Dataset Information

Interventions in preconception and pregnant women at risk of gestational diabetes; a systematic review and meta-analysis of randomised controlled trials.

ABSTRACT:

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; I² 58.69%), inositol (risk difference - 0.19, 95% CI 0.33, - 0.06; I² 92.19%), and vitamin D supplements (risk difference - 0.16, 95% CI 0.25, - 0.06; I² 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; I² 11.23%) while inositol supplementation was effective in women with overweight or obesity (risk difference - 0.17, 95% CI 0.22, - 0.11; I² 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.

SUBMITTER: Quotah OF

PROVIDER: S-EPMC10765912 | biostudies-literature | 2024 Jan

REPOSITORIES: biostudies-literature

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Publications

Interventions in preconception and pregnant women at risk of gestational diabetes; a systematic review and meta-analysis of randomised controlled trials.

Quotah Ola F OF Andreeva Daria D Nowak Katarzyna G KG Dalrymple Kathryn V KV Almubarak Aljawharah A Patel Anjali A Vyas Nirali N Cakir Gözde S GS Heslehurst Nicola N Bell Zoe Z Poston Lucilla L White Sara L SL Flynn Angela C AC

Diabetology & metabolic syndrome 20240104 1

<h4>Background</h4>Women at risk of gestational diabetes mellitus (GDM) need preventative interventions.<h4>Objective</h4>To evaluate targeted interventions before and during pregnancy for women identified as being at risk of developing GDM.<h4>Methods</h4>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 ri ...[more]

PMID: 38178175

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Project description:BackgroundEffective management of gestational diabetes mellitus (GDM) is essential because it is one of the most prevalent diseases during pregnancy, and the consequent condition maternal hyperglycemia is closely related to considerable short- and long-term maternal and neonatal complications. Web-based interventions (WBIs), defined as therapeutic interventions offered via the web, have been implemented to assist in managing GDM owing to their advantages of high accessibility and efficiency, but findings across relevant studies are inconsistent.ObjectiveThis systematic review and meta-analysis aimed to evaluate the effectiveness of WBIs on glycemic control among pregnant women with GDM; examine whether specific types of intervention interactivity, format, and technology have beneficial effects on maternal glycemic control; and comprehensively assess the efficacy of WBIs in maternal behavioral outcomes, cognitive and attitudinal outcomes, mental health, maternal and neonatal clinical outcomes, and medical service use and costs among pregnant women with GDM.MethodsPubMed, Embase, Cochrane Library, Web of Science, CINAHL, and PsycINFO were searched from their respective inception to November 19, 2022, to identify relevant randomized controlled trials and controlled clinical trials. The methodological quality of the included studies was assessed using the Effective Public Health Practice Project tool. Where possible, the data for all outcomes were meta-analyzed using the Stata software (version 12.0; StataCorp). Overall, 3 subgroup analyses and post hoc sensitivity analyses of maternal glycemic control parameters were performed.ResultsOverall, 25 publications arising from 21 randomized controlled trials and controlled clinical trials were included. The overall meta-analyses on glycemic control parameters demonstrated that WBIs could significantly improve fasting blood glucose (standardized mean difference=-1.764, 95% CI -2.972 to -0.557; P=.004) and 2-hour postprandial blood glucose (standardized mean difference=-1.433, 95% CI -2.561 to -0.304; P=.01) compared with the control group, whereas no significant effect was found on glycated hemoglobin and 1-hour postprandial blood glucose. The results of the subgroup analyses indicated that mobile app-delivered interventions with a personalized format and interactive function showed more beneficial effects on maternal glycemic control. Moreover, WBIs could significantly enhance compliance with the self-monitoring of blood glucose; increase the rate of normal vaginal delivery; and decrease the chance of emergency cesarean, admission to the neonatal intensive care unit, and composite neonatal complications. GDM knowledge, risk perception of the disease, self-efficacy, satisfaction with care, and medical service use of the participants in the WBI group were also improved compared with the control group. However, the effectiveness of WBIs on other secondary outcomes was either nonsignificant or uncertain.ConclusionsWBIs are a promising approach to GDM management. Personalized, interactive, and mobile app-delivered interventions seem more worthy of being recommended for future clinical practice. Further high-quality studies are required to verify these findings before making broad recommendations.Trial registrationPROSPERO CRD42022296625; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=296625.

Project description:BackgroundObesity in pregnancy increases the risk of gestational diabetes mellitus (GDM) and associated adverse outcomes. Despite metabolic differences, all pregnant women with obesity are considered to have the same risk of developing GDM. Improved risk stratification is required to enable targeted intervention in women with obesity who would benefit the most. The aim of this study is to identify pregnant women with obesity at higher risk of developing GDM and, in a pilot randomised controlled trial (RCT), test feasibility and assess the efficacy of a lifestyle intervention and/or metformin to improve glycaemic control.MethodsWomen aged 18 years or older with a singleton pregnancy and body mass index (BMI) ≥ 30kg/m2 will be recruited from one maternity unit in London, UK. The risk of GDM will be assessed using a multivariable GDM prediction model combining maternal age, mid-arm circumference, systolic blood pressure, glucose, triglycerides and HbA1c. Women identified at a higher risk of developing GDM will be randomly allocated to one of two intervention groups (lifestyle advice with or without metformin) or standard antenatal care. The primary feasibility outcomes are study recruitment, retention rate and intervention adherence and to collect information needed for the sample size calculation for the definitive trial. A process evaluation will assess the acceptability of study processes and procedures to women. Secondary patient-centred outcomes include a reduction in mean glucose/24h of 0.5mmol/l as assessed by continuous glucose monitoring and changes in a targeted maternal metabolome, dietary intake and physical activity. A sample of 60 high-risk women is required.DiscussionEarly risk stratification of GDM in pregnant women with obesity and targeted intervention using lifestyle advice with or without metformin could improve glucose tolerance compared to standard antenatal care. The results from this feasibility study will inform a larger adequately powered RCT should the intervention show trends for potential effectiveness.Trial registrationThis study has been approved by the NHS Research Ethics Committee (UK IRAS integrated research application system; reference 18/LO/1500). EudraCT number 2018-000003-16 .

Project description:BackgroundInterventions that provide pregnant women with opportunities to access and participate in physical activity have been shown to be beneficial to their health. Much of this evidence however has been based on self-reported physical activity data, which may be prone to inflated effects due to recall bias and social desirability bias. No previous synthesis of randomised controlled trials has assessed the effectiveness of these interventions using only device measured data, to assess their health benefits more accurately in pregnant women. This systematic review and meta-analysis aimed to address this evidence gap.Data sourcesCochrane Central Register of Controlled Trials, Medline, SportDiscus, APA PsycINFO, Embase and Web of Science databases were queried from inception up to December 2, 2021. An updated search of PubMed was conducted on May 16, 2022.Study eligibility criteriaRandomised controlled trials that recruited pregnant women, participating in any physical activity intervention (excluding interventions aimed entirely at body conditioning), compared with standard antenatal care (comparators), using device-measured total physical activity as an outcome were eligible for inclusion.Methods3144 titles and abstracts were screened for eligibility, and 18 met the inclusion criteria. Data were analysed using random effect models, (standardised mean difference and mean difference), using data from baseline to last available follow-up (primary end point), and until between 24 to 30 weeks gestation. Gestational weight gain was also assessed at these timepoints in the included trials.ResultsNo significant differences between the groups were found for total physical activity at last available follow-up or 24 to 30 weeks gestation (95% CI 0.03 to 0.27, p = 0.10: 95% CI -0.05 to 0.33, p = 0.15) respectively. On average, pregnant women randomised to a physical activity intervention completed 435 and 449 more steps per day than comparators at last available follow-up and at 24 to 30 weeks gestation (95% CI -0.5-870.6, p = 0.05: 95% CI 5.5-892.7, p = 0.05) respectively. Intervention participants also gained 0.69 kg less (95% CI -1.30 to -0.08, p = 0.03) weight than comparators.ConclusionBased on device-measured data, interventions to promote physical activity during pregnancy have small but important effects on increasing physical activity and managing excessive gestational weight gain.

Project description:IntroductionGestational diabetes mellitus (GDM) is one of the most prevalent diseases during pregnancy, which is closely associated with many short-term and long-term maternal and neonatal complications and can incur heavy financial burden on both families and society. Web-based interventions have been used to manage GDM because of the advantages of high accessibility and flexibility, but their effectiveness has remained inconclusive. This systematic review and meta-analysis aims to comprehensively investigate the multidimensional effectiveness of web-based interventions for pregnant women with GDM, thereby aiding implementation decisions in clinical settings.Methods and analysisThis systematic review protocol strictly adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. Six electronic databases (PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Embase, CINAHL and PsycINFO) will be comprehensively searched from their inception to 26 January 2022 to identify randomised controlled trials and controlled clinical trials regarding the efficacy of web-based interventions for pregnant women with GDM on glycaemic control, behavioural outcomes, cognitive and attitudinal outcomes, mental health, maternal and neonatal clinical outcomes, and medical service utilisation and costs. Two reviewers will independently conduct the study selection, data extraction and quality assessment. The methodological quality of included studies will be assessed using the Effective Public Health Practice Project assessment tool. The overall meta-analyses for each of the interested outcomes will be performed if the outcome data are sufficient and provides similar effect measures, as well as subgroup analyses for glycaemic control indicators based on the different types of intervention format, interactivity and technology. We will conduct a qualitative synthesis for studies that cannot be quantitatively synthesised.Ethics and disseminationEthics approval is not required for this review as no human participants will be involved. The results will be disseminated via a peer-reviewed journal or an academic conference.Prospero registration numberCRD42022296625.

Project description:BackgroundGestational diabetes mellitus (GDM) is now a global health problem. Poor blood glucose control during pregnancy may lead to maternal and neonatal/foetal complications. Recently, the development of information and communication technology has resulted in new technical support for the clinical care of GDM. Telemedicine is defined as health services and medical activities provided by healthcare professionals through remote communication technologies. This study aimed to update the systematic review of the effectiveness of telemedicine interventions on glycaemic control and pregnancy outcomes in pregnant women with GDM.MethodsWe searched the Web of Science, PubMed, Scopus, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, Wan-fang Database, China Biology Medicine and VIP Database for randomized controlled trials (RCTs) related to the effectiveness of telemedicine interventions for GDM from database inception to July 31st, 2019. Languages were limited to English and Chinese. Literature screening, data extraction and assessment of the risk of bias were completed independently by two reviewers. Meta-analysis and trial sequential analysis were conducted in Stata 14.0 and TSA v0.9.5.10 beta, respectively.ResultsA total of 32 RCTs were identified, with a total of 5108 patients. The meta-analysis showed that telemedicine group had significant improvements in controlling glycated haemoglobin (HbA1c) [mean difference (MD) = - 0.70, P < 0.01], fasting blood glucose (FBG) (MD = -0.52, P < 0.01) and 2-h postprandial blood glucose (2hBG) (MD = -1.03, P = 0.01) compared to the corresponding parameters in the standard care group. In the telemedicine group, lower incidences of caesarean section [relative risk (RR) = 0.82, P = 0.02], neonatal hypoglycaemia (RR = 0.67, P < 0.01), premature rupture of membranes (RR = 0.61, P < 0.01), macrosomia (RR = 0.49, P < 0.01), pregnancy-induced hypertension or preeclampsia (RR = 0.48, P < 0.01), preterm birth (RR = 0.27, P < 0.01), neonatal asphyxia (RR = 0.17, P < 0.01), and polyhydramnios (RR = 0.16, P < 0.01) were found. The trial sequential analyses conclusively demonstrated that the meta-analytic results of the change in HbA1c, the change in 2hBG, the change in FBG, the incidence rates of caesarean section, pregnancy-induced hypertension or preeclampsia, premature rupture of membranes, premature birth, neonatal asphyxia, and polyhydramnios were stable.ConclusionsCompared to standard care, telemedicine interventions can decrease the glycaemic levels of patients with GDM more effectively and reduce the risk of maternal and neonatal/foetal complications.

Project description:OBJECTIVE:To assess the effect of the Pregnant+ app on the 2-hour glucose level of the routine postpartum oral glucose tolerance test (OGTT) among women with gestational diabetes mellitus (GDM). The Pregnant+ app was designed to provide information about GDM, and promote physical activity and a healthy diet. DESIGN:A multicentre, non-blinded randomised controlled trial. SETTING:Five diabetes outpatient clinics in the Oslo region. PARTICIPANTS:Women ≥18 years old with a 2-hour OGTT blood glucose level ≥9 mmol/L who owned a smartphone; understood Norwegian, Urdu or Somali; and were <33 weeks pregnant. A total of 238 women were randomised; 158 women completed the OGTT post partum. INTERVENTION:The Pregnant+ app and usual care, the control group received usual care. PRIMARY AND SECONDARY OUTCOMES:The primary outcome was the 2-hour blood glucose level of the routine postpartum OGTT. Secondary outcomes reported were mode of delivery, induction of labour, Apgar score, birth weight, transfer to the neonatal intensive care unit and breast feeding practice. Blood glucose levels during pregnancy, knowledge of diabetes, diet and physical activity are not reported. RESULTS:No difference was found for the 2-hour blood glucose level of the postpartum OGTT, with 6.7 mmol/L (95% CI 6.2 to 7.1) in the intervention group and 6.0 mmol/L (95% CI 5.6 to 6.3) in the control group. The significant difference in the proportion of emergency caesarean sections between the intervention group, 10 (8.8%) and the usual care group, 27 (22.1%), disappeared when adjusted for parity. There were no differences in birth weight, breast feeding practice, obstetric complications or transfer to the intensive neonatal care unit. No adverse events were registered. CONCLUSION:The Pregnant+ app had no effect on 2-hour glucose level at routine postpartum OGTT. After controlling for parity, the difference in emergency caesarean section was not statistically significant. TRIAL REGISTRATION NUMBER:NCT02588729.

Project description:BackgroundNon-pharmacological interventions are the first line of Gestational diabetes mellitus (GDM) management. Community-based interventions are cheaper, more accessible, with higher patient satisfaction.ObjectivesTo systematically review community-based non-pharmacological interventions and evaluate their effectiveness for GDM.Search strategyTwelve bibliographic databases and reference list of related studies from inception until January 2022.Selection criteriaAll primary studies of community-based non-pharmacological interventions for GDM reported in English which investigated any behavioural or clinical outcome(s).Data collection and analysisData were extracted using modified Cochrane's data extraction template. Studies were evaluated using Cochrane Collaboration's risk of bias tool. Narrative synthesis was used to summarise findings. This study is registered with PROSPERO (CRD42021257634).Main resultsTwenty-seven studies involving 6,242 pregnant women with GDM investigated self-management programmes, medical nutrition/diet therapy, exercise/physical activity, combined diet and exercise, calcium plus vitamin D supplementation, and continuous glucose monitoring. Self-management programmes were more effective than routine care in improving self-efficacy, two-hour postprandial blood glucose, and lifestyle behaviours but were as effective as routine care in improving infant birth weight. Self-management programmes were superior to or as effective as usual care in improving fasting blood glucose, blood glucose control, glycated haemoglobin, macrosomia, and preterm delivery. Medical nutrition/diet therapy was more effective than usual care in improving postprandial blood glucose levels. Postprandial blood glucose levels were better improved by regular supervised exercise plus daily brisk walks or a daily walking intervention than routine obstetric care or no treatment. The effects of exercise/physical activity programmes were mostly inconsistent for other outcomes. Diet and exercise were superior to diet alone in reducing maternal weight gain although there were similar outcomes for other pregnancy and foetal outcomes. Limited or conflicting evidence was found for other outcomes and interventions including calcium and vitamin D supplementation and continuous glucose monitoring intervention.ConclusionsCommunity-based non-pharmacological interventions are more effective than placebo; and are more or as effective as usual care. Self-management programmes and medical nutrition/diet therapy had the most promising GDM outcomes.FundingThere was no funding for this study. The study design, data collection, data analysis and interpretation, and writing of this manuscript were not influenced externally by any funder.

Dataset Information

Interventions in preconception and pregnant women at risk of gestational diabetes; a systematic review and meta-analysis of randomised controlled trials.

Background

Objective

Methods

Results

Conclusions

Publications

Interventions in preconception and pregnant women at risk of gestational diabetes; a systematic review and meta-analysis of randomised controlled trials.

Similar Datasets

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