Division of Health Sciences, Warwick Medical School, Gibbet Hill, University of Warwick, Warwick, Coventry, CV4 7AL, UK.
School of Mathematics and Statistics, The Open University, Milton Keynes, UK.
Nutr Diabetes. 2023 Nov 16;13(1):22. doi: 10.1038/s41387-023-00251-5.
Gestational Diabetes Mellitus (GDM) is hyperglycaemia first detected during pregnancy. Globally, GDM affects around 1 in 6 live births (up to 1 in 4 in low- and middle-income countries- LMICs), thus, urgent measures are needed to prevent this public health threat.
To determine the effectiveness of pre-pregnancy lifestyle in preventing GDM.
We searched MEDLINE, Web of science, Embase and Cochrane central register of controlled trials. Randomized control trials (RCTs), case-control studies, and cohort studies that assessed the effect of pre-pregnancy lifestyle (diet and/or physical activity based) in preventing GDM were included. Random effects model was used to calculate odds ratio (OR) with 95% confidence interval. The Cochrane ROB-2 and the Newcastle-Ottawa Scale were used for assessing the risk of bias. The protocol was registered in PROSPERO (ID: CRD42020189574) RESULTS: Database search identified 7935 studies, of which 30 studies with 257,876 pregnancies were included. Meta-analysis of the RCTs (N = 5; n = 2471) in women who received pre-pregnancy lifestyle intervention showed non-significant reduction of the risk of developing GDM (OR 0.76, 95% CI: 0.50-1.17, p = 0.21). Meta-analysis of cohort studies showed that women who were physically active pre-pregnancy (N = 4; n = 23263), those who followed a low carbohydrate/low sugar diet (N = 4; n = 25739) and those women with higher quality diet scores were 29%, 14% and 28% less likely to develop GDM respectively (OR 0.71, 95% CI: 0.57, 0.88, p = 0.002, OR 0.86, 95% CI: 0.68, 1.09, p = 0.22 and OR 0.72, 95% CI 0.60-0.87, p = 0.0006).
This study highlights that some components of pre-pregnancy lifestyle interventions/exposures such as diet/physical activity-based preparation/counseling, intake of vegetables, fruits, low carbohydrate/low sugar diet, higher quality diet scores and high physical activity can reduce the risk of developing gestational diabetes. Evidence from RCTs globally and the number of studies in LMICs are limited, highlighting the need for carefully designed RCTs that combine the different aspects of the lifestyle and are personalized to achieve better clinical and cost effectiveness.
妊娠期糖尿病（GDM）是指怀孕期间首次发现的高血糖症。在全球范围内，GDM 影响了约 1/6 的活产儿（在低收入和中等收入国家- LMICs 中高达 1/4），因此需要采取紧急措施来预防这一公共卫生威胁。
确定孕前生活方式在预防 GDM 中的有效性。
我们检索了 MEDLINE、Web of science、Embase 和 Cochrane 对照试验中心注册库。纳入了评估基于饮食和/或体力活动的孕前生活方式对预防 GDM 影响的随机对照试验（RCTs）、病例对照研究和队列研究。使用随机效应模型计算优势比（OR）及其 95%置信区间。使用 Cochrane ROB-2 和纽卡斯尔-渥太华量表评估偏倚风险。该方案已在 PROSPERO（ID：CRD42020189574）中注册。
数据库检索确定了 7935 项研究，其中 30 项研究（n=257876 例妊娠）符合纳入标准。对接受孕前生活方式干预的妇女的 RCTs（n=5；n=2471）进行荟萃分析显示，GDM 发病风险无显著降低（OR 0.76，95%CI：0.50-1.17，p=0.21）。队列研究的荟萃分析表明，孕前体力活动（n=4；n=23263）、低碳水化合物/低糖饮食（n=4；n=25739）和饮食质量评分较高的妇女患 GDM 的风险分别降低了 29%、14%和 28%（OR 0.71，95%CI：0.57，0.88，p=0.002，OR 0.86，95%CI：0.68，1.09，p=0.22 和 OR 0.72，95%CI 0.60-0.87，p=0.0006）。
本研究强调，孕前生活方式干预/暴露的某些成分，如基于饮食/体力活动的准备/咨询、蔬菜、水果、低碳水化合物/低糖饮食、更高的饮食质量评分和较高的体力活动，可以降低患妊娠期糖尿病的风险。全球 RCT 证据和 LMICs 的研究数量有限，这突出表明需要精心设计的 RCT，将生活方式的不同方面结合起来，并针对个体进行个性化设计，以实现更好的临床和成本效益。
