Lifestyle changes reduce complications in babies and mothers in Gestational Diabetes

Lifestyle changes (including as a minimum healthy eating, physical activity, and self-monitoring of blood sugar levels) was associated with possible health improvements for women and their babies during gestational diabetes mellitus(GDM), reports the findings of Cochrane systematic reviews.

GDM can occur in mid-to-late pregnancy. High blood glucose levels (hyperglycemia) may cause possible harm to both the woman and her baby's health in the short- and long-term.

Martis R and his co-workers performed Cochrane overview to provide a summary of the effects of interventions for women who develop diabetes during pregnancy (gestational diabetes mellitus, GDM) and the effects on women's health and the health of their babies. The investigators assessed all relevant Cochrane Reviews till Jan 2018.

The authors found 14 Cochrane systematic reviews and included 10 reviews covering 128 studies in their analysis, which included a total of 17,984 women, and their babies.

The authors considered various interventions which are as follows:

• Lifestyle changes which combine two or more interventions such as healthy eating, exercise, education, mindfulness eating (focusing the mind on eating), yoga, relaxation, etc.

Lifestyle interventions may be associated with fewer babies being born large (moderate-quality evidence) but may result in an increase in inductions of labor (moderate-quality evidence).

• Taking insulin or other drugs to control diabetes (including insulin and oral-glucose lowering drugs).

Insulin probably increases the risk of high blood pressure and its problems in pregnancy (hypertensive disorders of pregnancy) when compared to oral-therapy (moderate-quality evidence).

• Dietary interventions (including the change to low or moderate glycaemic index (GI) diet, calorie restrictions, low carbohydrate diet, high complex carbohydrate diet, high saturated fat diet, high fiber diet, soy-protein enriched diet, etc.)

Not enough data on anyone dietary intervention was found to be able to say whether it helped or not.

• Exercise programmes(including brisk walking, cycling, resistance circuit-type training, instruction on an active lifestyle, home-based exercise programme, 6-week or 10-week exercise programme, yoga, etc.)

Similarly, there was not enough data on any specific exercise regimen to say if it helped or not.

• Supplements(myo-inositol given as a water-soluble powder or capsule).

The investigators found there was not enough data to be able to say if myo-inositol was helpful or not.

• Management strategies(including early birth, methods of blood glucose monitoring).

The authors found little data for strategies which included planned induction of labor or planned birth by cesarean section, and there was no clear difference in outcomes among these care plans. Similarly, no clear difference among outcomes for different methods of blood glucose monitoring was found.

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The analysis concluded that lifestyle changes (including as a minimum healthy eating, physical activity, and self-monitoring of blood sugar levels) were the only intervention that showed possible health improvements for women and their babies. Lifestyle interventions may result in fewer babies being large. On the contrary lifestyle interventions may also increase the number of inductions. Taking insulin was also associated with an increase in hypertensive disorders when compared to oral therapy.

In women, GDM is associated with an increased risk of developing high blood pressure and protein in the urine (pre-eclampsia). Women with GDM also have a higher chance of developing type 2 diabetes, heart disease, and stroke later in life. Babies born to mothers with GDM are at increased risk of being large, having low blood glucose (hypoglycemia) after birth, and yellowing of the skin and eyes (jaundice). As these babies become children, they are at higher risk of being overweight and developing type 2 diabetes.

For reference log on to

https://www.cochrane.org/CD012327/PREG_treatments-improve-pregnancy-outcomes-women-who-develop-diabetes-during-pregnancy-overview-cochrane