Why the study?
Women at risk of gestational diabetes mellitus require preventative interventions, prompting an evaluation of targeted interventions before and during pregnancy.
Do targeted interventions (behavioural, dietary supplementation, pharmacological) reduce the incidence of gestational diabetes in at-risk preconception and pregnant women?
Do targeted interventions (behavioural, dietary supplementation, pharmacological) reduce the incidence of gestational diabetes in at-risk preconception and pregnant women?
Diet and physical activity interventions, as well as inositol and vitamin D supplementation, may effectively reduce the risk of gestational diabetes in high-risk women.
Supports diet, activity, inositol, and vitamin D for GDM prevention in high-risk women; strengthens meta-analytic evidence for targeted interventions.
Background Women at risk of gestational diabetes mellitus (GDM) need preventative interventions. Objective To evaluate targeted interventions before and during pregnancy for women identified as being at risk of developing GDM. Methods Systematic review and meta-analysis conducted following PRISMA guidelines. MEDLINE, EMBASE and the Cochrane Library in addition to reference and citation lists were searched to identify eligible randomised controlled trials (RCTs) utilising risk stratification during the preconception period or in the first/early second trimester. Screening and data extraction were carried out by the authors independently. Quality assessment was conducted based on the Cochrane risk-of-bias tool. Random effects meta-analysis and narrative synthesis were performed. Results Eighty-four RCTs were included: two during preconception and 82 in pregnancy, with a pooled sample of 22,568 women. Interventions were behavioural (n = 54), dietary supplementation (n = 19) and pharmacological (n = 11). Predictive factors for risk assessment varied; only one study utilised a validated prediction model. Gestational diabetes was reduced in diet and physical activity interventions (risk difference − 0.03, 95% CI 0.06, − 0.01; I 2 58.69%), inositol (risk difference − 0.19, 95% CI 0.33, − 0.06; I 2 92.19%), and vitamin D supplements (risk difference − 0.16, 95% CI 0.25, − 0.06; I 2 32.27%). Subgroup analysis showed that diet and physical activity interventions were beneficial in women with ≥ 2 GDM risk factors (risk difference − 0.16, 95% CI 0.25, − 0.07; I 2 11.23% ) while inositol supplementation was effective in women with overweight or obesity (risk difference − 0.17, 95% CI 0.22, − 0.11; I 2 0.01%). Effectiveness of all other interventions were not statistically significant. Conclusions This review provides evidence that interventions targeted at women at risk of GDM may be an effective strategy for prevention. Further studies using validated prediction tools or multiple risk factors to target high-risk women for intervention before and during pregnancy are warranted.
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Quotah et al. (2024) studied this question.
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