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:https://doi.org/10.1016/j.jand.2019.07.021

      Abstract

      Background

      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.

      Objective

      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.

      Methods

      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.

      Results

      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.

      Conclusions

      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.

      Keywords

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      Biography

      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.

      Biography

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

      Biography

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

      Biography

      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.

      Biography

      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.