Michalopoulou Moscho, Jebb Susan A, Astbury Nerys M
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
NIHR Oxford Biomedical Research Centre, Oxford, UK.
Proc Nutr Soc. 2023 Nov 30:1-13. doi: 10.1017/S0029665123004822.
The aim of this review is to provide an overview of dietary interventions delivered during pregnancy for the prevention of gestational diabetes mellitus (GDM). GDM increases the risk of adverse pregnancy and neonatal outcomes, and also increases future cardiometabolic risks for both the mother and the offspring. Carrying or gaining excessive weight during pregnancy increases the risk of developing GDM, and several clinical trials in women with overweight or obesity have tested whether interventions aimed at limiting gestational weight gain (GWG) could help prevent GDM. Most dietary interventions have provided general healthy eating guidelines, while some had a specific focus, such as low glycaemic index, increased fibre intake, reducing saturated fat or a Mediterranean-style diet. Although trials have generally been successful in attenuating GWG, the majority have been unable to reduce GDM risk, which suggests that limiting GWG may not be sufficient in itself to prevent GDM. The trials which have shown effectiveness in GDM prevention have included intensive face-to-face dietetic support, and/or provision of key foods to participants, but it is unclear whether these strategies could be delivered in routine practice. The mechanism behind the effectiveness of some interventions over others remains unclear. Dietary modifications from early stages of pregnancy seem to be key, but the optimum dietary composition is unknown. Future research should focus on designing acceptable and scalable dietary interventions to be tested early in pregnancy in women at risk of GDM.
本综述的目的是概述孕期进行的饮食干预措施，以预防妊娠期糖尿病（GDM）。GDM会增加不良妊娠和新生儿结局的风险，还会增加母亲和后代未来发生心脏代谢疾病的风险。孕期体重超标或增加过多会增加患GDM的风险，针对超重或肥胖女性的多项临床试验检验了旨在限制孕期体重增加（GWG）的干预措施是否有助于预防GDM。大多数饮食干预提供了一般的健康饮食指南，而有些则有特定的重点，如低血糖指数、增加纤维摄入量、减少饱和脂肪或采用地中海式饮食。尽管试验通常在减轻GWG方面取得了成功，但大多数试验未能降低GDM风险，这表明仅限制GWG本身可能不足以预防GDM。在预防GDM方面显示出有效性的试验包括提供强化的面对面饮食支持和/或向参与者提供关键食物，但尚不清楚这些策略能否在常规实践中实施。某些干预措施比其他措施更有效的背后机制仍不清楚。孕期早期的饮食调整似乎是关键，但最佳饮食构成尚不清楚。未来的研究应侧重于设计可接受且可扩展的饮食干预措施，以便在孕期早期对有GDM风险的女性进行测试。
