Gestational diabetes mellitus: does an effective prevention strategy exist?

Abstract

The overall incidence of gestational diabetes mellitus (GDM) is increasing worldwide. Preventing pathological hyperglycaemia during pregnancy could have several benefits: a reduction in the immediate adverse outcomes during pregnancy, a reduced risk of long-term sequelae and a decrease in the economic burden to healthcare systems. In this Review we examine the evidence supporting lifestyle modification strategies in women with and without risk factors for GDM, and the efficacy of dietary supplementation and pharmacological approaches to prevent this disease. A high degree of heterogeneity exists between trials so a generalised recommendation is problematic. In population studies of dietary or combined lifestyle measures, risk of developing GDM is not improved and those involving a physical activity intervention have yielded conflicting results. In pregnant women with obesity, dietary modification might reduce fetal macrosomia but in these patients, low compliance and no significant reduction in the incidence of GDM has been observed in trials investigating physical activity. Supplementation with probiotics or myoinositol have reduced the incidence of GDM but confirmatory studies are still needed. In randomized controlled trials, metformin does not prevent GDM in certain at-risk groups. Given the considerable potential for reducing disease burden, further research is needed to identify strategies that can be easily and effectively implemented on a population level.

Adolescence and the next generation

“…Antenatal interventions to prevent these consequences appear to have limited benefits. Exercise has the potential to promote greater maternal insulin sensitivity, but its benefits during pregnancy are debated 113,114 . A recent Cochrane review failed to demonstrate that dietary and lifestyle (including exercise) interventions for women with gestational diabetes mellitus restored glycaemic control or prevented adverse effects for women or their babies 113,115 .…”

“…Exercise has the potential to promote greater maternal insulin sensitivity, but its benefits during pregnancy are debated 113,114 . A recent Cochrane review failed to demonstrate that dietary and lifestyle (including exercise) interventions for women with gestational diabetes mellitus restored glycaemic control or prevented adverse effects for women or their babies 113,115 . Although two reports have suggested some modest benefits of antenatal exercise in obese women, its late timing in those with no regular pattern of physical activity before pregnancy seems likely to bring limited benefits 116,117 .…”

The effect of a prenatal lifestyle intervention on glucose metabolism: results of the Norwegian Fit for Delivery randomized controlled trial

“…Gestational diabetes mellitus (GDM) is defined as hyperglycemia first detected during pregnancy, ultimately due to insufficient insulin production relative to the physiologic insulin resistance of pregnancy [5]. The level of maternal glucose that constitutes a risk for mother and fetus is much debated, and there is currently no international consensus on glucose thresholds for the diagnosis of GDM [6–8]. Effective antenatal lifestyle intervention to improve maternal glucose metabolism and reduce GDM risk is in high demand [9].…”

“…Trials published to date indicate that prenatal interventions combining diet and exercise reduce gestational weight gain but not GDM risk [10–13]. Few trials of antenatal diet and exercise have reported levels of glucose, insulin and insulin resistance [8]. These levels may give information about alterations in maternal metabolism that are not disclosed by simply reporting the incidence of GDM.…”

Circulating LncRNA Serve as Fingerprint for Gestational Diabetes Mellitus Associated with Risk of Macrosomia

“…Insulin treatment was administrated when dietary control could not achieve this goal. The babies of GDM group were diagnosed as macrosomia when their birth-weight was equal to or exceeded 4000 g [14,15]. Controls were from healthy volunteers without any health problems during their health checkups at the at the Obstetrics and Gynecology Department in Wuxi Maternity and Child Health Hospital.…”