Dietary patterns before and during pregnancy and risk of gestational diabetes mellitus a systematic review
Those that met the following criteria were included in the review: randomized controlled trials (RCTs), prospective or retrospective cohort studies or nested case-control studies; studies enrolling human subjects who were pregnant women or women capable of becoming pregnant, healthy or at elevated c...
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| Corporate Authors: | , |
| Format: | eBook |
| Language: | English |
| Published: |
Washington, D.C.
United States Department of Agriculture
April 2019, 2019
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| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | Those that met the following criteria were included in the review: randomized controlled trials (RCTs), prospective or retrospective cohort studies or nested case-control studies; studies enrolling human subjects who were pregnant women or women capable of becoming pregnant, healthy or at elevated chronic disease risk (only some, not all, could have a chronic or pregnancy-related condition), and between the ages of 15 and 44; subjects from countries with high or very high human development (2015 Human Development Index); and studies published in English in peer-reviewed journals.3. The date range was from January 1980 to January 2017. The intervention or exposure was dietary patterns before or during pregnancy measured via indices and scores, cluster or factor analysis, reduced rank regression, or other methods. Evidence is insufficient to estimate the association between dietary patterns during pregnancy and risk of gestational diabetes mellitus.Grade: Grade not assignable METHODS: 1. The systematic review was conducted by a team of staff from the Nutrition Evidence Systematic Review in collaboration with a Technical Expert Collaborative.2. Literature searches were conducted using PubMed, Embase, Cochrane, and other databases to identify studies that evaluated the relationship between dietary patterns before and during pregnancy and risk of gestational diabetes mellitus. A manual search was conducted to identify articles that may not have been included in the electronic databases searched. Articles were screened by two authors independently for inclusion based on pre-determined criteria. In addition, one RCT assigned subjects to one of two experimental diets.3. Overall, 8 of the 11 included studies found statistically significant associations between dietary patterns and GDM risk among healthy Caucasian women with access to health care. Greater adherence to a protective dietary pattern before and during pregnancy was associated with a decrease in GDM risk of 24% to 56%. Higher adherence to a detrimental pattern was associated with an increase in risk of 23% to 63%.4. There is heterogeneity in terms of when dietary data were assessed. Five studies measured diet before pregnancy while the rest (n=6) assessed diet during pregnancy. ○ Greater adherence to a healthy diet assessed 2-10 years before pregnancy showed a consistent inverse association with the risk of GDM in all the studies. The outcome was risk of GDM and related intermediate outcomes (glucose intolerance, insulin resistance, HbA1C, HOMA-IR, fasting blood glucose, and oral glucose tolerance test).4. Data from each included article were extracted, risks of bias were assessed, and both were checked for accuracy. The body of evidence was qualitatively synthesized, a conclusion statement was developed, and the strength of the evidence (grade) was assessed using pre-established criteria including evaluation of the internal validity/risk of bias, adequacy, consistency, impact, and generalizability of available evidence. SUMMARY OF EVIDENCE: 1. This systematic review includes 10 prospective cohort studies and 1 pilot RCT, published between 1998 and 2016.2. The studies used multiple approaches to assess dietary patterns. Five studies used indices/scores to assess dietary patterns, four studies used factor or principal component analysis (PCA) and one study used both an index/score and PCA. BACKGROUND: 1. This systematic review was conducted as part of the U.S. Department of Agriculture and Department of Health and Human Services Pregnancy and Birth to 24 Months Project.2. The goal of this systematic review was to examine the following question: What is the relationship between dietary patterns before and during pregnancy and risk of gestational diabetes mellitus? CONCLUSION STATEMENT AND GRADES: 1. Limited but consistent evidence suggests that certain dietary patterns before pregnancy are associated with a reduced risk of gestational diabetes mellitus. These protective dietary patterns are: ○ higher in vegetables, fruits, whole grains, nuts, legumes, and fish, and○ lower in red and processed meats.2. Most of the research was conducted in healthy, Caucasian women with access to health care.Grade: Limited 1. These findings are also in agreement with the evidence linking dietary patterns and type 2 diabetes mellitus risk in non-pregnant populations.○ There were mixed findings in studies that assessed diet during pregnancy: 1) three studies showed an association with GDM, 2) one showed an inverse association with blood glucose, only, and not with GDM, 3) one showed an effect on blood glucose and insulin response but did not study GDM, and 4) one other study showed no association with GDM.5. Generalizability of the studies is limited to healthy Caucasian women who have access to health care. Minority women and those of lower SES are underrepresented in this body of evidence |
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| Physical Description: | 1 PDF file (89 pages) illustrations |