Nutritional and Exercise-Focused Lifestyle Interventions and Glycemic Control in Women with Diabetes in Pregnancy: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Abstract

Diabetes disrupts one in six pregnancies, bestowing immediate and long-term health risks to mother and child. Diet and exercise are commonly prescribed to control dysglycemia, but their effectiveness across sub-populations and types of diabetes (type-1; type-2; or gestational diabetes mellitus, GDM) is uncertain. Therefore, a systematic review and meta-analysis on the effect of diet and/or exercise on glycemia in pregnant women with diabetes was conducted. Random effects models were used to evaluate effect sizes across studies and anticipated confounders (e.g., age, ethnicity, BMI). Of the 4845 records retrieved, 26 studies (8 nutritional supplements, 12 dietary, and 6 exercise interventions) were included. All studies were conducted in patients with GDM. Overall, supplement- and exercise-based interventions reduced fasting glucose (−0.30 mmol/L; 95% CI = −0.55, −0.06; p = 0.02; and 0.10 mmol/L; 95% CI = −0.20, −0.01; p = 0.04); and supplement- and diet-based interventions reduced HOMA-IR (−0.40; 95% CI = −0.58, −0.22; p < 0.001; and −1.15; 95% CI = −2.12, −0.17; p = 0.02). Subgroup analysis by confounders only confirmed marginal changed effect sizes. Our results suggest a favorable role of certain nutritional supplements, diet, and exercise practices on glycemia in women with GDM and underline a lack of evidence in ~20% of other diabetes-related pregnancies (i.e., women with pre-existing diabetes).

Weight Management during Pregnancy and the Postpartum Period in Women with Gestational Diabetes Mellitus: A Systematic Review and Summary of Current Evidence and Recommendations

“…Of the ten systematic reviews included in the evidence extraction, there were one from the Cochrane database [47], five from the MEDLINE database [48][49][50][51][52], three from the CINAHL database [53][54][55], and one from the Embase database [56]. One study was a review of systematic reviews [47], one study included both randomized controlled trials and observational studies [53], and the original study for all other studies was randomized controlled trials [48][49][50][51][52][54][55][56]. Six systematic reviews were of women with GDM, two of which focused on lifestyle interventions [47,54], and four of which focused on dietary changes only [50][51][52]55].…”

Recent progress in metabolic reprogramming in gestational diabetes mellitus: a review

“…Exercise interventions, including aerobic and resistance exercise, have also received increasing attention ( 71 ). Aerobic or resistance exercise positively affects blood glucose levels, adverse pregnancy outcomes and insulin use in patients with GDM ( 72 – 74 ). More multi-center, large-sample, high-quality RCTs should be conducted to clarify the optimal type, frequency, and duration of exercise and other factors to determine prevention strategies for GDM.…”

Intense Locomotion Enhances Oviposition in the Freshwater Mollusc Lymnaea stagnalis: Cellular and Molecular Correlates

“…Behavioural modulation of reproductive functions is an important field in modern medicine and developmental biology. In humans, the influence of physical activity on male [ 1 ] and female [ 2 ] fertility, embryonic gestation [ 3 ] and offspring health [ 4 , 5 , 6 ] is being actively studied. However, little is known about the mechanisms underlying this influence and the possible adaptive significance.…”