title: Gestational diabetes mellitus: does an effective prevention strategy exist?
abstract: The overall incidence of gestational diabetes mellitus (GDM) is increasing worldwide. Preventing pathological hyperglycaemia during pregnancy could have several benefits: a reduction in the immediate adverse outcomes during pregnancy, a reduced risk of long-term sequelae and a decrease in the economic burden to healthcare systems. In this Review we examine the evidence supporting lifestyle modification strategies in women with and without risk factors for GDM, and the efficacy of dietary supplementation and pharmacological approaches to prevent this disease. A high degree of heterogeneity exists between trials so a generalised recommendation is problematic. In population studies of dietary or combined lifestyle measures, risk of developing GDM is not improved and those involving a physical activity intervention have yielded conflicting results. In pregnant women with obesity, dietary modification might reduce fetal macrosomia but in these patients, low compliance and no significant reduction in the incidence of GDM has been observed in trials investigating physical activity. Supplementation with probiotics or myoinositol have reduced the incidence of GDM but confirmatory studies are still needed. In randomized controlled trials, metformin does not prevent GDM in certain at-risk groups. Given the considerable potential for reducing disease burden, further research is needed to identify strategies that can be easily and effectively implemented on a population level.
authors.affiliation: Division of Diabetes, Endocrinology and Metabolism, G3 Medical School Building, Imperial College London, Norfolk Place, London, W2 1PG, UK.
authors.forename: Rochan
authors.initials: R
authors.lastname: Agha-Jaffar
authors.affiliation: Division of Diabetes, Endocrinology and Metabolism, G3 Medical School Building, Imperial College London, Norfolk Place, London, W2 1PG, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Oliver
authors.affiliation: Division of Diabetes, Endocrinology and Metabolism, G3 Medical School Building, Imperial College London, Norfolk Place, London, W2 1PG, UK.
authors.forename: Desmond
authors.initials: D
authors.lastname: Johnston
authors.affiliation: Department of Metabolic Medicine, Mint Wing, St Mary's Hospital, Imperial College NHS Trust, Praed Street, London, W2 1NY, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Robinson
mesh_terms: D016640:Diabetes, Gestational / Q000378:metabolism* / Q000517:prevention & control* / Q000628:therapy; D019587:Dietary Supplements; D015444:Exercise / Q000502:physiology*; D005260:Female; D047109:Fetal Development / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D008687:Metformin / Q000627:therapeutic use; D011247:Pregnancy; D019936:Probiotics / Q000627:therapeutic use; D040242:Risk Reduction Behavior
chemical_list: D008687:Metformin