Academy of Nutrition and Dietetics Gestational Diabetes Evidence-Based Nutrition Practice Guideline

Duarte-Gardea, María; Gonzales-Pacheco, Diana; Reader, Diane; Thomas, Alyce M.; Wang, Susan R.; Gregory, Rebecca; Piemonte, Tami A.; Thompson, Kyle L.; Moloney, Lisa

doi:10.1016/j.jand.2018.03.014

Cited by 71 publications

(139 citation statements)

References 43 publications

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“…In our study, pairwise meta-analysis and NMA results showed that nutrient supplementation significantly decreased FPG, serum insulin, and HOMA-IR compared with the effects of the placebo. According to the Academy of Nutrition and Dietetics, nutritional therapy is the basis of GDM therapy [39], and all individuals with prediabetes and any other type of diabetes should receive individualized nutritional therapy according to the condition. The NMA results showed that vitamin D is better than omega-3, zinc, and probiotics for decreasing FPG and that magnesium is better than probiotics for decreasing FPG.…”

Section: Discussionmentioning

confidence: 99%

Effects of Nutritional Strategies on Glucose Homeostasis in Gestational Diabetes Mellitus: A Systematic Review and Network Meta-Analysis

Jin

Sha

Dong

et al. 2020

Journal of Diabetes Research

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Background. Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy, and nutritional therapy is the basis of GDM treatment. However, the effects of different forms of nutritional supplementation on improving gestational diabetes are uncertain. Objective. We conducted a network meta-analysis to evaluate the effects of supplementation with different nutrients on glucose metabolism in women with GDM. Methods. We conducted a literature search using PubMed, EMBASE, and the Cochrane Library to identify randomized controlled trials (RCTs) comparing the differences between different nutritional strategies in women with GDM. The Cochrane tool was used to assess the risk of bias. Pairwise meta-analysis and network meta-analysis were used to compare and rank the effects of nutritional strategies for the improvement of fasting plasma glucose (FPG), serum insulin, and homeostasis model assessment-insulin resistance (HOMA-IR). Results. We included thirteen RCTs with a total of 754 participants. Compared with placebo, omega-3, magnesium, vitamin D, zinc, and probiotics were more beneficial for improving FPG, serum insulin, and HOMA-IR. Network analysis showed that vitamin D supplementation was superior to omega-3 (-3.64 mg/dL, 95% CI: -5.77 to -1.51), zinc (-5.71 mg/dL, 95% CI: -10.19 to -1.23), probiotics (-6.76 mg/dL, 95% CI: -10.02 to -3.50), and placebo (-12.13 mg/dL, 95% CI: -14.55 to -9.70) for improving FPG. Magnesium supplementation was more beneficial for decreasing serum insulin compared with probiotics (-5.10 μIU/mL, 95% CI: -9.32 to -0.88) and placebo (-7.80 μIU/mL; 95% CI-11.95, -3.65). Vitamin D was more effective than probiotics (-0.99, 95% CI: -1.84 to -0.14) and placebo (-1.80, 95% CI: -2.45 to -1.16) for improving HOMA-IR. Conclusion. Vitamin D supplementation significantly reduced FPG and regulated HOMA-IR. Magnesium supplementation was superior in decreasing serum insulin than supplementation with other nutrients. Nutrient supplementation seemed to have an effect on glucose homeostasis maintenance in patients with GDM and may be considered an adjunctive therapy.

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Section: Discussionmentioning

confidence: 99%

Effects of Nutritional Strategies on Glucose Homeostasis in Gestational Diabetes Mellitus: A Systematic Review and Network Meta-Analysis

Jin

Sha

Dong

et al. 2020

Journal of Diabetes Research

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“…In the long-term, women with GDM and their infants are at an increased risk of cardio-metabolic disorders and type 2 diabetes mellitus [ 5 ]. The primary intervention for GDM is lifestyle changes, including medical nutrition therapy provided by a qualified dietitian [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

An implementation science approach for developing and implementing a dietitian-led model of care for gestational diabetes: a pre-post study

Meloncelli

Barnett

Jersey

2020

BMC Pregnancy Childbirth

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Background There is strong evidence that women with gestational diabetes mellitus (GDM) who receive a minimum of three appointments with a dietitian may require medication less often. The aim of this study was to evaluate the impact of a dietitian-led model of care on clinical outcomes and to understand the utility of the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework as a prospective tool for implementation. Methods This was a pre-post intervention study measuring outcomes before-and-after changing a gestational diabetes (GDM) model of care and included women with GDM managed at a large, regional hospital in Queensland, Australia. The i-PARIHS framework was used to develop, implement and evaluate a dietitian-led model of care which increased dietetic input for women with GDM to a minimum of one initial education and two review appointments. The outcomes were adherence to the schedule of appointments, clinician perspective of the implementation process, pharmacotherapy use, gestational age at commencement of pharmacotherapy and birth weight. Pre- and post- comparisons of outcomes were made using t-tests and chi-squared tests. Results Adherence to the dietetic schedule of appointments was significantly increased from 29 to 82% (p < 0.001) but pharmacotherapy use also increased by 10% (p = 0.10). There were significantly more women in the post-intervention group who were diagnosed with GDM prior to 24 weeks gestation, a strong independent predictor of pharmacotherapy use. Infant birthweight remained unchanged. The i-PARIHS framework was used as a diagnostic tool and checklist in the model of care development phase; a facilitation tool during the implementation phase; and during the evaluation phase was used as a reflection tool to identify how the i-PARIHS constructs and their interactions that may have impacted on clinical outcomes. Conclusions The i-PARIHS framework was found to be useful in the development, implementation and evaluation of a dietitian-led model of care which saw almost 90% of women with GDM meet the minimum schedule of dietetic appointments.

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“…But there are also a large number of women who are not trying to change their behaviours 30. Quantitative studies related to GDM have provided some clinical guidance, such as the need for dietary management to effectively control blood glucose 31 32. However, there are many challenges in the process of self-management, and it is very difficult for women to maintain a reasonable blood glucose level 33…”

Section: Introductionmentioning

confidence: 99%

Experiences of pregnant women with gestational diabetes mellitus: a systematic review of qualitative evidence protocol

Wang

Liu

et al. 2020

BMJ Open

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IntroductionThe incidence of gestational diabetes mellitus (GDM) is increasing and an issue of global concern. GDM can cause severe adverse effects for pregnant women and their fetuses. This systematic review is proposed to explore women’s experiences during the pregnancy with GDM. This review will provide insights into the physical, psychological and social adaptation experiences of women with GDM that can help to identify challenges of glycaemic control and provide targeted care and interventions to improve maternal and child health.Methods and analysisThe databases we will search include English databases (ie, PubMed, CINAHL, Embase, the Cochrane Library, Web of Science, Joanna Briggs Institute (JBI) Database of Systematic Reviews, PsycINFO, OpenGrey and Deep Blue) and Chinese databases (ie, China Biology Medicine disc, China National Knowledge Infrastructure, and VIP Database for Chinese Technical Periodicals). Published qualitative evidence of life changes or experiences of the women with GDM will be searched. There will be no limits on publication year. Two reviewers will independently use the JBI Critical Appraisal Checklist for Qualitative Research for methodological validity prior to inclusion in this review. Any disagreements regarding article evaluation will be resolved through discussion or with a third reviewer. Data will be extracted using the standardised data extraction tool from JBI System for the Unified Management, Assessment and Review of Information. Synthesis will include in-depth reading of the original text and the discovery of the results, and then summarising similar categories for more advanced synthesised findings. The final synthesised findings will be graded according to the ConQual approach for establishing confidence.Ethics and disseminationThis study does not require ethical approval as primary data will not be collected. Results of this systematic review will be submitted to peer-reviewed international journals for publication and be presented in relevant international conferences.PROSPERO registration numberCRD42019132065.

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Academy of Nutrition and Dietetics Gestational Diabetes Evidence-Based Nutrition Practice Guideline

Cited by 71 publications

References 43 publications

Effects of Nutritional Strategies on Glucose Homeostasis in Gestational Diabetes Mellitus: A Systematic Review and Network Meta-Analysis

Effects of Nutritional Strategies on Glucose Homeostasis in Gestational Diabetes Mellitus: A Systematic Review and Network Meta-Analysis

An implementation science approach for developing and implementing a dietitian-led model of care for gestational diabetes: a pre-post study

Experiences of pregnant women with gestational diabetes mellitus: a systematic review of qualitative evidence protocol

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