Dietary Intervention in Patients With Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis of Randomized Clinical Trials on Maternal and Newborn Outcomes
Dietary Intervention in Patients With Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis of Randomized Clinical Trials on Maternal and Newborn Outcomes
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DOI：
10.2337/dc14-1530
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发表时间：
2014-12-01
期刊：
影响因子：
16.2
通讯作者：
Azevedo, Mirela Jobim
中科院分区：
文献类型：
--
作者：
Viana, Luciana Vercoza;Gross, Jorge Luiz;Azevedo, Mirela Jobim
合理饮食是妊娠期糖尿病（GDM）患者的基础治疗，但其对孕产妇和新生儿结局的作用几乎没有研究。本研究的目的是分析饮食干预对孕妇或新生儿结局GDM.RESEARCH设计和METHODSA患者的有效性的系统评价和荟萃分析的随机临床试验（RCT）的饮食干预在GDM或妊娠高血糖进行。MEDLINE、Embase、ClinicalTrials。gov、科克伦和Scopus检索至2014年3月。主要评价的母体结局是使用胰岛素的患者比例和剖宫产比例;新生儿结局是巨大儿和低血糖的比例和新生儿体重。来自1,170项研究的9项RCT，包括884名年龄31.5岁（28.7-33.2），妊娠27.4周（24.1-30.3）的女性，符合条件。我们根据饮食干预的类型将RCT分为：低血糖指数（GI）（n = 4; 257例患者）、总能量限制（n = 2; 425例患者）、低碳水化合物（n = 2; 182例患者）和其他（n = 1; 20例患者）。与对照饮食相比，低GI饮食降低了使用胰岛素的患者比例（相对风险0.767 [95% CI 0.597，0.986]; P = 0.039）和新生儿出生体重（体重平均差异2161.9 g [95% CI 2246.4，277.4]; P = 0.000）。总限制和低碳水化合物饮食并没有改变无论是产妇或新生儿outcomes.CONCLUSIONSA低GI饮食与胰岛素使用频率较低，出生体重较低，比对照饮食，这表明它是最合适的饮食干预规定GDM患者。
OBJECTIVEDiet is the cornerstone treatment of patients with gestational diabetes mellitus (GDM), but its role inmaternal and newborn outcomes has been scarcely studied. The purpose of this study was to analyze the efficacy of dietary interventions on maternal or newborn outcomes in patients with GDM.RESEARCH DESIGN AND METHODSA systematic review and meta-analysis of randomized clinical trials (RCTs) of dietary intervention in GDM or pregnancy with hyperglycemia was performed. MEDLINE, Embase, ClinicalTrials. gov, Cochrane, and Scopus were searched through to March 2014. The main evaluated maternal outcomes were proportion of patients using insulin and proportion of cesarean delivery; the newborn outcomes were proportion of macrosomia and hypoglycemia and newborn weight.RESULTSFrom 1,170 studies, nine RCTs, including 884 women aged 31.5 years (28.7-33.2) with 27.4 weeks (24.1-30.3) of gestation, were eligible. We divided the RCTs according to the type of dietary intervention: low glycemic index (GI) (n = 4; 257 patients), total energy restriction (n = 2; 425 patients), low carbohydrates (n = 2; 182 patients), and others (n = 1; 20 patients). Diet with low GI reduced the proportion of patients who used insulin (relative risk 0.767 [95% CI 0.597, 0.986]; P = 0.039) and the newborn birth weight (weight mean differences 2161.9 g [95% CI 2246.4, 277.4]; P = 0.000) as compared with control diet. Total restriction and low carbohydrate diets did not change either maternal or newborn outcomes.CONCLUSIONSA low GI diet was associated with less frequent insulin use and lower birth weight than control diets, suggesting that it is the most appropriate dietary intervention to be prescribed to patients with GDM.