Community-based non-pharmacological interventions for pregnant women with gestational diabetes mellitus: a systematic review.
Study Goal
The researchers aimed to evaluate the effectiveness of community-based non-pharmacological interventions, including walking, for managing gestational diabetes mellitus (GDM).
Results Summary
Postprandial blood glucose levels were better improved by regular supervised exercise plus daily brisk walks or a daily walking intervention compared to routine obstetric care or no treatment. However, the effects of exercise/physical activity programs were inconsistent for other outcomes.
Population
Pregnant women with gestational diabetes mellitus (GDM).
Effective Dosage
Daily brisk walks or a daily walking intervention (specific duration/frequency not detailed).
Duration
Not specified in the abstract.
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
Self-management programmes | increase | self-efficacy | pregnant women with GDM | - | more effective than routine care in improving | #1 |
Self-management programmes | decrease | two-hour postprandial blood glucose | pregnant women with GDM | - | more effective than routine care in improving | #2 |
Self-management programmes | increase | lifestyle behaviours | pregnant women with GDM | - | more effective than routine care in improving | #3 |
Self-management programmes | no change | infant birth weight | pregnant women with GDM | - | as effective as routine care in improving | #4 |
Self-management programmes | decrease | fasting blood glucose | pregnant women with GDM | - | superior to or as effective as usual care in improving | #5 |
Self-management programmes | increase | blood glucose control | pregnant women with GDM | - | superior to or as effective as usual care in improving | #6 |
Self-management programmes | decrease | glycated haemoglobin | pregnant women with GDM | - | superior to or as effective as usual care in improving | #7 |
Self-management programmes | decrease | macrosomia | pregnant women with GDM | - | superior to or as effective as usual care in improving | #8 |
Self-management programmes | decrease | preterm delivery | pregnant women with GDM | - | superior to or as effective as usual care in improving | #9 |
Medical nutrition/diet therapy | decrease | postprandial blood glucose levels | pregnant women with GDM | - | more effective than usual care in improving | #10 |
regular supervised exercise plus daily brisk walks | decrease | postprandial blood glucose levels | pregnant women with GDM | - | better improved | #11 |
daily walking intervention | decrease | postprandial blood glucose levels | pregnant women with GDM | - | better improved | #12 |
exercise/physical activity programmes | no change | other outcomes | pregnant women with GDM | - | effects were mostly inconsistent | #13 |
Diet and exercise | decrease | maternal weight gain | pregnant women with GDM | - | superior to diet alone in reducing | #14 |
Diet and exercise | no change | other pregnancy and foetal outcomes | pregnant women with GDM | - | similar outcomes | #15 |
calcium and vitamin D supplementation | no change | other outcomes | pregnant women with GDM | - | limited or conflicting evidence was found | #16 |
continuous glucose monitoring intervention | no change | other outcomes | pregnant women with GDM | - | limited or conflicting evidence was found | #17 |
Community-based non-pharmacological interventions | increase | - | pregnant women with GDM | - | more effective than placebo | #18 |
Community-based non-pharmacological interventions | increase | - | pregnant women with GDM | - | more or as effective as usual care | #19 |
BACKGROUND: Non-pharmacological interventions are the first line of Gestational diabetes mellitus (GDM) management. Community-based interventions are cheaper, more accessible, with higher patient satisfaction. OBJECTIVES: To systematically review community-based non-pharmacological interventions and evaluate their effectiveness for GDM. SEARCH STRATEGY: Twelve bibliographic databases and reference list of related studies from inception until January 2022. SELECTION CRITERIA: All primary studies of community-based non-pharmacological interventions for GDM reported in English which investigated any behavioural or clinical outcome(s). DATA COLLECTION AND ANALYSIS: Data were extracted using modified Cochrane's data extraction template. Studies were evaluated using Cochrane Collaboration's risk of bias tool. Narrative synthesis was used to summarise findings. This study is registered with PROSPERO (CRD42021257634). MAIN RESULTS: Twenty-seven studies involving 6,242 pregnant women with GDM investigated self-management programmes, medical nutrition/diet therapy, exercise/physical activity, combined diet and exercise, calcium plus vitamin D supplementation, and continuous glucose monitoring. Self-management programmes were more effective than routine care in improving self-efficacy, two-hour postprandial blood glucose, and lifestyle behaviours but were as effective as routine care in improving infant birth weight. Self-management programmes were superior to or as effective as usual care in improving fasting blood glucose, blood glucose control, glycated haemoglobin, macrosomia, and preterm delivery. Medical nutrition/diet therapy was more effective than usual care in improving postprandial blood glucose levels. Postprandial blood glucose levels were better improved by regular supervised exercise plus daily brisk walks or a daily walking intervention than routine obstetric care or no treatment. The effects of exercise/physical activity programmes were mostly inconsistent for other outcomes. Diet and exercise were superior to diet alone in reducing maternal weight gain although there were similar outcomes for other pregnancy and foetal outcomes. Limited or conflicting evidence was found for other outcomes and interventions including calcium and vitamin D supplementation and continuous glucose monitoring intervention. CONCLUSIONS: Community-based non-pharmacological interventions are more effective than placebo; and are more or as effective as usual care. Self-management programmes and medical nutrition/diet therapy had the most promising GDM outcomes. FUNDING: There was no funding for this study. The study design, data collection, data analysis and interpretation, and writing of this manuscript were not influenced externally by any funder.