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

摘要

Purpose To systematically review lifestyle interventions for women with prior Gestational Diabetes Mellitus (GDM) to report study characteristics, intervention design and study quality and explore changes in 1) diet, physical activity and sedentary behaviour; 2) anthropometric outcomes and; 3) glycaemic control and diabetes risk. Methods Databases (Web of Science, CCRCT, EMBASE and Science DIRECT) were searched (1980 to April 2014) using keywords for controlled or pre–post design trials of lifestyle intervention targeting women with previous GDM reporting at least one behavioural, anthropometric or diabetes outcome. Selected studies were narratively synthesized with anthropometric and glycaemic outcomes synthesized using meta-analysis. Results Three of 13 included studies were rated as low bias risk. Recruitment rates were poor but study retention good. Six of 11 studies reporting on physical activity reported favourable intervention effects. All six studies reporting on diet reported favourable intervention effects. In meta-analysis, significant weight-loss was attributable to one Chinese population study (WMD=?1.06kg (95% CI=?1.68, ?0.44)). Lifestyle interventions did not change fasting blood glucose (WMD=?0.05mmol/L, 95% CI=?0.21, 0.11) or type 2 diabetes risk. Conclusions Lack of methodologically robust trials gives limited evidence for the success of lifestyle interventions in women with prior GDM. Recruitment into trials is challenging. Highlights ? There is good evidence for diet change after lifestyle intervention in GDM. ? Limited evidence of PA, anthropometric or glycaemic change with lifestyle in GDM ? More methodologically robust trials of lifestyle intervention in GDM are required. ? Recruitment to lifestyle intervention trials for women with GDM is challenging.