Efficacy of diet interventions on pregnant women with gestational diabetes mellitus: an umbrella review_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Huiyi , XING Nianlu , WU Xiaochen , RUAN Yuye ,  ZHOU Yingfeng

Department of Nursing, Fudan University, Shanghai 200032, P. R. China;

Corresponding author：

ZHOU Yingfeng, Email: zyingfeng@fudan.edu.cn

Keywords：

Diet therapy; Gestational diabetes mellitus; Systematic review; Umbrella review

DOI：

10.7507/1672-2531.202501112

Video：

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Objective To overview the systematic review (SR) of the effects of dietary pattern intervention during pregnancy on pregnant women with gestational diabetes mellitus (GDM). Methods The Cochrane Library, The Joanna Briggs Institute Library, Embase, PubMed, Web of Science, CINAHL, CBM, CNKI, WanFang Data, and VIP database were electronically searched to collect SR and meta-analysis on the effects of different dietary patterns on maternal and infant outcomes of gestational diabetes mellitus from inception to October 1, 2024. Two reviewers independently screened literature, extracted data, and then AMSTAR 2 tool was used to assess the methodological quality of included studies. Meta-analysis performed by using RevMan 5.3 software. Results A total of 15 relevant SR were included, the methodological quality of the included SR was generally low, with 3 SR at a low level and 12 SR at a very low level. Major dietary patterns include the low glycemic index (GI) diet, carbohydrate (CHO) restricted diet, energy restricted diet, dietary approaches to stop hypertension (DASH) diet, high-fiber diet, polyunsaturated fatty acid (PUFA) rich diet, soy protein-enriched diet, low glycemic load (GL) diet, and mediterranean diet. A meta-analysis of primary outcome measures showed that the low GI diet, DASH diet and low GL load diet had a lower incidence of blood glucose levels and adverse pregnancy outcomes (including maternal weight gain, insulin use, cesarean section, macrosomia, newborn birth weight) compared with the control diets. Conclusion It was recommended that GDM pregnant women follow the low GI diet, DASH diet, or low GL diet to control blood glucose levels and improve pregnancy outcomes. There is currently insufficient evidence to support the effects of other dietary patterns on GDM.

1.	中华医学会妇产科学分会产科学组, 中华医学会围产医学分会妊娠合并糖尿病协作组. 妊娠合并糖尿病诊治指南(2014). 中国实用乡村医生杂志, 2017, 24(8): 45-52.
2.	Magliano DJ, Boyko EJ, IDF Diabetes Atlas 10th edition scientific committee. IDF diabetes atlas. 10th ed. Brussels: International Diabetes Federation, 2021.
3.	American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2020. Diabetes Care, 2020, 43(Suppl 1): S14-S31.
4.	Juan J, Yang HX, Su RN, et al. Diagnosis of gestational diabetes mellitus in China: perspective, progress and prospects. Matern-Fetal Med, 2019, 1(1): 31-37.
5.	American Diabetes Association. 14. Management of diabetes in pregnancy: standards of medical care in diabetes-2020. Diabetes Care, 2020, 43(Suppl 1): S183-S192.
6.	National Institute for Health and Care Excellence (NICE). National Institute for Health and Care Excellence: guidelines. 2020.
7.	Song SJ, Lee JE, Paik HY, et al. Dietary patterns based on carbohydrate nutrition are associated with the risk for diabetes and dyslipidemia. Nutr Res Pract, 2012, 6(4): 349-356.
8.	Guastadisegni C, Donfrancesco C, Palmieri L, et al. Nutrients intake in individuals with hypertension, dyslipidemia, and diabetes: an italian survey. Nutrients, 2020, 12(4): 923.
9.	范岩峰, 钟红秀, 李丽榕, 等. 营养干预对妊娠期糖尿病孕妇孕期体重增长和血脂代谢水平及分娩结局的影响. 中国实用妇科与产科杂志, 2022, 38(9): 929-933.
10.	Amati F, Hassounah S, Swaka A. The impact of mediterranean dietary patterns during pregnancy on maternal and offspring health. Nutrients, 2019, 11(5): 1098.
11.	Louie JC, Markovic TP, Perera N, et al. A randomized controlled trial investigating the effects of a low-glycemic index diet on pregnancy outcomes in gestational diabetes mellitus. Diabetes Care, 2011, 34(11): 2341-2346.
12.	Rae A, Bond D, Evans S, et al. A randomised controlled trial of dietary energy restriction in the management of obese women with gestational diabetes. Aust N Z J Obstet Gynaecol, 2000, 40(4): 416-422.
13.	Asemi Z, Samimi M, Tabassi Z, et al. The effect of DASH diet on pregnancy outcomes in gestational diabetes: a randomized controlled clinical trial. Eur J Clin Nutr, 2014, 68(4): 490-495.
14.	Mijatovic J, Louie JCY, Buso MEC, et al. Effects of a modestly lower carbohydrate diet in gestational diabetes: a randomized controlled trial. Am J Clin Nutr, 2020, 112(2): 284-292.
15.	Reece EA, Hagay Z, Caseria D, et al. Do fiber-enriched diabetic diets have glucose-lowering effects in pregnancy. Am J Perinatol, 1993, 10(4): 272-274.
16.	Assaf-Balut C, García de la Torre N, Durán A, et al. A Mediterranean diet with additional extra virgin olive oil and pistachios reduces the incidence of gestational diabetes mellitus (GDM): a randomized controlled trial: The St. Carlos GDM prevention study. PLoS One, 2017, 12(10): e0185873.
17.	Moreno-Castilla C, Hernandez M, Bergua M, et al. Low-carbohydrate diet for the treatment of gestational diabetes mellitus: a randomized controlled trial. Diabetes Care, 2013, 36(8): 2233-2238.
18.	Aromataris ELC, Porritt K, Pilla B, et al. JBI manual for evidence synthesis. 2024.
19.	陶欢, 杨乐天, 平安, 等. 随机或非随机防治性研究系统评价的质量评价工具AMSTAR2解读. 中国循证医学杂志, 2018, 18(1): 101-108.
20.	Viana LV, Gross JL, Azevedo MJ. Dietary intervention in patients with gestational diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials on maternal and newborn outcomes. Diabetes Care, 2014, 37(12): 3345-3355.
21.	火睿. 饮食干预对2型糖尿病和妊娠期糖尿病患者的血糖及相关因素影响的Meta分析. 武汉: 华中科技大学, 2015.
22.	Wei J, Heng W, Gao J. Effects of low glycemic index diets on gestational diabetes mellitus: a meta-analysis of randomized controlled clinical trials. Medicine (Baltimore), 2016, 95(22): e3792.
23.	赵春媚, 周波. 妊娠糖尿病孕妇接受低血糖生成指数食物干预效果的系统评价. 实用临床医药杂志, 2016, 20(15): 66-70.
24.	Han S, Middleton P, Shepherd E, et al. Different types of dietary advice for women with gestational diabetes mellitus. Cochrane Database Syst Rev, 2017, (2): CD009275.
25.	Hillyard M, Casson K, Sinclair M, et al. Can physical activity and dietary interventions improve maternal and fetal outcomes in women with gestational diabetes mellitus. A systematic review and meta-analysis. Evidence Based Midwifery, 2018, 16(3): 76-83.
26.	Whitehead L. The effects of different types of dietary advice for women with gestational diabetes mellitus on pregnancy outcomes. Clin Nurse Spec, 2018, 32(4): 175-176.
27.	Yamamoto JM, Kellett JE, Balsells M, et al. 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. Diabetes Care, 2018, 41(7): 1346-1361.
28.	Wan CS, Nankervis A, Teede H, et al. Dietary intervention strategies for ethnic Chinese women with gestational diabetes mellitus: a systematic review and meta-analysis. Nutr Diet, 2019, 76(2): 211-232.
29.	Xu J, Ye S. Influence of low-glycemic index diet for gestational diabetes: a meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med, 2020, 33(4): 687-692.
30.	Feng Y, Zhao Z, Fu D, et al. Maternal and neonatal outcomes after energy-restricted diet for women with gestational diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore), 2021, 100(14): e25279.
31.	张琪. 低血糖生成指数饮食对妊娠期糖尿病治疗作用的meta分析. 承德: 承德医学院, 2022.
32.	Lin Q, Zhang Z, Meng Q, et al. Effects of different dietary patterns during pregnancy on birth outcomes and glucose parameters in women with gestational diabetes mellitus: a systematic review and meta-analysis. Prim Care Diabetes, 2023, 17(4): 287-308.
33.	盛金叶, 吴瑞臻, 梁肖肖, 等. 低升糖指数饮食模式对妊娠期糖尿病妊娠结局影响的Meta分析. 中国食物与营养, 2023, 29(12): 56-61.
34.	Wong MMH, Yuen-Man Chan M, Ng TP, et al. Impact of carbohydrate quantity and quality on maternal and pregnancy outcomes in gestational diabetes mellitus: a systematic review and meta-analysis. Diabetes Metab Syndr, 2024, 18(1): 102941.
35.	Parums DV. Editorial: review articles, systematic reviews, meta-analysis, and the updated preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines. Med Sci Monit, 2021, 27: e934475.
36.	Kintiraki E, Goulis DG. Gestational diabetes mellitus: multi-disciplinary treatment approaches. Metabolism, 2018, 86: 91-101.
37.	Viana LV, Gross JL, Azevedo MJ. Dietary intervention in patients with gestational diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials on maternal and newborn outcomes. Diabetes Care, 2014, 37(12): 3345-3355.

1. 中华医学会妇产科学分会产科学组, 中华医学会围产医学分会妊娠合并糖尿病协作组. 妊娠合并糖尿病诊治指南(2014). 中国实用乡村医生杂志, 2017, 24(8): 45-52.
2. Magliano DJ, Boyko EJ, IDF Diabetes Atlas 10th edition scientific committee. IDF diabetes atlas. 10th ed. Brussels: International Diabetes Federation, 2021.
3. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2020. Diabetes Care, 2020, 43(Suppl 1): S14-S31.
4. Juan J, Yang HX, Su RN, et al. Diagnosis of gestational diabetes mellitus in China: perspective, progress and prospects. Matern-Fetal Med, 2019, 1(1): 31-37.
5. American Diabetes Association. 14. Management of diabetes in pregnancy: standards of medical care in diabetes-2020. Diabetes Care, 2020, 43(Suppl 1): S183-S192.
6. National Institute for Health and Care Excellence (NICE). National Institute for Health and Care Excellence: guidelines. 2020.
7. Song SJ, Lee JE, Paik HY, et al. Dietary patterns based on carbohydrate nutrition are associated with the risk for diabetes and dyslipidemia. Nutr Res Pract, 2012, 6(4): 349-356.
8. Guastadisegni C, Donfrancesco C, Palmieri L, et al. Nutrients intake in individuals with hypertension, dyslipidemia, and diabetes: an italian survey. Nutrients, 2020, 12(4): 923.
9. 范岩峰, 钟红秀, 李丽榕, 等. 营养干预对妊娠期糖尿病孕妇孕期体重增长和血脂代谢水平及分娩结局的影响. 中国实用妇科与产科杂志, 2022, 38(9): 929-933.
10. Amati F, Hassounah S, Swaka A. The impact of mediterranean dietary patterns during pregnancy on maternal and offspring health. Nutrients, 2019, 11(5): 1098.
11. Louie JC, Markovic TP, Perera N, et al. A randomized controlled trial investigating the effects of a low-glycemic index diet on pregnancy outcomes in gestational diabetes mellitus. Diabetes Care, 2011, 34(11): 2341-2346.
12. Rae A, Bond D, Evans S, et al. A randomised controlled trial of dietary energy restriction in the management of obese women with gestational diabetes. Aust N Z J Obstet Gynaecol, 2000, 40(4): 416-422.
13. Asemi Z, Samimi M, Tabassi Z, et al. The effect of DASH diet on pregnancy outcomes in gestational diabetes: a randomized controlled clinical trial. Eur J Clin Nutr, 2014, 68(4): 490-495.
14. Mijatovic J, Louie JCY, Buso MEC, et al. Effects of a modestly lower carbohydrate diet in gestational diabetes: a randomized controlled trial. Am J Clin Nutr, 2020, 112(2): 284-292.
15. Reece EA, Hagay Z, Caseria D, et al. Do fiber-enriched diabetic diets have glucose-lowering effects in pregnancy. Am J Perinatol, 1993, 10(4): 272-274.
16. Assaf-Balut C, García de la Torre N, Durán A, et al. A Mediterranean diet with additional extra virgin olive oil and pistachios reduces the incidence of gestational diabetes mellitus (GDM): a randomized controlled trial: The St. Carlos GDM prevention study. PLoS One, 2017, 12(10): e0185873.
17. Moreno-Castilla C, Hernandez M, Bergua M, et al. Low-carbohydrate diet for the treatment of gestational diabetes mellitus: a randomized controlled trial. Diabetes Care, 2013, 36(8): 2233-2238.
18. Aromataris ELC, Porritt K, Pilla B, et al. JBI manual for evidence synthesis. 2024.
19. 陶欢, 杨乐天, 平安, 等. 随机或非随机防治性研究系统评价的质量评价工具AMSTAR2解读. 中国循证医学杂志, 2018, 18(1): 101-108.
20. Viana LV, Gross JL, Azevedo MJ. Dietary intervention in patients with gestational diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials on maternal and newborn outcomes. Diabetes Care, 2014, 37(12): 3345-3355.
21. 火睿. 饮食干预对2型糖尿病和妊娠期糖尿病患者的血糖及相关因素影响的Meta分析. 武汉: 华中科技大学, 2015.
22. Wei J, Heng W, Gao J. Effects of low glycemic index diets on gestational diabetes mellitus: a meta-analysis of randomized controlled clinical trials. Medicine (Baltimore), 2016, 95(22): e3792.
23. 赵春媚, 周波. 妊娠糖尿病孕妇接受低血糖生成指数食物干预效果的系统评价. 实用临床医药杂志, 2016, 20(15): 66-70.
24. Han S, Middleton P, Shepherd E, et al. Different types of dietary advice for women with gestational diabetes mellitus. Cochrane Database Syst Rev, 2017, (2): CD009275.
25. Hillyard M, Casson K, Sinclair M, et al. Can physical activity and dietary interventions improve maternal and fetal outcomes in women with gestational diabetes mellitus. A systematic review and meta-analysis. Evidence Based Midwifery, 2018, 16(3): 76-83.
26. Whitehead L. The effects of different types of dietary advice for women with gestational diabetes mellitus on pregnancy outcomes. Clin Nurse Spec, 2018, 32(4): 175-176.
27. Yamamoto JM, Kellett JE, Balsells M, et al. 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. Diabetes Care, 2018, 41(7): 1346-1361.
28. Wan CS, Nankervis A, Teede H, et al. Dietary intervention strategies for ethnic Chinese women with gestational diabetes mellitus: a systematic review and meta-analysis. Nutr Diet, 2019, 76(2): 211-232.
29. Xu J, Ye S. Influence of low-glycemic index diet for gestational diabetes: a meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med, 2020, 33(4): 687-692.
30. Feng Y, Zhao Z, Fu D, et al. Maternal and neonatal outcomes after energy-restricted diet for women with gestational diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore), 2021, 100(14): e25279.
31. 张琪. 低血糖生成指数饮食对妊娠期糖尿病治疗作用的meta分析. 承德: 承德医学院, 2022.
32. Lin Q, Zhang Z, Meng Q, et al. Effects of different dietary patterns during pregnancy on birth outcomes and glucose parameters in women with gestational diabetes mellitus: a systematic review and meta-analysis. Prim Care Diabetes, 2023, 17(4): 287-308.
33. 盛金叶, 吴瑞臻, 梁肖肖, 等. 低升糖指数饮食模式对妊娠期糖尿病妊娠结局影响的Meta分析. 中国食物与营养, 2023, 29(12): 56-61.
34. Wong MMH, Yuen-Man Chan M, Ng TP, et al. Impact of carbohydrate quantity and quality on maternal and pregnancy outcomes in gestational diabetes mellitus: a systematic review and meta-analysis. Diabetes Metab Syndr, 2024, 18(1): 102941.
35. Parums DV. Editorial: review articles, systematic reviews, meta-analysis, and the updated preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines. Med Sci Monit, 2021, 27: e934475.
36. Kintiraki E, Goulis DG. Gestational diabetes mellitus: multi-disciplinary treatment approaches. Metabolism, 2018, 86: 91-101.
37. Viana LV, Gross JL, Azevedo MJ. Dietary intervention in patients with gestational diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials on maternal and newborn outcomes. Diabetes Care, 2014, 37(12): 3345-3355.

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