Effects of Additional Dietary Fiber Supplements on Pregnant Women with Gestational Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Studies.

Abstract

The efficacy of different types and doses of dietary fiber supplementation in the treatment of gestational diabetes (GDM) remains controversial. The purpose of this study is to investigate the effect of dietary fiber on blood glucose control in pregnant women with gestational diabetes mellitus, and further observe the effect on their blood lipids and pregnancy outcomes. We searched on Web of Science, PubMed, Embase, Scopus, and Cochrane, and included several articles on additional fortification with dietary fiber for gestational diabetes interventions. This meta-analysis included 8 trials. We found that additional dietary fiber supplements significantly reduced fasting glucose (Hedges'g = -0.3; 95% CI [-0.49, -0.1]), two-hour postprandial glucose (Hedges'g = -0.69; 95% CI [-0.88, -0.51]), glycated hemoglobin (Hedges'g = -0.5; 95% CI [-0.68, -0.31]), TC (Hedges'g = -0.44; 95% CI [-0.69, -0.19]), TG (Hedges'g = -0.3; 95% CI [-0.4, -0.2]) and LDL-C (Hedges'g = -0.48; 95% CI [-0.63, -0.33]). It also significantly reduced preterm delivery (Hedges'g = 0.4, 95% CI [0.19~0.84]), cesarean delivery (Hedges'g = 0.6; 95% CI [0.37~0.97]), fetal distress (Hedges'g = 0.51; 95% CI [0.22~1.19]), and neonatal weight (Hedges'g = -0.17; 95% CI [-0.27~-0.07]). In a subgroup analysis comparing dietary fiber type and dose, insoluble dietary fiber was more effective than soluble dietary fiber in reducing fasting glucose (Hedges'g = -0.44; 95% CI [-0.52, -0.35]). ≥12 g fiber per day may be more effective in improving glycemic lipid and pregnancy outcomes than <12 g/day, but the difference was not statistically significant. In conclusion, our meta-analysis showed that dietary fiber supplementation significantly improved glycolipid metabolism and pregnancy outcomes in gestational diabetes. Dietary fiber may be considered adjunctive therapy for gestational diabetes, and an additional supplement with insoluble dietary fiber is more recommended for those with poor fasting glucose. However, more high-quality studies are needed on the further effect of fiber type and the dose-effect relationship.