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

作者：Jennifer M. Yamamoto, Joanne Kellett, Montserrat Balsells, Apolonia García‐Patterson, Eran Hadar, Iván Solà, Ignasi Gich, Eline M. van der Beek, Eurídice Castañeda‐Gutiérrez, Seppo Heinonen, Moshe Hod, Kirsi Laitinen, Sjúrđur F. Olsen, Lucilla Poston, Ricardo Rueda, Petra Rust, Lilou van Lieshout, Bettina Schelkle, Helen R. Murphy, Rosa Corcoy · 发表于：Diabetes Care · 年份：2018 · DOI：10.2337/dc18-0102 · 被引用次数：308 · 研究领域：Gestational Diabetes Research and Management、Birth, Development, and Health、Pregnancy and preeclampsia studies

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 lo...