Different types of dietary advice for women with gestational diabetes mellitus

One type of dietary advice might possibly not be more effective than another type of advice for women with gestational diabetes mellitus on pregnancy outcomes but the evidence is insufficient.

The quality of evidence is downgraded by study limitations (unclear allocation concealment in half of the studies, no blinding of outcome assessment, and selective reporting) and by imprecise results (few patients and wide confidence intervals).

Summary

A Cochrane review included 9 studies with a total of 429 women (436 babies). All trials had small sample sizes and a total of 11 different types of dietary advice were assessed under six different comparisons.

In the low-moderate glycaemic index (GI) food vs moderate-high GI food comparison, no significant differences were seen for macrosomia (RR 0.45, 95% CI 0.10 to 2.08; 2 trials, 89 babies) or large-for-gestational age (LGA) (RR 0.95, 95% CI 0.27 to 3.36); or caesarean section (RR 0.66, 95% CI 0.29 to 1.47, 1 trial, n=63). In the low-GI diet vs high-fibre moderate-GI diet comparison, no significant differences were seen for macrosomia (RR 0.32, 95% CI 0.03 to 2.96; 1 trial, n=92) or LGA (RR 2.87, 95% CI 0.61 to 13.50); or caesarean section (RR 1.80, 95% CI 0.66 to 4.94; 1 trial, n=88). In the energy-restricted vs unrestricted diet comparison, no significant differences were seen for macrosomia (RR 1.56, 95% CI 0.61 to 3.94; 1 trial, n=122); LGA (RR 1.17, 95% CI 0.65 to 2.12; 1 trial, n=123); or caesarean section (RR 1.18, 95% CI 0.74 to 1.89; 1 trial, n=121). In the low- vs high-carbohydrate diet comparison (≤ 45% vs ≥ 50% daily total energy intake from carbohydrate), none of the 30 babies in a single trial were macrosomic; and no significant differences in caesarean section rates were seen (RR 1.40, 95% CI 0.57 to 3.43; 1 trial, n=30). In the high-monounsaturated fat versus high-carbohydrate diet comparison (at least 20% total energy from monounsaturated fat vs at least 50% total energy from carbohydrate), neither macrosomia or LGA (1 trial, n=27) (RR 0.65, 95% CI 0.91 to 2.18), (RR 0.54 95% CI 0.21 to 1.37), respectively showed significant differences. Perinatal mortality was reported in only trial which recorded no fetal deaths in either the energy- restricted or unrestricted diet group. A single trial comparingvAmerican Diabetes Association diet (20 grams gram fibre/day) with fibre-enriched fibre enriched diet (80 grams gram fibre/day) did not report any of our prespecified primary outcomes.

Date of latest search: 16 October 2012

Ədəbiyyat

1. Han S, Crowther CA, Middleton P et al. Different types of dietary advice for women with gestational diabetes mellitus. Cochrane Database Syst Rev 2013;(3):CD009275.