Di Jiaoyang, Fan Jingjing, Ma Fangxu
Department of Obstetrics and Gynecology, Hebei General Hospital, Shijiazhuang, China.
Department of Respiratory and Critical Care Medicine, Hebei Chest Hospital, Shijiazhuang, China.
Front Endocrinol (Lausanne). 2025 May 19;16:1512493. doi: 10.3389/fendo.2025.1512493. eCollection 2025.
Gestational diabetes mellitus (GDM) poses significant risks to both maternal and fetal health, and effective dietary interventions are critical for managing the condition. This study aimed to evaluate the efficacy of various dietary interventions on glycemic control and adverse pregnancy outcomes in GDM patients through a network meta-analysis.
A systematic review and network meta-analysis of randomized controlled trials (RCTs) were conducted in accordance with PRISMA guidelines. Data were sourced from PubMed, MEDLINE, Embase, Web of Science, and CNKI up to September 3, 2024. The primary outcomes were fasting blood glucose (FBG), 2-hour postprandial blood glucose (2h-PBG), insulin resistance (HOMA-IR), and adverse pregnancy outcomes, including cesarean section, macrosomia, and gestational hypertension. Effect sizes were reported as odds ratios (OR) for dichotomous outcomes and mean differences (MD) or standardized mean differences (SMD) for continuous outcomes, with 95% confidence intervals (CI).
A total of 28 RCTs with 2666 participants were included, evaluating seven distinct dietary interventions. Among them, 19 studies assessed the low-glycemic index (Low-GI) diet, 4 evaluated the Dietary Approaches to Stop Hypertension (DASH) diet, 4 investigated low-carbohydrate diets, 1 examined the low-glycemic load (Low-GL) diet, and 1 explored a combined low-carbohydrate and DASH diet. The remaining trials compared standard dietary recommendations or structured meal planning. The DASH diet was the most effective intervention for glycemic control, significantly reducing FBG (SMD = -2.35, 95% CI [-4.15, -0.54]), 2h-PBG (SMD = -1.41, 95% CI [-2.56, -0.25]), and HOMA-IR (MD = -1.90, 95% CI [-2.44, -1.36]). Both the DASH and Low-GI diets significantly reduced adverse pregnancy outcomes. Specifically, the DASH diet significantly reduced the risk of cesarean section (OR = 0.54, 95% CI [0.40, 0.74]), while the Low-GI diet significantly reduced the risk of macrosomia (OR = 0.12, 95% CI [0.03, 0.51]).
This network meta-analysis suggests that the DASH and Low-GI diets may be beneficial for managing gestational diabetes mellitus. The DASH diet showed favorable trends in improving glycemic control, while both diets appeared to reduce the risks of cesarean delivery and macrosomia. Further high-quality research is needed to confirm these findings and optimize dietary recommendations for clinical practice.
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251008181.
妊娠期糖尿病（GDM）对母婴健康构成重大风险，有效的饮食干预对于控制病情至关重要。本研究旨在通过网络荟萃分析评估各种饮食干预对GDM患者血糖控制和不良妊娠结局的疗效。
按照PRISMA指南对随机对照试验（RCT）进行系统评价和网络荟萃分析。数据来源于截至2024年9月3日的PubMed、MEDLINE、Embase、Web of Science和中国知网。主要结局指标为空腹血糖（FBG）、餐后2小时血糖（2h-PBG）、胰岛素抵抗（HOMA-IR）以及不良妊娠结局，包括剖宫产、巨大儿和妊娠期高血压。二分类结局的效应量以比值比（OR）表示，连续型结局的效应量以均值差（MD）或标准化均值差（SMD）表示，并给出95%置信区间（CI）。
共纳入28项RCT，涉及2666名参与者，评估了七种不同的饮食干预措施。其中，19项研究评估了低血糖指数（Low-GI）饮食，4项评估了终止高血压饮食方法（DASH）饮食，4项研究了低碳水化合物饮食，1项研究了低血糖负荷（Low-GL）饮食，1项研究了低碳水化合物与DASH联合饮食。其余试验比较了标准饮食建议或结构化饮食计划。DASH饮食是血糖控制最有效的干预措施，显著降低了FBG（SMD = -2.35，95%CI [-4.15，-0.54]）、2h-PBG（SMD = -1.41，95%CI [-2.56，-0.25]）和HOMA-IR（MD = -1.90，95%CI [-2.44，-1.36]）。DASH饮食和Low-GI饮食均显著降低了不良妊娠结局。具体而言，DASH饮食显著降低了剖宫产风险（OR = 0.54，95%CI [0.40，0.74]），而Low-GI饮食显著降低了巨大儿风险（OR = 0.12，95%CI [0.03，0.51]）。
这项网络荟萃分析表明，DASH饮食和Low-GI饮食可能有助于管理妊娠期糖尿病。DASH饮食在改善血糖控制方面显示出良好趋势，而这两种饮食似乎都降低了剖宫产和巨大儿的风险。需要进一步的高质量研究来证实这些发现，并优化临床实践中的饮食建议。
