Abstract
Abstract
Background
Gestational Diabetes Mellitus (GDM) is hyperglycaemia first detected during pregnancy. Globally, GDM affects around 1 in 6 live births (up to 1 in 4 in low- and middle-income countries- LMICs), thus, urgent measures are needed to prevent this public health threat.
Objective
To determine the effectiveness of pre-pregnancy lifestyle in preventing GDM.
Methods
We searched MEDLINE, Web of science, Embase and Cochrane central register of controlled trials. Randomized control trials (RCTs), case-control studies, and cohort studies that assessed the effect of pre-pregnancy lifestyle (diet and/or physical activity based) in preventing GDM were included. Random effects model was used to calculate odds ratio (OR) with 95% confidence interval. The Cochrane ROB-2 and the Newcastle-Ottawa Scale were used for assessing the risk of bias. The protocol was registered in PROSPERO (ID: CRD42020189574)
Results
Database search identified 7935 studies, of which 30 studies with 257,876 pregnancies were included. Meta-analysis of the RCTs (N = 5; n = 2471) in women who received pre-pregnancy lifestyle intervention showed non-significant reduction of the risk of developing GDM (OR 0.76, 95% CI: 0.50–1.17, p = 0.21). Meta-analysis of cohort studies showed that women who were physically active pre-pregnancy (N = 4; n = 23263), those who followed a low carbohydrate/low sugar diet (N = 4; n = 25739) and those women with higher quality diet scores were 29%, 14% and 28% less likely to develop GDM respectively (OR 0.71, 95% CI: 0.57, 0.88, p = 0.002, OR 0.86, 95% CI: 0.68, 1.09, p = 0.22 and OR 0.72, 95% CI 0.60–0.87, p = 0.0006).
Conclusion
This study highlights that some components of pre-pregnancy lifestyle interventions/exposures such as diet/physical activity-based preparation/counseling, intake of vegetables, fruits, low carbohydrate/low sugar diet, higher quality diet scores and high physical activity can reduce the risk of developing gestational diabetes. Evidence from RCTs globally and the number of studies in LMICs are limited, highlighting the need for carefully designed RCTs that combine the different aspects of the lifestyle and are personalized to achieve better clinical and cost effectiveness.
Funder
RCUK | Medical Research Council
Novo Nordisk
RCUK | MRC | Medical Research Foundation
Publisher
Springer Science and Business Media LLC
Subject
Endocrinology, Diabetes and Metabolism,Internal Medicine
Reference65 articles.
1. WHO. Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy. 2013. https://apps.who.int/iris/bitstream/handle/10665/85975/WHO_NMH_MND_13.2_eng.pdf;jsessionid=E5806DC69967B1753795EB66C155EF30?sequence=1 (accessed 05.12. 2022).
2. International Diabetes Federation. IDF Diabetes Atlas teB, Belgium. IDF Diabetes Atlas, 10th edn. 2021. Available at: https://www.diabetesatlas.org (accessed 15.02. 2023).
3. Carpenter MW, Canick JA, Hogan JW, Shellum C, Somers M, Star JA. Amniotic fluid insulin at 14-20 weeks’ gestation: association with later maternal glucose intolerance and birth macrosomia. Diabetes Care. 2001;24:1259–63.
4. Riskin-Mashiah S, Younes G, Damti A, Auslender R. First-trimester fasting hyperglycemia and adverse pregnancy outcomes. Diabetes Care. 2009;32:1639–43.
5. Venkataraman H, Ram U, Craik S, Arungunasekaran A, Seshadri S, Saravanan P. Increased fetal adiposity prior to diagnosis of gestational diabetes in South Asians: more evidence for the ‘thin–fat’ baby. Diabetologia. 2017;60:399–405.