Jing Shi, Ke Chen, Yingxue Tang, Xingzhe Ren, Yong Zhang
Current evidence suggests that inositol, the DASH diet, plant sterols, and fish oil may play a positive role in the prevention and management of gestational diabetes. However, the effects of interventions with very high SUCRA scores but limited supporting evidence-such as blueberries combined with dietary fiber and magnesium-zinc-calcium-vitamin D supplements-should be interpreted with caution. Well-designed, large-scale randomized controlled trials are needed in the future to further confirm these findings.
BACKGROUND: While nutritional interventions are pivotal for the prevention and management of gestational diabetes mellitus (GDM), the optimal nutritional strategy remains unclear.
METHODS: PubMed, EMBASE, Cochrane Library and Web of Science were searched for randomized controlled trials (RCTs). Eligible studies targeted both GDM-diagnosed patients and high-risk cohorts, comparing nutritional interventions with standard controls. Data were extracted and synthesized through network meta-analyses to estimate the standardized mean difference (SMD) or relative risk (RR). The primary outcomes were incidence of GDM, fasting blood glucose (FBG), HOMA-IR, glycated hemoglobin (HbA1c), gestational weight gain (GWG), and cesarean section rate (CSR).
RESULTS: A total of 59 trials involving 10,262 women evaluated 24 nutritional strategies. Among high-risk pregnant women, inositol was associated with a reduced incidence of GDM (RR = 0.50, 95% CI: 0.37, 0.68; SUCRA = 84.5%) and lower FBG levels (SMD = -0.42, 95% CI: -0.66, -0.18; SUCRA = 89.8%). For CSR in high-risk pregnant women, blueberry combined with dietary fiber showed a favorable ranking (RR = 0.30, 95% CI: 0.10, 0.90; SUCRA = 97.8%). Among patients with GDM, the Dietary Approaches to Stop Hypertension (DASH) diet showed a significant effect on HOMA-IR (SMD = -2.79, 95% CI: -4.49, -1.09; SUCRA = 95.9%). Plant sterols showed a favorable effect on HbA1c levels (SMD = -1.40, 95% CI: -2.00, -0.80; SUCRA = 95.7%). Fish oil was associated with reduced GWG (SMD = -0.44, 95% CI: -0.76, -0.12; SUCRA = 94.1%). Combined supplementation with magnesium, zinc, calcium, and vitamin D ranked favorably for CSR compared with the control group (RR = 0.44, 95% CI: 0.15, 1.29; SUCRA = 82.1%), but this finding was based on limited evidence.
CONCLUSIONS: Current evidence suggests that inositol, the DASH diet, plant sterols, and fish oil may play a positive role in the prevention and management of gestational diabetes. However, the effects of interventions with very high SUCRA scores but limited supporting evidence-such as blueberries combined with dietary fiber and magnesium-zinc-calcium-vitamin D supplements-should be interpreted with caution. Well-designed, large-scale randomized controlled trials are needed in the future to further confirm these findings.