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

Abstract

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.

WITHDRAWN: Association of Maternal Serum Zinc, Copper and Magnesium Levels, Pre-pregnancy Body Mass Index and Gestational Weight Gain Patterns With the Risk of Gestational Diabetes Mellitus Among Third-trimester Pregnant Women: a Cross-sectional Study

“…Mg supplementation has been reported to reduce the risk of GDM in hypomagnesemia pregnant women [59]. A recent meta-analysis indicated that Mg supplementation was far more effective than other nutrients supplementation in maintaining glucose metabolic homeostasis and decreasing serum insulin in women with GDM [60]. Mg is required in multiple steps of the insulin-signaling pathways, and the depletion of it can affect the process of glucose metabolism.…”

Diet and Pre-Intervention Washout Modifies the Effects of Probiotics on Gestational Diabetes Mellitus: A Comprehensive Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Although the presence of heterogeneity was substantial, the point estimates for the majority of the included studies were in the same direction favoring probiotics. Our findings on FPG corroborated the previous meta-analyses [ 27 , 35 , 37 , 38 , 44 ] that reported the effects of probiotics on glycemic outcomes in GDM. By contrast, Han et al [ 43 ] reported no significant reduction in FPG after probiotics supplementation in women with GDM.…”

“…Previous meta-analyses explored the effects of probiotic intervention on glycemic control [35][36][37][38][39][40][41][42], and limited meta-analyses analyzed lipid metabolism [39,40,43,44], inflammatory [27,44], oxidative stress [27,44], and pregnancy outcomes in pregnant women with GDM [41,43,44]. The majority of these reviews suggested that probiotic supplementation has beneficial effects on glycemic outcomes.…”

Magnesium in the prevention of gestational complications in women with pregnancy induced in the art cycle

“…Мета-аналіз 2020 р. [24] показав, що добавки магнію корисніші для зниження сироваткового інсуліну в порівнянні з пробіотиками (-5,10 мМО/мл, 95% довірчий інтервал (ДІ) від -9,32 до -0,88) і плацебо (-7,80 мМО/мл, 95% ДІ від -9,32 до -0,88).…”