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Community-based non-pharmacological interventions for pregnant women with gestational diabetes mellitus: a systematic review.

BMC women's health
January 1, 1970
Chinonso Nwamaka Igwesi-Chidobe et al. (4 authors)
Systematic ReviewJournal ArticleHuman Study
Study Details

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

Extracted Claims (19)
InterventionDirectionEndpointPopulationDosageImpactClaim #
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
Abstract

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.

Medical Subject Headings (MeSH)
PregnancyInfantInfant, NewbornHumansFemaleDiabetes, GestationalPregnant PeopleBlood GlucoseCalciumBlood Glucose Self-MonitoringVitamin D
Study Links
Quality Scores
SafetyNot Assessed
Efficacy75/10
Quality85/10
Citation Metrics
Total Citations8
Citations/Year2.7
Relative Citation Ratio1.46
NIH Percentile64.1%
Research Impact Scores
APT Score0.75
Weight Score1.69
Normalized Score0.67
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