study.
The diagram illustrates the procedure followed to identify the eligible studies. Studies were excluded in each critical screening step based on the eligibility criteria.
Fig. 2
Fig. 2. Forest plot depicting the effect of physical activity on reducing the risk of GDM.
The estimates of 17 studies were pooled using the random-effects model to estimate the pooled effect of physical activity intervention on reducing the risk of GDM. The overall estimate represented in diamond shape shows the effect size (risk ratio with 95% confidence interval). The square shapes in individual study suggests the effect size estimate—the bigger the shape, the larger the effect size and the reverse is true.
Fig. 3
Fig. 3. Forest plot depicting the effect of dietary intervention on reducing the incidence of GDM.
The estimates of 16 studies were pooled using the random-effects model to estimate the pooled effect of dietary intervention on reducing the risk of GDM. The overall estimate represented in diamond shape shows the effect size (risk ratio with 95% confidence interval). The square shapes in individual studies suggest the effect size estimate—the bigger the shape, the larger the effect size, and the reverse is true.
Fig. 4
Fig. 4. Forest plot depicting the effect of metformin on preventing GDM.
The estimates of 13 studies were pooled using the random-effect model to estimate the pooled effect of metformin intervention on reducing the risk of GDM. The overall estimate represented in diamond shape shows the effect size (risk ratio with 95% confidence interval). The square shapes in individual studies suggest the effect size estimate—the bigger the shape, the larger the effect size, and the reverse is true.
Fig. 5
Fig. 5. Forest plot depicting the effect of probiotics supplements on preventing GDM.
The estimates of six studies were pooled using the random-effect model to estimate the effects of different categories of probiotics supplementation on reducing the risk of GDM. The red diamond shape shows the effect size (risk ratio) in each subgroup. The overall estimate represented in the green diamond at the bottom shows the overall effect size (risk ratio). The square shapes in individual studies suggest the effect size estimate ─the bigger the shape, the larger the effect size, and the reverse is true.
Fig. 6
Fig. 6. A forest plot showing the effect of myoinositol/inositol on reducing the risk of GDM.
The estimates of seven studies were pooled using the random-effects model to estimate the effects of different categories of myoinositol supplementation on reducing the risk of GDM. The overall estimate represented in the green diamond at the bottom of the figure shows the overall effect size (risk ratio with 95% confidence interval). The square shapes in individual studies suggest the effect size estimate—the bigger the shape, the larger the effect size, and the reverse is true.
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References

    1. American Diabetes Association 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2019. Diabetes Care. 2019;42:S13–S28. doi: 10.2337/dc19-S002. - DOI - PubMed
    1. Wang H, et al. IDF diabetes atlas: estimation of global and regional gestational diabetes mellitus prevalence for 2021 by International Association of Diabetes in Pregnancy Study Group’s Criteria. Diabetes Res. Clin. Pract. 2022;183:109050. doi: 10.1016/j.diabres.2021.109050. - DOI - PubMed
    1. Malaza N, et al. A Systematic Review to compare adverse pregnancy outcomes in women with pregestational diabetes and gestational diabetes. Int. J. Environ. Res. Public Health. 2022;19:10846. doi: 10.3390/ijerph191710846. - DOI - PMC - PubMed
    1. Wahabi HA, Esmaeil SA, Fayed A, Alzeidan RA. Gestational diabetes mellitus: maternal and perinatal outcomes in King Khalid University Hospital, Saudi Arabia. J. Egypt. Public Health Assoc. 2013;88:104–108. doi: 10.1097/01.EPX.0000430392.57811.20. - DOI - PubMed
    1. Gasim T. Gestational diabetes mellitus: maternal and perinatal outcomes in 220 Saudi women. Oman Med. J. 2012;27:140. doi: 10.5001/omj.2012.29. - DOI - PMC - PubMed