Treatments for women with gestational diabetes:

an overview of systematic reviews from Cochrane

1. Gestational Diabetes (GDM)

GDM can occur in mid to late pregnancy. Hyperglycaemia may have short- and long-term

negative effects on the woman and the health of her child.

For women, GDM can mean an increased risk of high blood pressure and protein in the

urine. Women with GDM are also more likely to develop type 2 diabetes, heart disease, and

stroke later in life. Newborns of mothers with GDM are more at risk for being very large,

having hypoglycaemia after birth, and yellowing of the skin and eyes. Later, these newborns

have a higher risk of becoming overweight and developing type 2 diabetes.

Several Cochrane reviews evaluated different interventions for women with GDM. This

review brings together these reviews. We looked at diet, exercise, medications,

supplements, lifestyle changes, and various options for treatment by health professionals.

2. Cochrane Overview Summary

2.1 Background

Successful treatments for GDM have the potential to improve the health of women with

GDM and their newborns.

The aim of this review was to provide a comprehensive synthesis of the evidence from

Cochrane reviews on the benefits and harmful effects of interventions to treat GDM for

affected women and their newborns. This is to provide a summary of the effects of

interventions for women who develop diabetes during pregnancy and the impact on the

health of these women and their infants.

2.2 Interventions

1. Any change in diet (including low to moderate GI diets, energy-restricted diets, non-
energy-restricted diets, DASH [Dietary Approaches to Stop Hypertension] diets, low-
carbohydrate diets, high-carbohydrate diets, diets high in unsaturated fatty acids, diets low
in unsaturated fatty acids, low GI diets, moderate GI diets high in fiber, diets enriched with
soy protein, diets high in fiber, ethnic-specific diets).

2. Any physical exercise such as brisk walking, weightlifting, home exercises, mindfulness,
yoga.

3. Pharmacological treatments like oral hypoglycemic agents (metformin, glibenclamide and

insulin basis and bolus).

4. Nutraceuticals or administration of other dietary supplements

5. Other interventions identified by the included reviews like glycemic treatment for and
management of delivery in women with GDM including lifestyle interventions.

2.3 Results

One was included 14 reviews. Of these, 10 provided relevant data of high quality and with a

low risk of bias from 128 randomized controlled trials with 27 comparisons, 17,984 women,

16,305 newborns, and 1,441 children. The evidence varied between high and very low

quality. Only one effective treatment method was found for women with GDM. There are

limited data on the different interventions. Lifestyle changes was the only intervention that

showed potential health improvements for women and their children. Lifestyle

interventions may result in fewer children being excessively large at birth. Conversely,

lifestyle interventions, in terms of harms, could also increase the number of birth

inductions. Insulin administration was also associated with an increase in hypertensive

disease, compared with oral therapies. There was very limited information on long-term

health and costs. Women may want to talk with their physician about lifestyle changes and

associated individual needs. Lifestyle modification compared with usual care likely reduces

the number of such newborns who are too heavy for gestational age.

References

Martis R, Crowther CA, Shepherd E, Alsweiler J, Downie MR, Brown J. Treatments for
women with gestational diabetes mellitus: an overview of Cochrane systematic reviews.
Cochrane Database of Systematic Reviews 2018, Issue 8. art. No.: CD012327. DOI:
10.1002/14651858.CD012327.pub2. Accessed 10 April 2022.