Gestational Diabetes Mellitus and Diet: A Systematic Review and Meta-analysis of Randomized Controlled Trials Examining the Impact of Modified Dietary Interventions on Maternal Glucose Control and Neonatal Birth Weight
Article Figures & Tables
Figures
- Figure 1
Forest plot of birth weight for modified dietary interventions compared with control diets in women with GDM. Reference citations for studies can be found in Table 1. CHO, carbohydrate; IV, inverse variance.
Tables
- Table 1
Characteristics of studies included
Author, year (ref.) Country n Estimated sample size Definition of GDM Duration of dietary intervention Gestational age in weeks at enrollment (mean ± SD) Baseline BMI, kg/m2 (mean ± SD) Mean maternal age, years (mean ± SD) Dietary intervention Diet composition (mean ± SD)* Low-GI diet Grant, 2011 (26) Canada 47 50 to detect a 0.6 mmol/L difference in capillary glucose; n not achieved Canadian Diabetes Association (40) 28 weeks until delivery Control: 29 ± 2.35 Intervention†: 29 ± 3.21 Control: 26 ± 4.69 Intervention: 27 ± 4.58 (prepregnancy) Control: 34 ± 0.46 Intervention: 34 ± 5.16 Low GI: Women were provided with a list of starch choices specific to either intervention (low GI) or control Control: GI 58.0 ± 0.5 Intervention: GI 49.0 ± 0.8 Louie, 2011 (29) Australia 99 120 to detect a 260-g difference in birth weight (stopped early because of smaller than expected SD) Australasian Diabetes in Pregnancy Society criteria (41) Randomization until delivery Control: 29.7 ± 3.5 Intervention: 29 ± 4.0 Control: 24.1 ± 5.7 Intervention: 23.9 ± 4.4 (prepregnancy) Control: 32.4 ± 4.5 Intervention: 34 ± 4.1 Low GI: Target GI ≤50 but otherwise similar composition to the control diet Control: energy 1,934 ± 465; carbohydrate 40.3 ± 8.3; protein 22.2 ± 7.5; fat 35.1 ± 16.9; GI 53.0 ± 6.5 Intervention: energy 1,836 ± 403; carbohydrate 38.7 ± 8.3; protein 23.4 ± 5.8; fat 34.9 ± 11.0; GI 47.0 ± 6.5 Ma, 2015 (30) China 95 Not reported Chinese Medical Association and American Diabetes Association (42) 24–26 weeks until delivery Control: 27.9 ± 1.1 Intervention: 27.5 ± 1.1 Control: 21.15 ± 2.75 Intervention: 21.90 ± 3.14 (prepregnancy) Control: 30.0 ± 3.5 Intervention: 30.1 ± 3.8 Low GI: Women provided with an exchange list for starch choices specific to either intervention (low GI) or control Control: energy 2,030 ± 215; carbohydrate 49.8 ± 6.8; protein 18.8 ± 2.5; fat 31.8 ± 3.8; GI 53.8 ± 2.5 Intervention: energy 2,006 ± 215; carbohydrate 48.56 ± 7.0; protein 18.9 ± 2.9; fat 32.1 ± 4.1; GI 50.1 ± 2.2 Moses, 2009 (13) Australia 63 Not reported Australasian Diabetes in Pregnancy Society (41) 28–32 weeks until delivery Control: 29.9 ± 1.11 Intervention: 30.3 ± 1.11 Control: 32.8 ± 7.92 Intervention: 32.0 ± 6.68 (at enrollment) Control: 31.3 ± 4.52 Intervention: 30.8 ± 3.90 Low GI: Women asked to avoid specific high-GI foods and were provided with a booklet outlining carbohydrate choices Control: energy 1,656 ± 433; carbohydrate 36.2 ± 8.2; protein 24.0 ± 4.4; fat 34.3 ± 9.9; GI 52.2 ± 6.0 Intervention: energy 1,713 ± 368; carbohydrate 36.7 ± 6.1; protein 23.9 ± 3.9; fat 33.4 ± 6.12; GI 48.0 ± 5.0 DASH diet Asemi, 2013 (22) Iran 34 32 for “key variable serum HDL” 50-g glucose challenge >140 mg/dL → 100 g OGTT; GDM if two or more of fasting >95 mg/dL, 1-h 180 mg/dL, 2-h 155 mg/dL, or 3-h 140 mg/dL 4 weeks Not reported Control: 31.4 ± 5.7 Intervention: 29.0 ± 3.2 (at enrollment) Control: 29.4 ± 6.2 Intervention: 30.7 ± 6.7 DASH diet: diet rich in fruit, vegetables, whole grains, and low-fat dairy; low in saturated fats, cholesterol, refined grains, and sweets Control: energy 2,392 ± 161; carbohydrate 54.0 ± 6.9; protein 17.6 ± 2.8; fat 29.3 ± 5.6 Intervention: energy 2,400 ± 25; carbohydrate 66.8 ± 2.2; protein 16.8 ± 1.2; fat 17.6 ± 0.9 Asemi, 2014 (23) Iran 52 42 to detect a 75-g difference in birth weight As above 4 weeks Control: 25.9 ± 1.4 Intervention: 25.8 ± 1.4 Control: 31 ± 4.9 Intervention: 29.2 ± 3.5 (at enrollment) Control: 30.7 ± 6.3 Intervention: 31.9 ± 6.1 DASH diet: as above Control: energy 2,352 ± 163; carbohydrate 54.2 ± 7.1; protein 18.2 ± 3.4; fat 28.5 ± 5.6 Intervention: energy 2,407 ± 30; carbohydrate 66.4 ± 2.04; protein 17.0 ± 1.3; fat 17.4 ± 1.0 Yao, 2015 (36) China 33 42 to detect a 75-g difference in birth weight; not achieved 50-g glucose challenge → 100 g OGTT results with two or more of fasting >95 mg/dL, 1-h ≥180 mg/dL, 2-h ≥155 mg/dL, or 3-h ≥140 mg/dL 4 weeks Control: 25.7 ± 1.3 Intervention: 26.9 ± 1.4 Control: 30.9 ± 3.6 Intervention: 30.2 ± 4.1 (at enrollment) Control: 28.3 ± 5.1 Intervention: 30.7 ± 5.6 DASH diet: same as above Control: energy 2,386 ± 174; carbohydrate 52.3 ± 7.2; protein 18.0 ± 3.3; fat 28.3 ± 5.1 Intervention: energy 2,408 ± 54; carbohydrate 66.7 ± 2.3; protein 16.9 ± 1.2; fat 17.17 ± 1.16 Low-carbohydrate diets Cypryk, 2007 (25) Poland 30 Not reported World Health Organization criteria 2 weeks 29.2 ± 5.4 Not reported 28.7 ± 3.7 Low (intervention) vs. high (control) carbohydrate (45% vs. 60% of total energy, respectively) Control‡: carbohydrate 60; protein 25; fat 15 Intervention‡: carbohydrate 45; protein 25; fat 30 Hernandez, 2016 (12) U.S. 12 Pilot study to estimate SD Carpenter and Coustan criteria (43) 30–31 weeks until delivery Control§: 31.7 ± 2.45 Intervention: 31.2 ± 0.98 Control: 34.3 ± 3.92 Intervention: 33.4 ± 3.43 (at enrollment) Control: 30 ± 2.45 Intervention: 28 ± 4.90 Low carbohydrate (intervention) vs. higher-complex carbohydrate/ lower fat (control) Control‡: carbohydrate 60; protein 15; fat 25 Intervention‡: carbohydrate 40; protein 15; fat 45 Moreno-Castilla, 2013 (31) Spain 152 152 to detect a 22% difference in need for insulin 2006 National Diabetes and Pregnancy Clinical Guidelines (44,45) ≤35 weeks until delivery Control: 30.1 ± 3.5 Intervention: 30.4 ± 3.0 Control: 26.6 ± 5.5 Intervention: 25.4 ± 5.7 (prepregnancy) Control: 32.1 ± 4.4 Intervention: 30.4 ± 3.0 Low carbohydrate (intervention) vs. control (40% vs. 55% of total diet energy as carbohydrate) Control‡: energy 1,800 minimum; carbohydrate 55; protein 20; fat 25 Intervention‡: energy 1,800 minimum; carbohydrate 40; protein 20; fat 40 Soy protein–enrichment diets Jamilian, 2015 (27) Iran 68 56 (minimum clinical difference not reported) One-step 75 g OGTT, American Diabetes Association (46) 6 weeks Not reported Control: 28.4 ± 3.4 Intervention: 28.9 ± 5.0 Control: 29.3 ± 4.2 Intervention: 28.2 ± 4.6 Soy protein diet had the same amount of protein as control diet but the protein portion was made up of 35% animal protein, 35% soy protein, 30% other plant proteins Control: energy 2,426 ± 191; carbohydrate 54.6 ± 7.1; protein 14.4 ± 1.7; fat 32.1 ± 5.4 Intervention: energy 2,308 ± 194; carbohydrate 54.6 ± 7.3; protein 15.0 ± 2.6; fat 30.3 ± 4.7 Sarathi, 2016 (14) India 62 Not reported International Association of Diabetes and Pregnancy Study Groups criteria (47) From diagnosis until delivery Control: 25.56 ± 1.69 Intervention: 25.19 ± 1.92 Not reported Control: 29.17 ± 3.38 Intervention: 29.43 ± 2.98 Soy protein diet: 25% of cereal part of high-fiber complex carbohydrates replaced with soy Control‡: energy 1,600–2,000; minimum carbohydrate 175 g Intervention‡: energy 1,600–2,000; minimum carbohydrate 175 g Fat-modification diets Lauszus, 2001 (28) Denmark 27 20 to detect a difference in cholesterol of 0.65 mmol/L 3-h 75 g OGTT with blood samples taken every 30 minutes, GDM if 2 or more glucoses >3 SD above the mean 34 weeks until delivery Not reported Control: 32.2 ± 5.61 Intervention: 35.3 ± 8.65 (at enrollment) Control: 29 ± 3.74 Intervention: 31 ± 3.61 High monounsaturated fatty acids: source was hybrid sunflower oil with high-content oleic acid and snacks of almonds and hazelnuts Control: energy 1,727; carbohydrate 50.0 ± 3.6; protein 19.0 ± 3.6; fat 30.0 ± 7.2 Intervention: energy 1,982; carbohydrate 46 ± 3.5; protein 16 ± 3.5; fat 37 ± 3.5 Wang, 2015 (35) China 84 Not reported International Association of Diabetes and Pregnancy Study Groups criteria (47) ∼27 weeks until delivery Control: 27.3 ± 1.96 Intervention: 27.4 ± 1.52 Control: 22.2 ± 3.6 Intervention: 21.4 ± 3.0 (prepregnancy) Control: 29.7 ± 4.64 Intervention: 30.3 ± 4.17 Polyunsaturated fatty acid meals (50–54% carbohydrate, 31–35% fat with 45–40 g sunflower oil) Control: energy 1,978 ± 107; carbohydrate 55.4 ± 2.0; protein 17.9 ± 1.0; fat 26.7 ± 1.3 Intervention: energy 1,960 ± 90; carbohydrate 47.7 ± 0.7; protein 18.0 ± 0.7; fat 34.3 ± 0.2 Other diets Bo, 2014 (24) Italy 99 in diet study (total n = 200) 200 to detect a 10% difference in fasting glucose (based on exercise portion of trial) 75 g OGTT 24–26 weeks until delivery Not reported Control: 26.8 ± 4.1 Intervention: 26.9 ± 4.6 Control: 33.9 ± 5.3 Intervention: 35.1 ± 4.4 Behavioral dietary recommendations: individual recommendations for helping dietary choices Control: energy 2,116 ± 383; carbohydrate 46.9 ± 5.9; protein 15.6 ± 2.6; fat 37.4 ± 4.2 Intervention: energy 2,156 ± 286; carbohydrate 47.8 ± 4.9; protein 15.5 ± 2.4; fat 36.7 ± 3.9 Rae, 2000 (32) Australia 124 120 to detect a decrease in insulin use from 40% to 15% and a decrease in macrosomia from 25% to 5% OGTT fasting glucose >5.4 mmol/L and/or 2-h glucose >7.9 mmol/L (48) <36 weeks until delivery Control: 28.3 ± 4.6 Intervention: 28.1 ± 5.8 Control: 38.0 ± 0.7 Intervention: 37.9 ± 0.7 (at diagnosis) Control: 30.6 Intervention: 30.2 (SD not reported) Moderate energy restriction (1,590–1,776 kcal/day) vs. control (2,010–2,220 kcal/day) Control: energy 1,630 ± 339; carbohydrate 41.0 ± 4.6; protein 24.0 ± 2.3; fat 34.0 ± 5.3 Intervention: energy 1,566 ± 289; carbohydrate 42.0 ± 5.7; protein 25.0 ± 2.4; fat 31.0 ± 5.7 Reece, 1995 (33) U.S. 50 Post hoc calculation Not reported 24–29 weeks until delivery Not reported Not reported Not reported Fiber-enriched diet: fiber taken as fiber-rich foods (40 g/day) and a high-fiber drink (40 g/day) Control‡: carbohydrate 50; fat 30; fiber 20 g/day Intervention‡: carbohydrate 60; fat 20 with 80 g fiber/day Valentini, 2012 (34) Italy 20 Not reported (pilot study) Fourth International Workshop Conference on Gestational Diabetes Mellitus (49) From diagnosis (screening at 24–28 weeks) until delivery Control 27.1 ± 5.9 Intervention: 21.3 ± 6.8 Control: 24.1 ± 4.7 Intervention: 25.7 ± 3.6 (prepregnancy) Control: 30.2 ± 4.7 Intervention: 28.9 ± 3.3 Ethnic meal plan: foods commonly consumed per participant’s ethnicity with the same kcal and nutrient composition as the control diet Control‡: carbohydrate 53; protein 18; fat 28; fiber 26 g/day Intervention‡: carbohydrate 55; protein 17; fat 28; fiber 21 g/day Unless otherwise stated, the units are kcal/day for energy, % for carbohydrate, protein, and fat. OGTT, oral glucose tolerance test.
↵*Reported actual dietary intake. When not reported, prescribed dietary intake is reported.
↵†Intervention is defined as dietary intervention different from the usual dietary intervention used in the control group.
↵‡Indicates prescribed diet.
↵§The control and intervention groups were reversed for the purpose of meta-analysis so it could be included in the low-carbohydrate group.
- Table 2
Pooled analyses of primary maternal glycemic and infant birth weight outcomes
Outcome Diet subgroup N of studies N of women Effect estimate I2 (%) Maternal glycemic outcomes Mean [95% CI] Change in fasting glucose (mg/dL) All diets 13 662 −4.07 [−7.58, −0.57] 86 Low GI (26,29,30) 3 195 −5.28 [−6.83, −3.73] 0 DASH (22,36) 2 67 −11.55 [−14.00, −9.09] 0 Low carbohydrate (12,25) 2 42 3.81 [−4.29, 11.92] 69 Fat modification (28,35) 2 109 4.87 [−0.44, 10.18] 0 Soy protein (14,27) 2 130 −7.47 [−20.28, 5.34] 91 Behavior (24) 1 99 −1.50 [−5.66, 2.66] — Ethnic (34) 1 20 −25.34 [−37.57, −13.11] — Change in postprandial glucose (mg/dL) All diets 9 475 −7.78 [−12.27, −3.29] 63 Low GI (26,30) 2 121 −7.08 [−12.07, −2.08] 4 DASH (22) 1 34 −45.22 [−68.97, −21.47] — Low carbohydrate (25) 1 30 −3.00 [−10.06, 4.06] — Fat modification (28,35) 2 109 −6.43 [−13.08, 0.22] 0 Soy protein (14) 1 62 −1.05 [−11.03, 8.93] — Behavior (24) 1 99 −6.90 [−11.68, −2.12] — Ethnic (34) 1 20 −16.28 [−22.83, −9.73] — Change in post-breakfast glucose (mg/dL) All 3 175 −4.76 [−9.13, −0.38] 34 Low GI (30) 1 83 −8.6 [−14.11, −3.09] — Low carbohydrate (25) 1 30 −3.00 [−8.15, 2.15] — Soy protein (14) 1 62 −1.05 [−9.73, 7.63] — Change in post-lunch glucose (mg/dL) All 2 92 4.50 [−1.90, 10.90] 0 Low carbohydrate (25) 1 30 4.00 [−4.56, 12.56] — Soy protein (14) 1 62 5.14 [−4.51, 14.79] — Change in post-dinner glucose (mg/dL) All 2 92 1.81 [−5.28, 8.90] 13 Low carbohydrate (25) 1 30 1.00 [−8.14, 10.14] — Soy protein (14) 1 62 3.03 [−8.20, 14.26] — Change in HOMA-IR (µIU/mL × mmol/L) All 4 212 −1.10 [−2.26, 0.07] 90 DASH (36) 1 33 −1.90 [−2.36, −1.44] — Low carbohydrate (12) 1 12 0.60 [−1.90, 3.10] — Soy protein (27) 1 68 −2.00 [−3.17, −0.83] — Behavior (24) 1 99 −0.30 [−0.71, 0.11] — Change in HbA1c (%) All 7 407 −0.05 [−0.13, 0.02] 84 Low GI (29,30) 2 167 0.01 [−0.02, 0.03] 0 DASH (22) 1 34 −0.25 [−0.42, −0.08] — Fat modification (28) 1 25 0.10 [−0.14, 0.34] — Soy protein (14) 1 62 −0.01 [−0.07, 0.05] — Behavior (24) 1 99 −0.19 [−0.26, −0.12] — Ethnic diet (34) 1 20 −0.05 [−0.27, 0.17] — RR [95% CI] Medication treatment All 15 1023 0.65 [0.47, 0.88] 55 Low GI (13,26,29,30) 4 293 0.80 [0.55, 1.14] 34 DASH (22,23,36) 3 119 0.29 [0.17, 0.50] 0 Low carbohydrate (31) 1 150 1.00 [0.75, 1.34] — Energy restriction (32) 1 117 1.05 [0.47, 2.34] — Fat modification (35) 1 84 Not estimable — Soy protein (14,27) 2 130 0.44 [0.21, 0.91] 0 Behavior (24) 1 99 0.61 [0.15, 2.42] — Ethnic (34) 1 20 2.00 [0.21, 18.69] — Fiber (33) 1 11 Not estimable — Infant birth weight outcomes Mean [95% CI] Birth weight (g) All 16 841 −170.62 [−333.64, −7.60] 88 Low GI (13,26,29,30) 4 276 −54.25 [−178.98, 70.47] 0 DASH (22,23,36) 3 119 −598.19 [−663.09, −533.30] 0 Low carbohydrate (12,25) 2 42 57.73 [−164.93, 280.39] 0 Energy restriction (32) 1 122 194.00 [−42.58, 430.58] — Fat modification (28,35) 2 109 −139.61 [−294.80, 15.58] 0 Soy protein (14,27) 2 131 −184.67 [−319.35, −49.98] 0 Ethnic diet (34) 1 20 −370.00 [−928.87, 188.87] — Fiber (33) 1 22 −94.00 [−446.68, 258.68] — RR [95% CI] Large for gestational age All 8 647 0.96 [0.63, 1.46] 0 Low GI (13,26,29) 3 193 1.33 [0.54, 3.31] 0 Low carbohydrate (31) 1 149 0.51 [0.13, 1.95] — Energy restriction (32) 1 123 1.17 [0.65, 2.12] — Soy protein (14) 1 63 0.45 [0.04, 4.76] — Behavior (24) 1 99 0.73 [0.25, 2.14] — Ethnic diet (34) 1 20 0.14 [0.01, 2.45] — Macrosomia All 12 834 0.49 [0.27, 0.88] 11 Low GI (13,26,29,30) 4 276 0.46 [0.15, 1.46] 0 DASH (23,36) 2 85 0.12 [0.03, 0.51] 0 Low carbohydrate (25,31) 2 179 0.20 [0.02, 1.69] — Energy restriction (32) 1 122 1.56 [0.61, 3.94] — Fat modification (35) 1 84 0.35 [0.04, 3.23] — Soy protein (27) 1 68 0.60 [0.16, 2.31] — Ethnic diet (34) 1 20 0.20 [0.01, 3.70] — - Table 3
Sensitivity analysis of primary maternal glycemic and infant birth weight outcomes
Outcome Diet subgroup N of studies N of women Effect estimate I2 (%) Maternal glycemic outcomes Mean [95% CI] Change in fasting glucose (mg/dL) All diets 10 575 −1.98 [−5.41, 1.45] 74 Low GI (26,29,30) 3 195 −5.33 [−6.91, −3.76] 0 DASH 0 0 Not estimable — Low carbohydrate (12,25) 2 42 3.66 [−4.42, 11.73] 57 Fat modification (28,35) 2 109 4.88 [−1.45, 11.21] 0 Soy protein (14,27) 2 130 −7.51 [−20.31, 5.30] 90 Behavior (24) 1 99 −1.50 [−6.47, 3.47] — Ethnic 0 0 Not estimable — Change in postprandial glucose (mg/dL) All diets 7 421 −5.90 [−7.93, −3.88] 0 Low GI (26,30) 2 121 −7.08 [−12.07, −2.08] 4 DASH 0 0 Not estimable — Low carbohydrate (25) 1 30 −3.00 [−8.15, 2.15] — Fat modification (28,35) 2 109 −4.85 [−13.32, 3.62] 40 Soy protein (14) 1 62 −1.05 [−9.73, 7.63] — Behavior (24) 1 99 −6.90 [−9.85, −3.95] — Ethnic 0 0 Not estimable — Change in post-breakfast glucose (mg/dL) All diets 3 175 −4.76 [−9.13, −0.38] 34 Low GI (30) 1 83 −8.6 [−14.11, −3.09] — Low carbohydrate (25) 1 30 −3.00 [−8.15, 2.15] — Soy protein (14) 1 62 −1.05 [−9.73, 7.63] — Change in post-lunch glucose (mg/dL) All diets 2 92 4.50 [−1.90, 10.90] 0 Low carbohydrate (25) 1 30 4.00 [−4.56, 12.56] — Soy protein (14) 1 62 5.14 [−4.51, 14.79] — Change in post-dinner glucose (mg/dL) All diets 2 92 1.81 [−5.28, 8.90] 0 Low carbohydrate (25) 1 30 1.00 [−8.14, 10.14] — Soy protein (14) 1 62 3.03 [−8.20, 14.26] — Change in HOMA-IR (µIU/mL × mmol/L) All diets 3 179 −0.74 [−2.09, 0.61] 75 DASH 0 0 Not estimable — Low carbohydrate (12) 1 12 0.60 [−1.90, 3.10] — Soy protein (27) 1 68 −2.00 [−3.17, −0.83] — Behavior (24) 1 99 −0.30 [−0.71, 0.11] — Change in HbA1c (%) All diets 5 353 −0.03 [−0.11, 0.05] 87 Low GI (29,30) 2 167 0.01 [−0.02, 0.03] 0 DASH 0 0 Not estimable — Fat modification (28) 1 25 0.10 [−0.14, 0.34] — Soy protein (14) 1 62 −0.01 [−0.07, 0.05] — Behavior (24) 1 99 −0.19 [−0.26, −0.12] — Ethnic diet 0 0 Not estimable — RR [95% CI] Medication treatment All diets 11 884 0.82 [0.65, 1.04] 24 Low GI (13,26,29,30) 4 293 0.80 [0.55, 1.14] 34 DASH 0 0 Not estimable — Low carbohydrate (31) 1 150 1.00 [0.75, 1.34] — Energy restriction (32) 1 117 1.05 [0.47, 2.34] — Fat modification (35) 1 84 Not estimable — Soy protein (14,27) 2 130 0.44 [0.21, 0.91] 0 Behavior (24) 1 99 0.61 [0.15, 2.42] — Ethnic 0 0 Not estimable — Fiber (33) 1 11 Not estimable — Infant birth weight outcomes Mean [95% CI] Birth weight (g) All diets 12 702 −74.88 [−144.86, −4.90] 1 Low GI (13,26,29,30) 4 276 −54.25 [−178.98, 70.47] 0 DASH 0 0 Not estimable — Low carbohydrate (12,25) 2 42 57.73 [−164.93, 280.39] 0 Energy restriction (32) 1 122 194.00 [−42.58, 430.58] — Fat modification (28,35) 2 109 −139.61 [−294.80, 15.58] 0 Soy protein (14,27) 2 131 −184.67 [−319.35, −49.98] 0 Ethnic diet 0 0 Not estimable — Fiber (33) 1 22 −94.00 [−446.68, 258.68] — RR [95% CI] Large for gestational age All diets 7 627 1.00 [0.66, 1.53] 0 Low GI (13,26,29) 3 193 1.33 [0.54, 3.31] 0 Low carbohydrate (31) 1 149 0.51 [0.13, 1.95] — Energy restriction (32) 1 123 1.17 [0.65, 2.12] — Soy protein (14) 1 63 0.45 [0.04, 4.76] — Behavior (24) 1 99 0.73 [0.25, 2.14] — Ethnic diet 0 0 Not estimable — Macrosomia All 9 729 0.73 [0.40, 1.31] 0 Low GI (13,26,29,30) 4 276 0.46 [0.15, 1.46] 0 DASH 0 0 Not estimable 0 Low carbohydrate (25,31) 2 179 0.20 [0.02, 1.69] — Energy restriction (32) 1 122 1.56 [0.61, 3.94] — Fat modification (35) 1 84 0.35 [0.04, 3.23] — Soy protein (27) 1 68 0.60 [0.16, 2.31] — Ethnic diet 0 0 Not estimable —
In this Issue
July 2018, 41(7)
Gestational Diabetes Mellitus and Diet: A Systematic Review and Meta-analysis of Randomized Controlled Trials Examining the Impact of Modified Dietary Interventions on Maternal Glucose Control and Neonatal Birth Weight
