Abstract
AimsEvidence to support dietary modifications to improve glycemia during pregnancy is limited, and the benefits of diet beyond limiting gestational weight gain is unclear. Therefore, a systematic review and network meta-analysis of randomized trials was conducted to compare the effects of various common diets, stratified by the addition of gestational weight gain advice, on fasting glucose and insulin, hemoglobin A1c (HbA1c), and homeostatic model assessment for insulin resistance (HOMA-IR) in pregnant women.MethodsMEDLINE, EMBASE, Cochrane database, and reference lists of published studies were searched through April 2017. Randomized trials directly comparing two or more diets for ≥2-weeks were eligible. Bayesian network meta-analysis was performed for fasting glucose. Owing to a lack of similar dietary comparisons, a standard pairwise meta-analysis for the other glycemic outcomes was performed. The certainty of the pooled effect estimates was assessed using the GRADE tool.ResultsTwenty-one trials (1,865 participants) were included. In general, when given alongside gestational weight gain advice, fasting glucose improved in most diets compared to diets that gave gestational weight gain advice only. However, fasting glucose increased in high unsaturated or monounsaturated fatty acids diets. In the absence of gestational weight gain advice, fasting glucose improved in DASH-style diets compared to standard of care. Although most were non-significant, similar trends were observed for these same diets for the other glycemic outcomes. Dietary comparisons ranged from moderate to very low in quality of evidence.Conclusion/InterpretationAlongside with gestational weight gain advice, most diets, with the exception of a high unsaturated or a high monounsaturated fatty acid diet, demonstrated a fasting glucose improvement compared with gestational weight gain advice only. When gestational weight gain advice was not given, the DASH-style diet appeared optimal on fasting glucose. However, a small number of trials were identified and most dietary comparisons were underpowered to detect differences in glycemic outcomes. Further studies that are high in quality and adequately powered are needed to confirm these findings.RegistrationPROSPERO CRD42015026008
Highlights
The need for implementation of effective dietary strategies in gestational diabetes mellitus (GDM) prevention and management has been emphasized by diabetes organizations [1,2,3]
When given alongside gestational weight gain advice, fasting glucose improved in most diets compared to diets that gave gestational weight gain advice only
In the absence of gestational weight gain advice, fasting glucose improved in Dietary Approach to Stop Hypertension (DASH)-style diets compared to standard of care
Summary
The need for implementation of effective dietary strategies in gestational diabetes mellitus (GDM) prevention and management has been emphasized by diabetes organizations [1,2,3]. One method of managing GDM risk is the use of dietary strategies. The success of diet and lifestyle changes in managing type 2 diabetes mellitus (T2DM), some of its etiology shared with GDM, in high-risk patients further emphasize the importance of dietary strategies in GDM management [8]. A clear benefit for dietary strategies have not been demonstrated in recent meta-analyses [9, 10]. These analyses have usually been limited to single pair-wise dietary comparisons with a small number of participants. Single pair-wise comparisons do not lend itself to determine if it is the most effective strategy amongst all the possible dietary strategies for GDM control
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