Effects of medical nutritional intervention on clinical outcome of gestational diabetes mellitus: a meta-analysis

Abstract

Objective To evaluate the effect of medical nutritional intervention on clinical outcome of gestational diabetes mellitus. Methods A meta-analysis of randomised controlled trials was conducted. PubMed, EMBASE, OVID, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Chinese WanFang Database were searched for the literatures related to the effect of medical nutritional intervention on clinical outcome of gestational diabetes mellitus from January 2005 to January 2015. At the same time, manual searching and reference review were conducted. Strict screening of the searched literatures was performed based on inclusion and exclusion criteria. All the included trials were divided into two groups based on whether the intervention involved insulin or not. The tool which Cochrane Handbook recommended was used to assess the risk of bias for included literatures. All the studies were graded and extracted by two researchers independently after reading research method in detail. Meta-analysis was conducted using RevMan5.2 software. The effect of medical nutritional intervention was described in terms of fasting blood glucose, birth body mass, and incidences of macrosomia, cesarean section, postpartum glucose intolerance and neonatal long-term chronic disease. Results Totally 27 trials were found, of which 13 met the inclusion and exclusion criteria. 1 trial was excluded because the outcomes were using different sample sizes, and finally 12 trials were included in the final meta-analysis, involving 1 392 patients. Among the 12 included trials, 7 only administered nutritional intervention, while the other 5 added insulin with nutritional intervention. The results showed that in the nutritional intervention group, medical nutritional intervention decreased the incidence of macrosomia [risk difference (RD): -0.35, 95% CI: -0.55--0.15, P<0.001, 1 trial], birth body mass [mean difference (MD): -581.27, 95% CI: -790.32--372.22, P<0.001, 2 trials], the rate of cesarean section (RD: -0.40, 95% CI: -0.58--0.21, P<0.001, 2 trials), fasting blood glucose (MD: -0.32, 95% CI: -0.59--0.06, P=0.02, 5 trials), and the incidence of postpartum glucose intolerance (RD: -0.34, 95% CI: -0.44--0.23, P<0.001, 1 trial). However, in the multiple intervention group (nutritional intervention plus insulin), no significant differences were shown in the incidence of macrosomia (RD: -0.02, 95% CI: -0.07-0.03, P=0.39, 3 trials), birth body mass (MD: 86.06, 95% CI: -104.97-277.09, P=0.38, 2 trials), the rate of cesarean section (RD: 0.02, 95% CI: -0.05-0.08, P=0.64, 5 trials), and fasting blood glucose (MD: -0.03, 95% CI: -0.16-0.11, P=0.71, 3 trials). Conclusion Medical nutritional intervention may be a protective measure against gestational diabetes mellitus, which could help to maintain serum glucose levels within the normal range and improve maternal and neonatal outcomes. Key words: Medical nutritional intervention; Gestational diabetes mellitus; Meta-analysis; Clinical outcome; Insulin