The Role of Diet in the Prevention of Diabetes among Women with Prior Gestational Diabetes: A Systematic Review of Intervention and Observational Studies

Published:October 18, 2019DOI:



      Women with prior gestational diabetes (GDM) have an increased lifetime risk of developing type 2 diabetes mellitus (T2DM). There are no up-to-date systematic reviews analyzing the relationship of diet with risk of developing T2DM following GDM.


      To systematically review the evidence from intervention and observational studies on effects of dietary interventions and associations of dietary intake with T2DM outcomes in women with a GDM history.


      Six electronic databases were searched (Cumulative Index to Nursing and Allied Health Literature, Embase, Medline, Cochrane Central, Proquest, and Scopus) for articles published until May 2019. This review includes intervention and observational studies among women of any age with a history of GDM that reported on the effects of dietary interventions or association of dietary intake (energy, nutrients, foods, dietary patterns) with T2DM, impaired glucose tolerance, impaired fasting glucose, or prediabetes.


      The systematic review identified five articles reporting results from four intervention studies, and seven articles reporting results from four observational studies. Findings from intervention studies indicated trends toward beneficial effects of a low-glycemic index diet, a low-carbohydrate diet, and a diet in line with general population dietary guidelines, but studies had unclear or high risk of bias. Findings from two cross-sectional and one prospective study indicated poorer diabetes outcomes for women with higher intakes of branched-chain amino acids, total and heme iron, and a diet relatively low in carbohydrates and high in animal fat and protein, and better outcomes among those consuming diets rich in fruit, vegetables, nuts, fish, and legumes, and low in red and processed meats and sugar-sweetened beverages, after adjustment for confounders, including body mass index.


      Findings from observational studies support current dietary guidelines for the prevention of T2DM. Further dietary intervention studies are needed to confirm whether or not dietary modification following a GDM pregnancy reduces women's risk of developing T2DM.


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      1. Section 13. Diabetes and reproductive health.
        in: General Practice Management of Type 2 Diabetes: 2016–18. The Royal Australian College of General Practitioners, East Melbourne, Victoria, Australia2016
        • Zhu Y.
        • Zhang C.
        Prevalence of gestational diabetes and risk of progression to type 2 diabetes: A global perspective.
        Curr Diab Rep. 2016; 16: 7
        • Dabelea D.
        • Snell-Bergeon J.K.
        • Hartsfield C.L.
        • Bischoff K.J.
        • Hamman R.F.
        • McDuffie R.S.
        Increasing prevalence of gestational diabetes mellitus (GDM) over time and by birth cohort: Kaiser Permanente of Colorado GDM Screening Program.
        Diabetes Care. 2005; 28: 579-584
        • Kim C.
        • Newton K.M.
        • Knopp R.H.
        Gestational diabetes and the incidence of type 2 diabetes: A systematic review.
        Diabetes Care. 2002; 25: 1862-1868
        • World Health Organization
        Global report on diabetes. 2016.
        Date accessed: August 19, 2019
        • International Diabetes Federation
        IDF diabetes atlas, 8th ed. 2017.
        Date accessed: August 19, 2019
        • Morton S.
        • Kirkwood S.
        • Thangaratinam S.
        Interventions to modify the progression to type 2 diabetes mellitus in women with gestational diabetes: A systematic review of literature.
        Curr Opin Obstet Gynecol. 2014; 26: 476-486
        • Gilinsky A.S.
        • Kirk A.F.
        • Hughes A.R.
        • Lindsay R.S.
        Lifestyle interventions for type 2 diabetes prevention in women with prior gestational diabetes: A systematic review and meta-analysis of behavioural, anthropometric and metabolic outcomes.
        Prev Med Rep. 2015; 2: 448-461
        • Guo J.
        • Chen J.L.
        • Whittemore R.
        • Whitaker E.
        Postpartum lifestyle interventions to prevent type 2 diabetes among women with history of gestational diabetes: A systematic review of randomized clinical trials.
        J Womens Health. 2016; 25: 38-49
        • Pedersen A.L.W.
        • Terkildsen Maindal H.
        • Juul L.
        How to prevent type 2 diabetes in women with previous gestational diabetes? A systematic review of behavioural interventions.
        Prim Care Diabet. 2017; 11: 403-413
        • Elliott-Sale K.J.
        • Barnett C.T.
        • Sale C.
        Exercise interventions for weight management during pregnancy and up to 1 year postpartum among normal weight, overweight and obese women: A systematic review and meta-analysis.
        Br J Sports Med. 2015; 49: 1336-1342
        • Amorim Adegboye A.R.
        • Linne Y.M.
        Diet or exercise, or both, for weight reduction in women after childbirth.
        Cochrane Database Syst Rev. 2013; 7Cd005627
        • Infanti J.J.
        • O'Dea A.
        • Gibson I.
        • McGuire B.E.
        • Newell J.
        • Glynn L.G.
        • et al.
        Reasons for participation and non-participation in a diabetes prevention trial among women with prior gestational diabetes mellitus (GDM).
        BMC Med Res Methodol. 2014; 14: 13
        • Montgomery K.S.
        • Bushee T.D.
        • Phillips J.D.
        • et al.
        Women's challenges with postpartum weight loss.
        Matern Child Health J. 2011; 15: 1176-1184
        • van der Pligt P.
        • Ball K.
        • Hesketh K.D.
        • Crawford D.
        • Teychenne M.
        • Campbell K.
        The views of first time mothers completing an intervention to reduce postpartum weight retention: A qualitative evaluation of the mums OnLiNE study.
        Midwifery. 2018; 56: 23-28
      2. Higgins J.P.T. Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. 2011
        Date accessed: August 19, 2019
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration.
        PLoS Med. 2009; 6e1000100
        • Wells G.A.
        • Shea B.
        • O’Connell D.
        • et al.
        The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.
        2009 (Accessed September 4, 2019)
        • Ghani R.A.
        • Shyam S.
        • Arshad F.
        • et al.
        The influence of fasting insulin level in post-gestational diabetes mellitus women receiving low-glycaemic-index diets.
        Nutr Diabet. 2014; 4: e107
        • Shyam S.
        • Arshad F.
        • Abdul Ghani R.
        • et al.
        Low glycaemic index diets improve glucose tolerance and body weight in women with previous history of gestational diabetes: A six months randomized trial.
        Nutr J. 2013; 12: 68
        • Bao W.
        • Chavarro J.E.
        • Tobias D.K.
        • et al.
        Long-term risk of type 2 diabetes in relation to habitual iron intake in women with a history of gestational diabetes: a prospective cohort study.
        Am J Clin Nutr. 2016; 103: 375-381
        • Bao W.
        • Li S.
        • Chavarro J.E.
        • et al.
        Low carbohydrate-diet scores and long-term risk of type 2 diabetes among women with a history of gestational diabetes mellitus: A prospective cohort study.
        Diabetes Care. 2016; 39: 43-49
        • Tobias D.K.
        • Hu F.B.
        • Chavarro J.
        • Rosner B.
        • Mozaffarian D.
        • Zhang C.
        Healthful dietary patterns and type 2 diabetes mellitus risk among women with a history of gestational diabetes mellitus.
        Arch Intern Med. 2012; 172: 1566-1572
        • Tobias D.K.
        • Clish C.
        • Mora S.
        • et al.
        Dietary intakes and circulating concentrations of branched-chain amino acids in relation to incident type 2 diabetes risk among high-risk women with a history of gestational diabetes mellitus.
        Clin Chem. 2018; 64: 1203-1210
        • Peterson C.M.
        • Jovanovic-Peterson L.
        Randomized crossover study of 40% vs. 55% carbohydrate weight loss strategies in women with previous gestational diabetes mellitus and non-diabetic women of 130-200% ideal body weight.
        J Am Coll Nutr. 1995; 14: 369-375
        • Wein P.
        • Beischer N.
        • Harris C.
        • Permezel M.
        A trial of simple versus intensified dietary modification for prevention of progression to diabetes mellitus in women with impaired glucose tolerance.
        Aust N Z J Obstet Gynaecol. 1999; 39: 162-166
        • Ostman E.M.
        • Frid A.H.
        • Groop L.C.
        • Bjorck I.M.
        A dietary exchange of common bread for tailored bread of low glycaemic index and rich in dietary fibre improved insulin economy in young women with impaired glucose tolerance.
        Eur J Clin Nutr. 2006; 60: 334-341
        • Kim S.H.
        • Kim M.Y.
        • Yang J.H.
        • et al.
        Nutritional risk factors of early development of postpartum prediabetes and diabetes in women with gestational diabetes mellitus.
        Nutrition. 2011; 27: 782-788
        • Mercier R.
        • Perron J.
        • Weisnagel S.J.
        • Robitaille J.
        Associations between fruit and vegetables intake and abnormal glucose tolerance among women with prior gestational diabetes mellitus.
        Eur J Nutr. 2019; 58: 689-696
        • Andersson-Hall U.
        • Carlsson N.G.
        • Sandberg A.S.
        • Holmang A.
        Circulating linoleic acid is associated with improved glucose tolerance in women after gestational diabetes.
        Nutrients. 2018; 10: 1-17
        • Knowler W.C.
        • Barrett-Connor E.
        • Fowler S.E.
        • et al.
        Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
        N Engl J Med. 2002; 346: 393-403
        • US Departments of Health and Human Services and Agriculture
        2015-2020 Dietary Guidelines for Americans. 8th edition. 2015.
        • National Health and Medical Research Council
        Australian dietary guidelines. 2013.
        • American Diabetes Association
        Prevention or delay of type 2 diabetes. Sec. 4. In Standards of Medical Care in Diabetes - 2016.
        Diabetes Care. 2016; 39: S36-S38
        • Hu F.B.
        • Manson J.E.
        • Stampfer M.J.
        • et al.
        Diet, lifestyle, and the risk of type 2 diabetes mellitus in women.
        N Engl J Med. 2001; 345: 790-797
        • Sanderson H.
        • Loveman E.
        • Colquitt J.
        • Royle P.
        • Waugh N.
        • Tan B.K.
        Improving uptake of postnatal checking of blood glucose in women who had gestational diabetes mellitus in universal healthcare settings: A systematic review.
        J Clin Med. 2018; 8: 1-15
        • Morrison M.K.
        • Koh D.
        • Lowe J.M.
        • et al.
        Postpartum diet quality in Australian women following a gestational diabetes pregnancy.
        Eur J Clin Nutr. 2012; 66: 1160-1165
        • Jones E.J.
        • Roche C.C.
        • Appel S.J.
        A review of the health beliefs and lifestyle behaviors of women with previous gestational diabetes.
        J Obstet Gynecol Neonatal Nurs. 2009; 38: 516-526


      E. D’Arcy is a research and evaluation officer, Health Intelligence Unit, NSW Health, Bathurst, New South Wales, Australia; at the time of conceptualizing the study, she was a lecturer, Griffith University, Gold Coast Campus, Queensland, Australia.


      At the time of the study, J. Rayner was a nutrition and dietetics honors student, Griffith University, Gold Coast Campus, Queensland, Australia.


      A. Hodge is an associate professor and principal fellow, Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.


      L. J. Ross is a lecturer, School of Allied Health Sciences, Nutrition and Dietetics, Gold Coast Campus, Griffith University, Southport, Queensland, Australia, and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.


      D. A. J. M. Schoenaker is a research fellow, School of Medicine, Faculty of Science, Medicine and Health, and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia, and an adjunct fellow, The Robinson Research Institute and Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, South Australia, Australia; at the time of the study, she was a senior research officer, Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia.