The efficacy of myo-inositol supplementation to prevent gestational diabetes onset: a meta-analysis of randomized controlled trials

Introduction: The efficacy of myo-inositol supplementation to prevent gestational diabetes onset remains controversial. We conducted a systematic review and meta-analysis to explore the influence of myo-inositol supplementation on the incidence of gestational diabetes.

Methods: We search PubMed, Embase, Web of science, EBSCO, and Cochrane Library databases through November 2017 for randomized controlled trials (RCTs) assessing the effect of myo-inositol supplementation on gestational diabetes onset. This meta-analysis is performed using the random-effect model.

Results: Five randomized controlled trials (RCTs) are included in the meta-analysis. Compared with control group in pregnant women, myo-inositol supplementation is associated with significantly reduced incidence of gestational diabetes (risk ratio (RR)?=?0.43; 95%CI?=?0.21–0.89; p?=?.02), and preterm delivery (RR?=?0.36; 95%CI?=?0.17–0.73; p?=?.005), but has no substantial impact on 2-h glucose oral glucose tolerance test (OGTT) (mean difference (MD)?=??6.90; 95%CI?=??15.07 to 1.27; p?=?.10), gestational age at birth (MD?=?0.74; 95%CI?=??1.06 to 2.54; p?=?.42), birth weight (MD?=??5.50; 95%CI?=??116.99 to 105.99; p?=?.92), and macrosomia (RR?=?0.65; 95%CI?=?0.20–2.11; p?=?.47).

Conclusions: Myo-inositol supplementation has some ability to reduce the incidence of gestational diabetes and preterm delivery in pregnant women.     

Efficacy of probiotic supplement for gestational diabetes mellitus: a systematic review and meta-analysis

Background: Probiotic supplement might be beneficial for gestational diabetes mellitus. However, the results remained controversial. We conducted a systematic review and meta-analysis to explore the efficacy of probiotic supplement in gestational diabetes mellitus.

Methods: PubMed, Embase, Web of science, EBSCO, and Cochrane Library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of probiotic supplement in gestational diabetes mellitus were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcome were fasting serum insulin and fasting plasma glucose. Meta-analysis was performed using the fixed-effect or random-effect model.

Results: Six RCTs involving 830 patients were included in the meta-analysis. Overall, compared with control intervention in gestational diabetes mellitus, probiotic supplementation intervention was found to significantly reduce fasting serum insulin (Std. mean difference?=??0.95; 95% CI?=??1.73 to ?0.17; p?p?=?.02), but showed no substantial impact on fasting plasma glucose (Std. mean difference =??0.49; 95% CI?=??1.05–0.08; p?=?.09), gestational age (Std. mean difference?=?0.07; 95% CI?=??0.20–0.34; p?=?.63), and gestational weight (Std. mean difference?=??0.11; 95% CI?=??0.38–0.16; p?=?.43).

Conclusions: Compared with control intervention in gestational diabetes mellitus, probiotic supplementation was found to significantly reduce insulin resistance (HOMA-IR) and fasting serum insulin, but had no substantial influence on fasting plasma glucose, gestational age and gestational weight.     

Screening for gestational diabetes mellitus in southern Asian women

AIM: To compare fasting plasma glucose (FPG) against 2-h postprandial plasma glucose (PPPG), following a carbohydrate meal, for screening of gestational diabetes mellitus (GDM) in southern Asian women with one or more risk factors. METHODS: A comparative study was conducted at a university obstetric unit in Sri Lanka. Two hundred and seventy one women undergoing oral glucose tolerance test (OGTT) according to the WHO criteria of 1999 had a 2-h PPPG performed within the following week. Sensitivity, specificity, predictive values and correlation coefficients for predicting a diagnosis of GDM and areas under receiver-operator curves (ROC) were calculated for FPG and PPPG. The ability to predict GDM and to reduce the need for OGTT were the main outcome measures. RESULTS: The mean period of gestation was 26.43 weeks (SD = 5.4) Seventy-five (27.7%) women were diagnosed with GDM. The optimal threshold for FPG was 4.4 mmol/L and for PPPG 4.7 mmol/L. At these, sensitivity was 92.0% and 90.7%, specificity 48.7% and 25.4% and the areas under the ROC 0.82 and 0.73 for FPG and PPPG, respectively. Nine (12%) women could be diagnosed as having GDM on the basis of the FPG being above the threshold. CONCLUSIONS: FPG is superior to 2-h PPPG for screening high-risk women for GDM. Nine women were diagnosed as having GDM on the basis of having an FPG above 7 mmol/L. FPG could reduce the number of OGTT needed by 40.9%, compared to 20.6% by PPPG. FPG is a less cumbersome and cost-effective screening test.     

Omega-3 fatty acid supplementation affects pregnancy outcomes in gestational diabetes: a randomized,double-blind,placebo-controlled trial

Objective: This study was designed to assess the effects of omega-3 fatty acid supplementation on inflammatory factors, biomarkers of oxidative stress, and pregnancy outcomes among pregnant women with gestational diabetes (GDM).

Methods: This randomized, double-blind, placebo-controlled clinical trial was performed among 56 women with GDM. Subjects were randomly selected to receive either 1000?mg omega-3 fatty acid supplements (containing 180?mg eicosapentaenoic acid and 120?mg docosahexanoic acid) (n?=?27) or a placebo (n?=?27) for 6 weeks. Fasting blood samples were taken at study baseline and after 6 weeks of intervention to quantify biochemical variables. Newborn’s weight, height, head circumference, Apgar score, and hyperbilirubinemia were determined.

Results: At the end of the 6 weeks, taking omega-3 fatty acid significantly decreased serum high-sensitivity C-reactive protein (hs-CRP) (change from baseline: ?245.1?±?1570.5 versus?+?913.9?±?2329.4?ng/mL, p?=?0.03) and plasma malondialdehyde (MDA) concentrations (?0.4?±?1.3 versus?+?0.6±2.3, p?=?0.04) compared with the placebo. Supplementation with omega-3 had a low incidence of hyperbilirubinemiain newborns (7.7% versus 33.3%, p?=?0.02) and decreased newborns’ hospitalization rate (7.7% versus 33.3%, p?=?0.02).

Conclusions: Taken together, omega-3 fatty acid supplementation in GDM women had beneficial effects on maternal serum hs-CRP, plasma MDA levels, incidence of newborn’s hyperbilirubinemia, and hospitalization.     

Fasting or two-hour postprandial plasma glucose levels in early months of pregnancy as screening tools for gestational diabetes mellitus developing in later months of pregnancy

PURPOSE: The present study was done to find out whether the fasting or 2-hour postprandial plasma glucose (PPPG) levels in early months of pregnancy can be used as screening tools for gestational diabetes mellitus (GDM) developing in later months of pregnancy. BASIC PROCEDURE: Fasting and 2-hour PPPG levels were measured in the early months of pregnancy in 246 women attending the antenatal clinic of the author. All of the women underwent glucose challenge tests with 50 grams of glucose at 24-28 weeks and if the value exceeded 140 mg%, a three-hour oral glucose tolerance test (OGTT) with 100 grams of glucose was performed to diagnose GDM. MAIN FINDINGS: The present study found that the incidence of GDM was 10.5% in the third trimester. Statistical analysis did not show any correlation between fasting and the PPPG values in the early months and GDM in later months of pregnancy. CONCLUSION: Fasting or PPPG values cannot be used as efficient screening tools for GDM developing in the later months of pregnancy.     

One step versus two step approach for gestational diabetes screening: systematic review and meta-analysis of the randomized trials

Introduction: To compare both the prevalence of gestational diabetes mellitus (GDM) as well as maternal and neonatal outcomes by either the one-step or the two-step approaches.

Material and methods: Electronic databases were searched from their inception until June 2017. We included all randomized controlled trials (RCTs) comparing the one-step with the two-step approaches for the screening and diagnosis of GDM. The primary outcome was the incidence of GDM.

Results: Three RCTs (n?=?2333 participants) were included in the meta-analysis. 910 were randomized to the one step approach (75?g, 2?hrs), and 1423 to the two step approach. No significant difference in the incidence of GDM was found comparing the one step versus the two step approaches (8.4 versus 4.3%; relative risk (RR) 1.64, 95%CI 0.77–3.48). Women screened with the one step approach had a significantly lower risk of preterm birth (PTB) (3.7 versus 7.6%; RR 0.49, 95%CI 0.27–0.88), cesarean delivery (16.3 versus 22.0%; RR 0.74, 95%CI 0.56–0.99), macrosomia (2.9 versus 6.9%; RR 0.43, 95%CI 0.22–0.82), neonatal hypoglycemia (1.7 versus 4.5%; RR 0.38, 95%CI 0.16–0.90), and admission to neonatal intensive care unit (NICU) (4.4 versus 9.0%; RR 0.49, 95%CI 0.29–0.84), compared to those randomized to screening with the two step approach.

Conclusions: The one and the two step approaches were not associated with a significant difference in the incidence of GDM. However, the one step approach was associated with better maternal and perinatal outcomes.     

Effectiveness of cognitive-behavioral stress management on psychological stress and glycemic control in gestational diabetes: a randomized controlled trial

Objective: This study was conducted to determine the effect of cognitive-behavioral stress management (CBT) on reducing psychological stress in diabetic pregnant women.

Method: This randomized controlled trial applied through pretest and post-test with control group was conducted on 88 eligible women with gestational diabetes. Women who had a stress score more than 15, randomly assigned to intervention or control groups. Intervention group received stress management training within six two-hour sessions for three weeks. Stress and FBS were measured before intervention and two weeks after the last session. Data were analyzed using the SPSS version 19.0. Results were analyzed using chi-square, paired t test and independent sample t test.

Results: In CBT training group, stress significantly decreased two weeks after the training (p?p?=?0.028). There was a significant difference between two groups in stress scores, two weeks after intervention (p?=?0.001).

Conclusion: Cognitive-behavioral stress management reduces stress in women with gestational diabetes and reducing stress may also improve the pregnancy outcomes, especially whose glycemic along with stress is not adequately controlled by medication.     

Myo-inositol may prevent gestational diabetes onset in overweight women: a randomized,controlled trial

Objective: To evaluate whether myo-inositol supplementation may reduce gestational diabetes mellitus (GDM) rate in overweight women.

Methods: In an open-label, randomized trial, myo-inositol (2?g plus 200?μg folic acid twice a day) or placebo (200?μg folic acid twice a day) was administered from the first trimester to delivery in pregnant overweight non-obese women (pre-pregnancy body mass index?≥?25 and?<?30 kg/m²). The primary outcome was the incidence of GDM.

Results: From January 2012 to December 2014, 220 pregnant women were randomized at two Italian University hospitals, 110 to myo-inositol and 110 to placebo. The incidence of GDM was significantly lower in the myo-inositol group compared to the placebo group (11.6% versus 27.4%, respectively, p?=?0.004). Myo-inositol treatment was associated with a 67% risk reduction of developing GDM (OR 0.33; 95% CI 0.15–0.70).

Conclusions: Myo-inositol supplementation, administered since early pregnancy, reduces GDM incidence in overweight non-obese women.     

Role of antioxidants in gestational diabetes mellitus and relation to fetal outcome: a randomized controlled trial

Objective: To examine the effect of antioxidant administration on the oxidative parameters in both blood and placental tissue and its relation to fetal outcome in women with GDM.

Patients and methods: Two-hundred pregnant women with gestational diabetes mellitus (GDM) were randomized into 2 groups, Group1 received 1 gram L-ascorbic acid per day and Group2 received placebo.

Results: The use of antioxidants significantly lower the needed insulin dose for blood sugar control (25.6?±?20.3 versus 40.5?±?23.7, respectively). In placental tissue homogenates, glutathione (GSH) was 49.6?±?5.9 versus 62.34?±?4.99, malondialdahyde (MDA) was 165.7?±?9.2 versus 264.15 ±?12, superoxide dismutase (SOD) was 0.3?±?0.3 versus 0.054?±?0.16 while catalase (CAT) was 14.06?±?2.4 versus 15.52?±?3.97 and glutathione peroxidase (GPx) was 14?±?4.1 versus 26.3?±?4.26 in antioxidant group compared to the control group (p?<?0.001). In maternal blood, GSH was 1.5?±?0.3 versus 0.74?±?0.088, CAT was 380.7?±?11 versus 325.44?±?21.8, GPx was 52.3?±?8.7 versus 75.82?±?6.84 and SOD was 188?±?15.3 versus 98.56?±?11.05 in antioxidant group compared to control group (p <?0.001). In neonatal blood, the level of MDA and SOD showed a statistically significant difference between antioxidants and control groups (4?±?0.7 versus 6.6 7 ±0.66 and1 8 8?±?15.3 versus 98.5?±?11.05, respectively) (p?<?0.001). The neonatal blood sugar after 1 and 2?hours of delivery was more stable in antioxidant group (56.7?±?10.9 versus 39.7?±?11.1 and 58.5?±?10.8 versus 41.7?±?13.1, respectively) (p <0.05). The neonates NICU admission was lower in antioxidant group (5 versus 11) (p <0.05).

Conclusion: The use of antioxidants markedly reverses the oxidative stresses in women with GDM with marked improvement on neonatal outcome.     

Association of first-trimester maternal lipid profiles and triglyceride-glucose index with the risk of gestational diabetes mellitus and large for gestational age newborn

Objective: To evaluate the association of maternal first-trimester plasma lipid profiles, fasting plasma glucose (FPG), and triglyceride (TyG) index with the risk of gestational diabetes mellitus (GDM) and large for gestational age (LGA) infant in Iranian mothers.

Methods: Nine hundred and fifty-four healthy pregnant women were prospectively followed till after delivery. Maternal fasting lipids and glucose concentration were measured at nine-week gestation on average. We used generalized linear models to calculate the relative risks and 95% confidence intervals.

Results: The incidence of GDM and LGA infants among our participants was 18.4% and 26.1%, respectively. There was a significant correlation between the increase in FPG, triglyceride, TG/HDL-C ratio, as well as TyG index with the risk of GDM and LGA infant. After adjusting for potential confounders, the relative risk of GDM in women in the top tertile of FPG, triglyceride (TG), triglyceride/high-density lipoprotein-cholesterol (TG/HDL-C) and TyG index was 4.2-, 4.2-, 3.9-, and 4.9-folds of its risk in women in the bottom tertile, respectively. Also after adjusting for GDM, the relative risk of LGA infants in women in the top tertile of FPG, TG, TG/HDL-C ratio and TyG index was 3.9-, 4.3-, 4.8-, and 5.3-folds of its risk in women in the bottom tertile, respectively.

Conclusions: Based on our findings, TyG index is more robust early predictors of GDM and LGA in Iranian women.     

Effect of exercise during pregnancy to prevent gestational diabetes mellitus: a systematic review and meta-analysis

Introduction: Exercise showed some potential in preventing gestational diabetes mellitus. However, the results remained controversial. We conducted a systematic review and meta-analysis to evaluate the impact of exercise during pregnancy on gestational diabetes mellitus.

Methods: PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the influence of exercise during pregnancy on gestational diabetes mellitus were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcome was the incidence of gestational diabetes mellitus. Meta-analysis was performed using random-effect model.

Results: Six RCTs involving 2164 patients were included in the meta-analysis. Compared with control intervention, exercise intervention was associated with significantly decreased incidence of gestational diabetes mellitus (Std. mean difference?=?0.59; 95%CI?=?0.39–.88; p?=?.01), but had no effect on gestational age at birth (Std. mean difference?=??0.03; 95%CI?=??0.12 to 0.07; p?=?.60), the number of preterm birth (OR?=?0.85; 95%CI?=?0.43–1.66; p?=?.63), glucose 2-h post-OGTT (Std. mean difference?=??1.02; 95%CI?=??2.75 to 0.71; p?=?.25), birth weight (Std. mean difference?=??0.13; 95%CI?=??0.26 to 0.01; p?=?.06), and Apgar score less than 7 (OR?=?.78; 95%CI?=?0.21–2.91; p?=?.71).

Conclusions: Compared to control intervention, exercise intervention could significantly decrease the risk of gestational diabetes mellitus, but showed no impact on gestational age at birth, preterm birth, glucose 2-h post-OGTT, birth weight, and Apgar score less than 7.     

Acupuncture for type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials

BackgroundAcupuncture has been used to treat type 2 diabetes (T2DM) for 2000 years and there are emerging clinical evidence and animal studies for its efficacy. However, we are unable to conclude the effectiveness and safety on this issue yet.ObjectivesTo assess the effects and safety of acupuncture for T2DM.MethodsWe systematically searched 5 databases and 2 clinical registry platforms from inception to 2018-6-4. RCTs for acupuncture or its variants compared with sham acupuncture or no acupuncture controls for T2DM were included. The primary outcomes were glycemic control and adverse events.ResultsA total of 21 studies, which comprised a total of 1943 participants, were included in the final meta-analysis. Compared with sham acupuncture or no acupuncture plus baseline treatments, acupuncture plus baseline treatments yield reduction in FBG(MD 1.21 mmol/l, 95%CI 1.56 to 0.87), 2 h BG(MD 2.13 mmol/l, 95%CI 2.79 to 1.46), HA1c (MD 1.12%, 95%CI 1.62 to 0.62). Our results also show acupuncture can improve blood lipids and blood pressure control, and reduce weight.ConclusionsAs one type of multifactorial intervention, acupuncture could be recommended as a supplementary treatment in the management of T2DM, especially in those with obesity or metabolic disorders. However, due to the small sample size, poor methodological quality of trials reviewed, the amount of evidence is not fully convincing. There is a need for well-planned, long-term studies.RegistrationInternational Prospective Register of Systematic Reviews (Number CRD42018094573).     

Preventing type 2 diabetes: public health implications for women with a history of gestational diabetes mellitus

There is now strong evidence that lifestyle modification can prevent or delay the development of type 2 diabetes mellitus in high-risk individuals. Women with gestational diabetes mellitus are at increased risk for type 2 diabetes and so are candidates for prevention programs. We review literature on type 2 diabetes risk in women with gestational diabetes, examine current recommendations for postpartum and long-term follow-up, and summarize findings from a 2007 expert-panel meeting. We found data to support that women with gestational diabetes have an increase in risk of type 2 diabetes comparable in magnitude with that of individuals with impaired glucose tolerance and/or impaired fasting glucose and that prevention interventions likely are effective in this population. Current recommendations from leading organizations on follow-up of women after delivery are conflicting and compliance is poor. Clinicians and public health workers face numerous challenges in developing intervention strategies for this population. Translation research will be critical in addressing this important public health issue.     

Screening for gestational diabetes mellitus by a model based on risk indicators: a prospective study

OBJECTIVE: This study was performed to prospectively evaluate a screening model for gestational diabetes mellitus on the basis of clinical risk indicators. STUDY DESIGN: In a prospective multicenter study with 5235 consecutive pregnant women, diagnostic testing with a 2-hour 75-g oral glucose tolerance test was routinely performed in women with risk indicators and offered to women without risk indicators as part of the study. RESULTS: Forty-four percent of the women underwent testing, 43% declined participation, 6% did not speak Danish, and 7% could not be contacted. By extrapolation of the results from tested women to the whole group in question, a 2.4% prevalence of gestational diabetes mellitus was calculated. Sensitivity and specificity of the model was 80.6 (73.7-87.6) and 64.8 (63.5-66.1), respectively (95% CIs). CONCLUSION: Under ideal conditions, sensitivity of the model was comparable with universal screening by fasting glucose or a 1-hour 50-g glucose challenge test. Both screening and diagnostic testing could be avoided in two thirds of all pregnant women.     

Efficacy of n-3 fatty acids supplementation on the prevention of pregnancy induced-hypertension or preeclampsia: A systematic review and meta-analysis

The efficacy of n-3 fatty acids supplementation on the prevention of pregnancy-induced hypertension or preeclampsia remains unclear. The aim of study was to examine the effect of supplementation with EPA, and/or DHA, and/or ALA during pregnancy on the pregnancy-induced hypertension or preeclampsia. A systematic search was performed on Scopus, PubMed, Web of Science (WoS), Cochrane Library, and Google scholar, which covered the period between 1991 and 2018. The clinical trials with any control groups (i.e. placebo or other supplementation) were selected. The whole process of meta-analysis and data analysis was done using Comprehensive Meta-Analysis (Version 2.0, Biostat). The searched keywords were: “Fatty Acids, Omega-3”, “n-3 Polyunsaturated Fatty Acid” “Eicosapentaenoic Acid”, “Docosahexaenoic Acids”, “n-3 Polyunsaturated Fatty Acid”, “n-3 PUFAs”, “alpha-Linolenic Acid”, “fish oil”, “Nuts”, “nutrient”, or their synonyms “pregnancy induced hypertension” and preeclampsia. In addition, some key journals, according to Scopus report and the references of the original and review articles, were manually searched for possible related studies. The meta-analysis of the 14 comparisons demonstrated that n-3 fatty acids supplementation played a protective role against the risk of preeclampsia (RR, 0.82; 95% CI, 0.70–0.97; p = 0.024; I2 = 19.0%). The analysis of the 10 comparisons revealed that n-3 fatty acid supplements for pregnant women did not mitigate the risk of pregnancy-induced hypertension (RR, 0.98; 95% CI, 0.90–1.07; p = 0.652; I2 = 0%). The n-3 fatty acid supplements are an effective strategy to prevent the incidence of preeclampsia in women with low-risk pregnancies.     

Association between intrahepatic cholestasis of pregnancy and risk of gestational diabetes and preeclampsia: a systematic review and meta-analysis

ABSTRACT

Objective

To investigate the association between intrahepatic cholestasis of pregnancy (ICP) and the risk of gestational diabetes mellitus (GDM) and preeclampsia via meta-analysis.     

Screening for gestational diabetes at antenatal booking in a Malaysian university hospital: the role of risk factors and threshold value for the 50-g glucose challenge test

BACKGROUND: The best method of screening for gestational diabetes (GDM) remains unsettled. The 50-g glucose challenge test (GCT) is used in a two-stage screening process but its best threshold value can vary according to population. AIMS: To evaluate the role of risk factors in conjunction with GCT and to determine an appropriate threshold for the one-hour venous plasma glucose with the GCT. METHOD: In a prospective study, 1600 women at antenatal booking without a history of diabetes mellitus or GDM filled a form on risk factors before GCT. Women who had GCT >or= 7.2 mmol/L underwent the 75-g oral glucose tolerance test (OGTT). GDM was diagnosed according to WHO (1999) criteria. RESULT: Thirty-five per cent had GCT >or= 7.2 mmol/L, 32.6% underwent OGTT and 34.5% of OGTT confirmed GDM. The GDM rate in our population was at least 11.4%. Examination of the receiver operator characteristic curve suggested that the best threshold value for the GCT in our population was >or= 7.6 mmol/L. Multivariable logistic regression demonstrated that only GCT >or= 7.6 mmol/L was an independent predictor for GDM (adjusted odds ratio 3.7: P < 0.001). After GCT, maternal age and anthropometry, OGTT during the third trimester, family history, obstetric history and glycosuria were not independent predictors of GDM. CONCLUSIONS: Risk factors were not independent predictors of GDM in women with GCT >or= 7.2 mmol/L. GCT threshold value >or= 7.6 mmol is appropriate for the Malaysian population at high risk of GDM.     

妊娠期糖尿病孕妇饮食处方初探

目的 观察简明饮食处方对妊娠期糖尿病病情控制的效果。方法 采用前瞻性类试验研究设计,将101例妊娠期糖尿病孕妇分为干预组和对照组,其中干预组孕妇按照简明饮食处方给予饮食指导,对照组采用普通饮食,比较两组孕妇血糖控制、体重增长及妊娠结局。结果 干预组孕妇的空腹和餐后血糖、妊娠末期体重及孕期体重增加、合并妊高征、巨大儿、低体重儿和新生儿低血糖等的发生,均显著低于对照组。结论该饮食处方对妊娠期糖尿病患者,有效实用。