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  • Review Article
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Gestational diabetes mellitus: does an effective prevention strategy exist?

Nature Reviews Endocrinology volume 12, pages 533–546 (2016)Cite this article

Subjects

Key Points

  • The use of dietary intervention or combined lifestyle measures does not seem to reduce the risk of developing gestational diabetes mellitus (GDM) in women with no defined risk factors, but the evidence for increasing physical activity is conflicting

  • Dietary intervention can reduce the risk of developing GDM and the proportion of infants born with macrosomia in pregnant women with obesity; physical activity interventions have not had the same effect

  • Combined lifestyle modifications have reduced gestational weight gain in pregnant women with obesity and have improved certain materno–fetal outcomes even if hyperglycaemia is not improved

  • In individuals at high risk of developing GDM, preliminary data have demonstrated that probiotic and myoinositol supplementation might reduce the incidence of GDM

  • The use of metformin does not seem to improve the incidence of GDM in either pregnant women with obesity or those with polycystic ovary syndrome.

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.

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Figure 1: Factors contributing to maternal insulin resistance and fetal growth.

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Acknowledgements

The authors wish to acknowledge support from the Novo Nordisk UK Research Charitable Foundation for a clinical research fellowship awarded to R.A.-J.

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  1. Division of Diabetes, Endocrinology and Metabolism, G3 Medical School Building, Imperial College London, Norfolk Place, London, W2 1PG, UK

    Rochan Agha-Jaffar, Nick Oliver & Desmond Johnston

  2. Department of Metabolic Medicine, Mint Wing, St Mary's Hospital, Imperial College NHS Trust, Praed Street, London, W2 1NY, UK

    Stephen Robinson

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R.A.-J. and S.R. researched data for the article. R.A.-J.wrote the manuscript. All authors made substantial contribution to discussion of the content, and reviewed and edited the manuscript before submission.

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Agha-Jaffar, R., Oliver, N., Johnston, D. et al. Gestational diabetes mellitus: does an effective prevention strategy exist?. Nat Rev Endocrinol 12, 533–546 (2016). https://doi.org/10.1038/nrendo.2016.88

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