Comparing outcomes of nutrition therapy, insulin and oral anti-diabetics in managing diabetes mellitus in Pregnancy: Retrospective study and review of current guidelines

Sunjaya, Anthony Paulo

doi:10.1016/j.dsx.2018.08.024

Cited by 3 publications

(7 citation statements)

References 23 publications

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“…NT as part of PC was considered in nine [6,9,10,15,18,[25][26][27][28] of the 15 included studies. Of these, only the study by Silva et al [26] reported an average of five appointments with the nutritionist.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Fourteen of 15 studies evaluated glycemic control (n=9096) [6,[9][10][11]15,18,[24][25][26][27][28][30][31][32]. Of these, six studies considered the oral glucose tolerance test (OGTT) as a tool to assess glycemic control, measured in fasting, 1h, and 2h postprandial with 75g of glucose [9,11,18,24,31,32].…”

Section: Glycemic Controlmentioning

confidence: 99%

“…Similarly, Allen et al [29] observed lower rates of preeclampsia in the group that started PC in the first trimester when compared to the groups that did not [30] HbA1c was used to assess glycemic control. Sunjaya and Sunjaya [10] evaluated glycemic control through HbA1c and fasting and 2h postprandial glucose. In the study by Carter et al [25] glycemic control was assessed through fasting glucose and HbA1c.…”

Section: Glycemic Controlmentioning

confidence: 99%

“…Prematurity was evaluated in six studies (n=40 118) [10,24,25,27,29,32] and of these, only three associated it with PC (n=39 461) [25,27,29]. Carter et al [25] observed 59% less probability of premature birth among women who received 15 or more PC appointments when compared to those who received eight or more appointments.…”

Section: Prematuritymentioning

confidence: 99%

“…To protect the health of pregnant women and their newborns from the negative effects of HIP, prenatal care (PC) has been recognized as an essential factor, as it allows timely interventions on possible complications [5][6][7][8] commonly associated with this condition, such as lack of glycemic control [9,10] and the birth of macrosomic or large for gestational age (LGA) newborns [11][12][13]. Therefore, prenatal health care is crucial to maximize the potential for a healthy life of both the mother and the fetus and the inadequacy of this assistance has been related to higher rates of maternal and infant morbidity and mortality [8, 14,15].…”

Section: Introductionmentioning

confidence: 99%

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Effect of Prenatal Care on Perinatal Outcomes of Pregnant Women with Diabetes Mellitus: A Systematic Review

da Silva,

Zajdenverg,

Keating

et al. 2024

Yale J Biol Med

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Objective: to evaluate the effect of prenatal care (PC) on perinatal outcomes of pregnant women with diabetes mellitus (DM). Methods: systematic review developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines and conducted through the population, intervention, control, and outcomes (PICO) strategy. Clinical trials and observational studies were selected, with adult pregnant women, single-fetus pregnancy, diagnosis of DM, or gestational DM and who had received PC and/or nutritional therapy (NT). The search was carried out in PubMed, Scopus, and BIREME databases. The quality of the studies was evaluated using the tools of the National Heart, Lung and Blood Institute-National Institutes of Health (NHLBI-NIH). Results: We identified 5972 records, of which 15 (n=47 420 pregnant women) met the eligibility criteria. The most recurrent outcomes were glycemic control (14 studies; n=9096 participants), hypertensive disorders of pregnancy (2; n=39 282), prematurity (6; n=40 163), large for gestational age newborns (4; n=1556), fetal macrosomia (birth weight >4kg) (6; n=2980) and intensive care unit admission (4; n=2022). Conclusions: The findings suggest that PC interferes with the perinatal outcome, being able to reduce the risks of complications associated with this comorbidity through early intervention, especially when the NT is an integral part of this assistance.

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Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Glycemic Controlmentioning

confidence: 99%

Section: Glycemic Controlmentioning

confidence: 99%

Section: Prematuritymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of Prenatal Care on Perinatal Outcomes of Pregnant Women with Diabetes Mellitus: A Systematic Review

da Silva,

Zajdenverg,

Keating

et al. 2024

Yale J Biol Med

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Insulin Use During Gestational and Pre-existing Diabetes in Pregnancy: A Systematic Review of Study Design

Castorino,

Osumili,

Lakiang

et al. 2024

Diabetes Ther

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Introduction Insulin is the first-line pharmacologic therapy for women with diabetes in pregnancy. However, conducting well-designed randomized clinical trials (RCTs) and achieving recommended glycemic targets remains a challenge for this unique population. This systematic literature review (SLR) aimed to understand the evidence for insulin use in pregnancy and the outcome metrics most often used to characterize its effect on glycemic, maternal and fetal outcomes in gestational diabetes mellitus (GDM) and in pregnant women with diabetes. Methods An SLR was conducted using electronic databases in Medline, EMBASE via Ovid platform, evidence-based medicine reviews (2010–2020) and conference proceedings (2018–2019). Studies were included if they assessed the effect of insulin treatment on glycemic, maternal or fetal outcomes in women with diabetes in pregnancy. Studies on any type of diabetes other than gestational or pre-existing diabetes as well as non-human studies were excluded. Results In women diagnosed with GDM or pre-existing diabetes, most studies compared treatment of insulin with metformin ( n = 35) followed by diet along with lifestyle intervention ( n = 24) and glibenclamide ( n = 12). Most studies reporting on glycemic outcomes compared insulin with metformin ( n = 22) and glibenclamide ( n = 4). Fasting blood glucose was the most reported clinical outcome of interest. Among the studies reporting maternal outcomes, method of delivery and delivery complications were most commonly reported. Large for gestational age, stillbirth and perinatal mortality were the most common fetal outcomes reported. Conclusion This SLR included a total of 108 clinical trials and observational studies with diverse populations and treatment arms. Outcomes varied across the studies, and a lack of consistent outcome measures to manage diabetes in pregnant women was observed. This elucidates a need for global consensus on study design and standardized clinical, maternal and fetal outcomes metrics. Supplementary Information The online version contains supplementary material available at 10.1007/s13300-024-01541-6.

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Nutritional Strategies Prescribed During Pregnancy and Weight Gain in Women with Gestational Diabetes Mellitus: A Systematic Review of Observational Studies

Araújo,

Lucena,

Fontes

et al. 2024

Nutrients

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Background/Objectives: This systematic review aims to identify diets related to weight gain in pregnant women diagnosed with gestational diabetes mellitus (GDM). Methods: This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and its protocol was registered on the International Prospective Register of Systematic Reviews (CRD42023432322). The searches used the medical subject headings in the PubMed/MEDLINE, Web of Science, Scopus, and EMBASE databases. Studies were selected, and data were extracted by three researchers. The Newcastle–Ottawa Scale (NOS) and the Joanna Briggs Institute (JBI) tool were used to assess methodological quality. Results: Six articles were included, most of them of the cohort type, with nutritional strategies lasting 2–15 weeks for overweight/obese women, based on the “macronutrient-adjusted diet” and “calorie-adjusted diet”. Only one study addressed dietary counseling in weight management, and none considered the dietary pattern. The gestational weight gain was 4.91–13.8 kg, and a lower weight gain was found in all studies that used the “macronutrient-adjusted diet” nutritional strategy. However, it did not meet the gestational weight gain targets. Conclusions: Despite the limited number of studies examining the impact of nutritional strategies on weight gain in women with GDM, some research suggests that diets focused on macronutrient adjustment may lead to less weight gain but are not adequate. Therefore, future studies are needed to evaluate which type of nutritional strategies ensure weight gain control during pregnancy.

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Comparing outcomes of nutrition therapy, insulin and oral anti-diabetics in managing diabetes mellitus in Pregnancy: Retrospective study and review of current guidelines

Cited by 3 publications

References 23 publications

Effect of Prenatal Care on Perinatal Outcomes of Pregnant Women with Diabetes Mellitus: A Systematic Review

Effect of Prenatal Care on Perinatal Outcomes of Pregnant Women with Diabetes Mellitus: A Systematic Review

Insulin Use During Gestational and Pre-existing Diabetes in Pregnancy: A Systematic Review of Study Design

Nutritional Strategies Prescribed During Pregnancy and Weight Gain in Women with Gestational Diabetes Mellitus: A Systematic Review of Observational Studies

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