title: Prevention of gestational diabetes in pregnant women with risk factors for gestational diabetes: a systematic review and meta-analysis of randomised trials.
abstract: BACKGROUND
  Gestational diabetes mellitus can be defined as 'glucose intolerance or hyperglycaemia with onset or first recognition during pregnancy.'
  
  
  OBJECTIVE
  The objective of our systematic review was to see if there was any intervention that could be used for primary prevention of gestational diabetes mellitus in women with risk factors for gestational diabetes mellitus.
  
  
  METHODS
  Major databases were searched from 1966 to Aug 2012 without language restriction.
  
  
  METHODS
  Randomised trials comparing intervention with standard care in women with risk factors for gestational diabetes were included. Meta-analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. The primary outcome assessed was the incidence of gestational diabetes.
  
  
  METHODS
  Data from included trials were extracted independently by two authors and analysed using Rev-Man 5.
  
  
  RESULTS
  A total of 2422 women from 14 randomised trials were included; which compared diet (four randomised trials), exercise (three randomised trials), lifestyle changes (five randomised trials) and metformin (two randomised trials) with standard care in women with risk factors for gestational diabetes mellitus. Dietary intervention was associated with a statistically significantly lower incidence of gestational diabetes (Odds ratio 0.33, 95% CI 0.14 to 0.76) and gestational hypertension (Odds ratio 0.28, 95% CI 0.09, 0.86) compared to standard care. There was no statistically significant difference in the incidence of gestational diabetes mellitus or in the secondary outcomes with exercise, lifestyle changes or metformin use compared to standard care.
  
  
  CONCLUSIONS
  The use of dietary intervention has shown a statistically significantly lower incidence of gestational diabetes mellitus and gestational hypertension compared to standard care in women with risk factors for gestational diabetes mellitus.
authors: Department of Obstetrics and Gynaecology, Jessop Wing, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
authors: P
authors: P
authors: Madhuvrata
authors: Department of Obstetrics and Gynaecology, Jessop Wing, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
authors: Gemma
authors: G
authors: Govinden
authors: Department of Obstetrics and Gynaecology, Jessop Wing, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
authors: R
authors: R
authors: Bustani
authors: Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
authors: S
authors: S
authors: Song
authors: Department of Obstetrics and Gynaecology, Jessop Wing, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
authors: T A
authors: TA
authors: Farrell
keywords: Gestational diabetes; diet; exercise; lifestyle and pharmacological intervention; prevention