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Cited by 149Gestational Diabetes Research and ManagementDiabetes, Cardiovascular Risks, and LipoproteinsPregnancy and Medication Impact

Interventions to prevent women from developing gestational diabetes mellitus: an overview of Cochrane Reviews

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Griffith, Rebecca J, Alsweiler, Jane, Moore, Abigail E, Brown, Stephen, Middleton, Philippa, Shepherd, Emily, Crowther, Caroline A·2020·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd012394.pub3PMC PMC7388385
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Abstract

BACKGROUND: The prevalence of gestational diabetes mellitus (GDM) is increasing, with approximately 15% of pregnant women affected worldwide, varying by country, ethnicity and diagnostic thresholds. There are associated short- and long-term health risks for women and their babies. OBJECTIVES: We aimed to summarise the evidence from Cochrane systematic reviews on the effects of interventions for preventing GDM. METHODS: We searched the Cochrane Database of Systematic Reviews (6 August 2019) with key words 'gestational diabetes' OR 'GDM' to identify reviews pre-specifying GDM as an outcome. We included reviews of interventions in women who were pregnant or planning a pregnancy, irrespective of their GDM risk status. Two overview authors independently assessed eligibility, extracted data and assessed quality of evidence using ROBIS and GRADE tools. We assigned interventions to categories with graphic icons to classify the effectiveness of interventions as: clear evidence of benefit or harm (GRADE moderate- or high-quality evidence with a confidence interval (CI) that did not cross the line of no effect); clear evidence of no effect or equivalence (GRADE moderate- or high-quality evidence with a narrow CI crossing the line of no effect); possible benefit or harm (low-quality evidence with a CI that did not cross the line of no effect or GRADE moderate- or high-quality evidence with a wide CI); or unknown benefit or harm (GRADE low-quality evidence with a wide CI or very low-quality evidence). MAIN RESULTS: We included 11 Cochrane Reviews (71 trials, 23,154 women) with data on GDM. Nine additional reviews pre-specified GDM as an outcome, but did not identify GDM data in included trials. Ten of the 11 reviews were judged to be at low risk of bias and one review at unclear risk of bias. Interventions assessed included diet, exercise, a combination of diet and exercise, dietary supplements, pharmaceuticals, and management of other health problems in pregnancy. The quality of evidence ranged from high to very low. Diet Unknown benefit or harm: there was unknown benefit or harm of dietary advice versus standard care, on the risk of GDM: risk ratio (RR) 0.60, 95% CI 0.35 to 1.04; 5 trials; 1279 women; very low-quality evidence. There was unknown benefit or harm of a low glycaemic index diet versus a moderate-high glycaemic index diet on the risk of GDM: RR 0.91, 95% CI 0.63 to 1.31; 4 trials; 912 women; low-quality evidence. Exercise Unknown benefit or harm: there was unknown benefit or harm for exercise interventions versus standard antenatal care on the risk of GDM: RR 1.10, 95% CI 0.66 to 1.84; 3 trials; 826 women; low-quality evidence. Diet and exercise combined Possible benefit: combined diet and exercise interventions during pregnancy versus standard care possibly reduced the risk of GDM: RR 0.85, 95% CI 0.71 to 1.01; 19 trials; 6633 women; moderate-quality evidence. Dietary supplements Clear evidence of no effect: omega-3 fatty acid supplementation versus none in pregnancy had no effect on the risk of GDM: RR 1.02, 95% CI 0.83 to 1.26; 12 trials; 5235 women; high-quality evidence. Possible benefit: myo-inositol supplementation during pregnancy versus control possibly reduced the risk of GDM: RR 0.43, 95% CI 0.29 to 0.64; 3 trials; 502 women; low-quality evidence. Possible benefit: vitamin D supplementation versus placebo or control in pregnancy possibly reduced the risk of GDM: RR 0.51, 95% CI 0.27 to 0.97; 4 trials; 446 women; low-quality evidence. Unknown benefit or harm: there was unknown benefit or harm of probiotic with dietary intervention versus placebo with dietary intervention (RR 0.37, 95% CI 0.15 to 0.89; 1 trial; 114 women; very low-quality evidence), or probiotic with dietary intervention versus control (RR 0.38, 95% CI 0.16 to 0.92; 1 trial; 111 women; very low-quality evidence) on the risk of GDM. There was unknown benefit or harm of vitamin D + calcium supplementation versus placebo (RR 0.33, 95% CI 0.01 to 7.84; 1 trial; 54 women; very low-quality evidence) or vitamin D + calcium + other minerals versus calcium + other minerals (RR 0.42, 95% CI 0.10 to 1.73; 1 trial; 1298 women; very low-quality evidence) on the risk of GDM. Pharmaceutical Possible benefit: metformin versus placebo given to obese pregnant women possibly reduced the risk of GDM: RR 0.85, 95% CI 0.61 to 1.19; 3 trials; 892 women; moderate-quality evidence. Unknown benefit or harm:eight small trials with low- to very low-quality evidence showed unknown benefit or harm for heparin, aspirin, leukocyte immunisation or IgG given to women with a previous stillbirth on the risk of GDM. Management of other health issues Clear evidence of no effect: universal versus risk based screening of pregnant women for thyroid dysfunction had no effect on the risk of GDM: RR 0.93, 95% CI 0.70 to 1.25; 1 trial; 4516 women; moderate-quality evidence. Unknown benefit or harm: there was unknown benefit or harm of using fractional exhaled nitrogen oxide

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  • A recent overview of Cochrane Reviews concluded an absence of effect and low quality of available evidence.

    “A recent overview of Cochrane Reviews [8] concludes an absence of effect and low quality of the available evidence.”

    From A systematic review and meta-analysis of exercise-based intervention to prevent gestational diabetes in women with overweight or obesity (2025) · cites this paper as [8]

    The Discussion (page unavailable) says no intervention had clear evidence of benefit or harm and calls for further high-quality evidence, supporting the claim's concern about uncertain evidence. It does not conclude that interventions have no effect: it identifies several with possible benefit. 'No clear evidence of an effect' is not the same as an absence of effect. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • An overview of Cochrane reviews found effects for preventing GDM only for combined diet and exercise during pregnancy and supplementation with myo-inositol, vitamin D and metformin, with low to moderate quality evidence.

    “The researchers found effects only for combined diet and exercise interventions during pregnancy and supplementation with myo-inositol, vitamin D and treatment with metformin, but the evidence was of low to moderate quality.”

    From A global view of hypertensive disorders and diabetes mellitus during pregnancy (2022) · cites this paper as [247]

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Authors
Griffith, R. J., Alsweiler, J., Moore, A. E., Brown, S., Middleton, P., Shepherd, E., & Crowther, C. A.
Affiliations
  • University of Auckland (NZ)
  • Auckland University of Technology (NZ)
  • South Australian Health and Medical Research Institute (AU)
  • The University of Adelaide (AU)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2020-06-11
Volume
2020
Issue
9
Pages
CD012394-CD012394
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd012394.pub3
PMC
PMC7388385
OpenAlex
W2945180025
Cited by
149
References
217
Citations by year
2026: 9 · 2025: 21 · 2024: 30 · 2023: 25 · 2022: 32 · 2021: 21 · 2020: 11
FWCI
2.62
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
Keywords
gestational diabetes mellitus, dietary recommendations, low glycemic index diet, exercise during pregnancy, dietary supplements, metformin, lifestyle intervention, maternal and neonatal outcomes, pregnancy risk factors, risk of bias, quality of evidence, GRADE, relative risk, risk difference, number needed to harm, number needed to treat, number needed to benefit
MeSH terms
Systematic Reviews as Topic, Diet, Diabetic, Female, Humans, Hypoglycemic Agents, Inositol, Metformin, Pregnancy, Vitamin B Complex, Vitamin D, Vitamins, Exercise, Fatty Acids, Omega-3, Diabetes, Gestational, Dietary Supplements, Probiotics

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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