Community-based non-pharmacological interventions for pregnant women
with gestational diabetes mellitus: a systematic review
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 27 studies involving 6,242
pregnant women with GDM involved 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. Limited/conflicting
evidence was found for other outcomes and interventions. Conclusions
Community-based non-pharmacological interventions are more effective
than placebo; and are more/as effective as usual care. Self-management
programmes and medical nutrition/diet therapy had the most promising GDM
outcomes.