Simmons D
Macarthur Clinical School, University of Western Sydney, Campbelltown, New South Wales, Australia.
Diabetes Obes Metab. 2015 Sep;17(9):824-34. doi: 10.1111/dom.12495. Epub 2015 Jul 1.
Gestational diabetes mellitus (GDM) is increasing at a rapid rate, driven by the increasing proportion of the population that is overweight/obese from a young age. More than 25 randomized controlled trials testing whether GDM can be prevented have now reported their findings, but only four different interventions have shown a reduction in the proportion of women with GDM (healthy eating alone, healthy eating with physical activity, myoinositol supplementation and probiotic treatment), and these results have not been replicated. The interventions tested to date include different diets and different forms of physical activity, in combination or alone, vitamin D, myoinositol, probiotics and metformin. Studies could be improved by using the International Association of Diabetes and Pregnancy Study Group criteria for GDM (which are probably more sensitive to change because of their multiple time points), targeting and tailoring interventions to subgroups most likely to benefit, and separating those with GDM early in pregnancy from those developing GDM de novo. The greatest societal benefit is likely to arise from population-based lifestyle approaches which include those women yet to become pregnant and those who are already pregnant and their families; an approach that is yet to be fully tested.
妊娠糖尿病（GDM）的发病率正在迅速上升，这是由年轻时超重/肥胖人口比例的增加所驱动的。目前已有超过25项关于GDM能否预防的随机对照试验报告了其研究结果，但只有四种不同的干预措施显示患有GDM的女性比例有所降低（仅健康饮食、健康饮食与体育活动相结合、补充肌醇和益生菌治疗），而且这些结果尚未得到重复验证。迄今为止所测试的干预措施包括不同的饮食、不同形式的体育活动（单独或联合使用）、维生素D、肌醇、益生菌和二甲双胍。通过采用国际糖尿病与妊娠研究组的GDM标准（由于其多个时间点，可能对变化更敏感）、针对最可能受益的亚组进行干预并进行个性化调整，以及在妊娠早期将患有GDM的女性与新发GDM的女性区分开来，研究可以得到改进。最大的社会效益可能来自基于人群的生活方式方法，其中包括尚未怀孕的女性、已经怀孕的女性及其家庭；这种方法尚未得到充分测试。
