Takaisin Tulosta

Lifestyle interventions for the treatment of women with gestational diabetes

Evidence summaries
Editors
17.1.2018

Level of evidence: B

Lifestyle interventions in women with gestational diabetes appear to be effective in decreasing large for gestational age (LGA) babies.

Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding of outcome assessment).

Clinical comment: In most studies the intervention was started late in gestation or the time was not stated.

Summary

A Cochrane review «Lifestyle interventions for the treatment of women with gestational diabetes»1 «Brown J, Alwan NA, West J et al. Lifestyle interve...»1 included 15 studies with a total of 4501 women and 3768 infants. The lifestyle interventions included a wide variety of components such as education, diet, exercise and self-monitoring of blood glucose. The control group included usual antenatal care or diet alone. There was no clear evidence of a difference between lifestyle intervention and control groups for the risk of hypertensive disorders of pregnancy (pre-eclampsia), caesarean section, development of type 2 diabetes, perineal trauma/tearing, or induction of labour «Lifestyle interventions versus control - Maternal outcomes...»1. More women in the lifestyle intervention group had met postpartum weight goals one year after birth than in the control group «Lifestyle interventions versus control - Maternal outcomes...»1. Lifestyle interventions were associated with a reduction in the risk of being born large-for-gestational age (LGA) «Lifestyle versus control - Neonatal and later outcomes...»2. There was a trend for lower birthweight, neonatal fat mass, and the incidence of macrosomia in the lifestyle intervention group «Lifestyle versus control - Neonatal and later outcomes...»2.

Table 1. Lifestyle interventions versus control - Maternal outcomes
Outcomes Relative effect (95% CI) Risk with usual care/control Risk with lifestyle intervention (95% CI) № of participants (studies) Quality of evidence
Hypertensive disorders of pregnancy (pre-eclampsia) RR 0.70 (0.40 to 1.22) 129 per 1000 90 per 1000 (51 to 157) (4 2796) Low
Perineal trauma/tear RR 1.04 (0.93 to 1.18) 498 per 1000 518 per 1000 (463 to 588) 1000 (1) Moderate
Caesarean section RR 0.90 (0.78 to 1.05) 380 per 1000 342 per 1000 (296 to 399) 3545 (10) Low
Induction of labour RR 1.20 (0.99 to 1.46) 211 per 1000 252 per 1000 (220 to 285) 2699 (4) High
Postnatal depression RR 0.49 (0.31 to 0.78) 169 per 1000 83 per 1000 (53 to 132) 573 (1) Low
Postnatal weight retention or return to pre-pregnancy weight RR 1.75 (1.05 to 2.90) 214 per 1000 375 per 1000 (225 to 621) 156 (1) Low
Development of type 2 diabetes (follow-up) RR 0.98 (0.54 to 1.76) 83 per 1000 81 per 1000 (45 to 146) 486 (2) Low
Table 2. Lifestyle versus control - Neonatal and later outcomes
Outcomes Relative effect (95% CI) Risk with usual care/control Risk with lifestyle intervention (95% CI) № of participants (studies) Quality of evidence
Large-for-gestational age RR 0.60 (0.50 to 0.71) 189 per 1000 113 per 1000 (95 to 134) 2994 (6) Moderate
Perinatal (fetal and neonatal death) and later infant mortality RR 0.09 (0.01 to 1.70) 5 per 1000 0 per 1000 (0 to 9) 1988 (2) Low
Neonatal hypoglycaemia RR 0.99 (0.65 to 1.52) 75 per 1000 74 per 1000 (49 to 114) 3000 (6) Moderate
Adiposity (neonatal) - Mean neonatal fat mass (g) - 427 g 37.30 g fewer (63.97 fewer to 10.63 fewer) - 958 (1) Low
Adiposity (child) - Childhood BMI > 85th percentile RR 0.91 (0.75 to 1.11) 350 per 1000 318 per 1000 (262 to 388) 767 (3) Moderate

References

  1. Brown J, Alwan NA, West J et al. Lifestyle interventions for the treatment of women with gestational diabetes. Cochrane Database Syst Rev 2017;(5):CD011970. «PMID: 28472859»PubMed