Effect of Medical Nutrition Therapy on glycemic control and adverse pregnancy outcomes with Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis
DOI:
https://doi.org/10.54097/9ggp4c42Keywords:
Medical Nutrition Therapy, Gestational Diabetes Mellitus, Glycemic Regulation, Maternal-neonatal Adverse Outcomes, Evidence based NursingAbstract
Objective: Medical nutrition therapy (MNT) and conventional dietary intervention were compared in this study to determine their respective impacts on glycemic regulation and the incidence of adverse pregnancy outcomes (APOs) in gestational diabetes mellitus (GDM). Methods: Through a systematic search of PubMed, Embase, Cochrane databases, Web of Science, as well as the Chinese Biomedical Literature Database (SinoMed), China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP databases, eligible randomized controlled trials (RCTs) comparing MNT with conventional dietary control were identified. The retrieval window included all records available since the establishment of the respective databases, with the final search date being September 6, 2025. Blood glucose control was studied by comparing glycated hemoglobin (HbA1c), fasting blood glucose (FBG), two-hour postprandial blood glucose (2hPBG) and fasting plasma glucose (FPG). The occurrence rate of APOs was investigated using comparative evidence on complications affecting mothers and neonates. Meta-analysis served as the analytical method, and either random-effects or fixed-effects modeling was used. Results: The meta-analysis incorporated 15 RCTs that enrolled a total of 1,479 patients with GDM. Relative to usual dietary control, MNT was linked to significant declines in HbA1c (MD = -0.99; 95% CI, -1.44 to -0.55; P < 0.00001), FBG (MD = -0.84; 95% CI, -1.07 to -0.60; P < 0.00001), 2hPBG (MD = -1.43; 95% CI, -1.87 to -0.98; P < 0.00001) and FPG (MD = -0.54; 95% CI, -0.58 to -0.32; P < 0.00001). Furthermore, MNT was associated with substantially diminished risks for maternal complications (RR = 0.41; 95% CI, 0.32 to 0.54) and neonatal complications (RR = 0.34; 95% CI, 0.26 to 0.44). Across the included studies, no serious adverse events that could be attributed to MNT were documented. Conclusion: For patients with GDM, the use of MNT during pregnancy is capable of improving blood sugar regulation and decreasing the risk of complications among mothers and neonates. For GDM management, MNT should be emphasized as a safe and effective non-pharmacological intervention measure. Further confirmation of its long-term effects requires additional RCTs with stronger study quality.
Downloads
References
[1] Genuth, S. M., Palmer, J. P., & Nathan, D. M. (2018). Classification and diagnosis of diabetes. In C. C. Cowie (Ed.), Diabetes in America (3rd ed.). National Institute of Diabetes and Digestive and Kidney Diseases (US).
[2] National Diabetes Data Group. (1979). Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes, 28(12), 1039–1057.
https://doi.org/10.2337/diab.28.12.1039 DOI: https://doi.org/10.2337/diab.28.12.1039
[3] Li, Q., Guo, Z., Xia, A., & Wang, X. (2023). Effect of early comprehensive nursing intervention combined with continuing care on blood glucose control and pregnancy outcome in gestational diabetes mellitus patients. Diabetes New World, 26(15), 147–150.
https://doi.org/10.16658/j.cnki.1672 4062.2023.15.147
[4] Duncan, B. B., Magliano, D. J., & Boyko, E. J. (2025). IDF Diabetes Atlas 11th edition 2025: global prevalence and projections for 2050. Nephrology, Dialysis, Transplantation: Official Publication of the European Dialysis and Transplant Association European Renal Association, 41(1), 7–9. https://doi.org/10.1093/ndt/gfaf177. DOI: https://doi.org/10.1093/ndt/gfaf177
[5] Catalano, P. M., Huston, L., Amini, S. B., & Kalhan, S. C. (1999). Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes mellitus. American Journal of Obstetrics and Gynecology, 180(4), 903–916. DOI: https://doi.org/10.1016/S0002-9378(99)70662-9
https://doi.org/10.1016/s0002 9378(99)70662 9
[6] Buchanan, T. A. (2001). Pancreatic B cell defects in gestational diabetes: Implications for the pathogenesis and prevention of type 2 diabetes. The Journal of Clinical Endocrinology and Metabolism, 86(3), 989–993.
https://doi.org/10.1210/jcem.86.3.7339 DOI: https://doi.org/10.1210/jcem.86.3.7339
[7] Black, M. H., Fingerlin, T. E., Allayee, H., Zhang, W., Xiang, A. H., Trigo, E., Hartiala, J., Lehtinen, A. B., Haffner, S. M., Bergman, R. N., McEachin, R. C., Kjos, S. L., Lawrence, J. M., Buchanan, T. A., & Watanabe, R. M. (2008). Evidence of interaction between PPARG2 and HNF4A contributing to variation in insulin sensitivity in Mexican Americans. Diabetes, 57(4), 1048–1056. https://doi.org/10.2337/db07 0848. DOI: https://doi.org/10.2337/db07-0848
[8] Kim, C., Newton, K. M., & Knopp, R. H. (2002). Gestational diabetes and the incidence of type 2 diabetes: A systematic review. Diabetes Care, 25(10), 1862–1868.
https://doi.org/10.2337/diacare.25.10.1862 DOI: https://doi.org/10.2337/diacare.25.10.1862
[9] Hu, C. (2021). Effect of early comprehensive nursing intervention on blood glucose control and pregnancy outcome in patients with gestational diabetes mellitus. Journal of Practical Gynecologic Endocrinology, 8(24), 96–99.
[10] Dingena, C. F., Arofikina, D., Campbell, M. D., Holmes, M. J., Scott, E. M., & Zulyniak, M. A. (2023). Nutritional and exercise focused lifestyle interventions and glycemic control in women with diabetes in pregnancy: A systematic review and meta analysis of randomized clinical trials. Nutrients, 15(2), 323. https://doi.org/10.3390/nu15020323. DOI: https://doi.org/10.3390/nu15020323
[11] Briggs Early, K., & Stanley, K. (2018). Position of the Academy of Nutrition and Dietetics: The role of medical nutrition therapy and registered dietitian nutritionists in the prevention and treatment of prediabetes and type 2 diabetes. Journal of the Academy of Nutrition and Dietetics, 118(2), 343–353. https://doi.org/10.1016/j.jand.2017.11.021. DOI: https://doi.org/10.1016/j.jand.2017.11.021
[12] Vasile, F. C., Preda, A., Ștefan, A. G., Vladu, M. I., Forțofoiu, M. C., Clenciu, D., Gheorghe, I. O., Forțofoiu, M., & Moța, M. (2021). An update of medical nutrition therapy in gestational diabetes mellitus. Journal of Diabetes Research, 2021, 5266919. https://doi.org/10.1155/2021/5266919. DOI: https://doi.org/10.1155/2021/5266919
[13] Oken, E., Ning, Y., Rifas Shiman, S. L., Rich Edwards, J. W., Olsen, S. F., & Gillman, M. W. (2007). Diet during pregnancy and risk of preeclampsia or gestational hypertension. Annals of Epidemiology, 17(9), 663–668.
https://doi.org/10.1016/j.annepidem.2007.03.003 DOI: https://doi.org/10.1016/j.annepidem.2007.03.003
[14] Hernandez, T. L., Van Pelt, R. E., Anderson, M. A., Reece, M. S., Reynolds, R. M., de la Houssaye, B. A., Heerwagen, M., Donahoo, W. T., Daniels, L. J., Chartier Logan, C., Janssen, R. C., Friedman, J. E., & Barbour, L. A. (2016). Women with gestational diabetes mellitus randomized to a higher complex carbohydrate/low fat diet manifest lower adipose tissue insulin resistance, inflammation, glucose, and free fatty acids: A pilot study. Diabetes Care, 39(1), 39–42. DOI: https://doi.org/10.2337/dc15-0515
https://doi.org/10.2337/dc15 0515
[15] Mayo, K., Melamed, N., Vandenberghe, H., & Berger, H. (2015). The impact of adoption of the international association of diabetes in pregnancy study group criteria for the screening and diagnosis of gestational diabetes. American Journal of Obstetrics and Gynecology, 212(2), 224.e1–224.e2249.
https://doi.org/10.1016/j.ajog.2014.08.027 DOI: https://doi.org/10.1016/j.ajog.2014.08.027
[16] Colletti, A., Cravotto, G., Citi, V., Martelli, A., Testai, L., & Cicero, A. F. G. (2021). Advances in technologies for highly active omega 3 fatty acids from krill oil: Clinical applications. Marine Drugs, 19(6), 306.
https://doi.org/10.3390/md19060306 DOI: https://doi.org/10.3390/md19060306
[17] Al Gubory, K. H. (2012). Mitochondria: Omega 3 in the route of mitochondrial reactive oxygen species. The International Journal of Biochemistry & Cell Biology, 44(9), 1569–1573.
https://doi.org/10.1016/j.biocel.2012.06.003 DOI: https://doi.org/10.1016/j.biocel.2012.06.003
[18] Langer, O., Conway, D. L., Berkus, M. D., Xenakis, E. M., & Gonzales, O. (2000). A comparison of glyburide and insulin in women with gestational diabetes mellitus. The New England Journal of Medicine, 343(16), 1134–1138.
https://doi.org/10.1056/NEJM200010193431601 DOI: https://doi.org/10.1056/NEJM200010193431601
[19] Barbour, L. A., Scifres, C., Valent, A. M., Friedman, J. E., Buchanan, T. A., Coustan, D., Aagaard, K., Thornburg, K. L., Catalano, P. M., Galan, H. L., Hay, W. W., Jr., Frias, A. E., Shankar, K., Simmons, R. A., Moses, R. G., Sacks, D. A., & Loeken, M. R. (2018). A cautionary response to SMFM statement: Pharmacological treatment of gestational diabetes. American Journal of Obstetrics and Gynecology, 219(4), 367.e1–367.e7. https://doi.org/10.1016/j.ajog.2018.06.013. DOI: https://doi.org/10.1016/j.ajog.2018.06.013
[20] Yamamoto, J. M., Kellett, J. E., Balsells, M., García Patterson, A., Hadar, E., Solà, I., Gich, I., van der Beek, E. M., Castañeda Gutiérrez, E., Heinonen, S., Hod, M., Laitinen, K., Olsen, S. F., Poston, L., Rueda, R., Rust, P., van Lieshout, L., Schelkle, B., Murphy, H. R., & Corcoy, R. (2018). 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. Diabetes Care, 41(7), 1346–1361. https://doi.org/10.2337/dc18 0102. DOI: https://doi.org/10.2337/dc18-0102
[21] Mo, Q., Liu, X., Zhao, Q., Wang, H., Hang, Y., Niu, J., & Yang, Q. (2023). Influencing factors of gestational diabetes mellitus and effect of individualized medical nutrition therapy. China Maternal and Child Health Care, 38(15), 2829–2832. https://doi.org/10.19829/j.zgfybj.issn.1001 4411.2023.15.030.
[22] Chen, J., Fan, Y., & Lin, S. (2024). Effect of medical nutrition therapy combined with exercise intervention on delivery outcomes of gestational diabetes mellitus parturients. Chinese Journal of Modern Drug Application, 18(20), 157–160. https://doi.org/10.14164/j.cnki.cn11 5581/r.2024.20.044.
[23] Li, P. (2023). Effect of individualized comprehensive medical nutrition therapy on maternal and infant outcomes in patients with gestational diabetes mellitus. Diabetes New World, 26(19), 42–45. https://doi.org/10.16658/j.cnki.1672 4062.2023.19.042.
[24] Hariton, E., & Locascio, J. J. (2018). Randomised controlled trials the gold standard for effectiveness research: Study design: Randomised controlled trials. BJOG: An International Journal of Obstetrics and Gynaecology, 125(13), 1716. DOI: https://doi.org/10.1111/1471-0528.15199
https://doi.org/10.1111/1471 0528.15199
[25] Zhang, C., Jin, C., Wei, X., Cui, X., Chen, X., & Liu, S. (2024). Effect of comprehensive nutrition management intervention on glycolipid metabolism and pregnancy outcomes in patients with gestational diabetes mellitus. Chinese Journal of Clinical Nutrition, 32(1), 8–14.
[26] Wang, F., & Guo, J. (2023). Analysis of the effect of individualized medical nutrition therapy on blood glucose and maternal and infant outcomes in patients with gestational diabetes mellitus. Diabetes New World, 26(10), 38–41. https://doi.org/10.16658/j.cnki.1672 4062.2023.10.038.
[27] Wang, R., Li, W., & Jiang, K. (2023). Application effect of nutrition therapy in early pregnancy in patients with gestational diabetes mellitus. Chinese Journal of Practical Medicine, 50(7), 76–79.
[28] Song, C. (2022). Observation on the effect of early individualized nutrition intervention on blood glucose and complication control in pregnant women with gestational diabetes mellitus. Women's Health Research, (24), 155–156, 187.
[29] Xu, C. (2022). Effect of individualized nutrition intervention on blood glucose level and pregnancy outcome in patients with gestational diabetes mellitus. Chinese Health Care, 40(22), 140–142.
[30] Guo, H., & Zhang, Y. (2022). Effect of medical nutrition intervention on blood glucose level and pregnancy outcome in patients with gestational diabetes mellitus. Journal of Qiannan Medical College for Nationalities, 35(1), 47–49.
[31] Xu, S., Zhao, J., & Wang, X. (2022). Effect of medical nutrition therapy on blood glucose control, pregnancy outcome and neonatal outcomes in pregnant women with gestational diabetes mellitus. Heilongjiang Medicine, 35(2), 431–433. https://doi.org/10.14035/j.cnki.hljyy.2022.02.072.
[32] Xu, X. (2021). Study on the effect of nutritional diet in the treatment of gestational diabetes mellitus. Diabetes New World, 24(17), 41–45.
https://doi.org/10.16658/j.cnki.1672 4062.2021.17.041
[33] Zhou, L., Yang, H., Jin, F., Zhang, R., Shen, W., & Bao, L. (2019). Effect of nutritional intervention in early pregnancy on glucose and lipid metabolism and fetal prognosis in women at high risk of gestational diabetes mellitus. Maternal and Child Health Care of China, 34(11), 2460–2462.
[34] Li, D., Shan, Y., Zou, D., Bao, X., & Tian, L. (2018). Effect of personalized nutrition intervention during pregnancy on glucose and lipid levels and pregnancy outcomes in women with gestational diabetes mellitus. Progress in Modern Biomedicine, 18(23), 4510–4513, 4570.
https://doi.org/10.13241/j.cnki.pmb.2018.23.026
[35] Ma, W. J., Huang, Z. H., Huang, B. X., Qi, B. H., Zhang, Y. J., Xiao, B. X., Li, Y. H., Chen, L., & Zhu, H. L. (2015). Intensive low glycaemic load dietary intervention for the management of glycaemia and serum lipids among women with gestational diabetes: A randomized control trial. Public Health Nutrition, 18(8), 1506–1513.
https://doi.org/10.1017/S1368980014001992 DOI: https://doi.org/10.1017/S1368980014001992
[36] Peng, L. (2015). Study on the effect of nutritional intervention model on blood glucose level in pregnant women with gestational diabetes mellitus. Women's Health Research, (1), 11.
[37] Asemi, Z., Tabassi, Z., Samimi, M., Fahiminejad, T., & Esmaillzadeh, A. (2013). Favourable effects of the Dietary Approaches to Stop Hypertension diet on glucose tolerance and lipid profiles in gestational diabetes: A randomised clinical trial. The British Journal of Nutrition, 109(11), 2024–2030. https://doi.org/10.1017/S0007114512004242. DOI: https://doi.org/10.1017/S0007114512004242
[38] Xiao, B., Qi, B., Zhang, Y., Li, Y., Yu, W., & Ma, W. (2013). Effect of nutritional intervention on glucose and lipid metabolism in pregnant women with abnormal blood glucose during pregnancy. Food and Nutrition in China, 19(11), 76–79.
[39] Zeng, Y., Yuan, L., Wang, L., Kang, L., Wan, J., Meng, S., & Mi, M. (2013). Evaluation of different medical nutrition therapy methods for gestational diabetes mellitus. Journal of Third Military Medical University, 35(10), 1030–1033. https://doi.org/10.16016/j.1000 5404.2013.10.014.
[40] Gao, X., Zheng, Q., Jiang, X., Chen, X., Liao, Y., & Pan, Y. (2023). The effect of diet quality on the risk of developing gestational diabetes mellitus: A systematic review and meta analysis. Frontiers in Public Health, 10, 1062304. https://doi.org/10.3389/fpubh.2022.1062304. DOI: https://doi.org/10.3389/fpubh.2022.1062304
[41] Kusinski, L. C., Jones, D., Atta, N., Turner, E., Smith, S., Oude Griep, L. M., Rennie, K., De Lucia Rolfe, E., Sharp, S. J., Farewell, V., Murphy, H. R., Taylor, R., & Meek, C. L. (2025). Reduced energy diet in women with gestational diabetes: The dietary intervention in gestational diabetes DiGest randomized clinical trial. Nature Medicine, 31(2), 514–523. DOI: https://doi.org/10.1038/s41591-024-03356-1
https://doi.org/10.1038/s41591 024 03356 1
[42] Cheong, L., Law, L. S., Tan, L. Y. L., Amal, A. A., Khoo, C. M., & Eng, P. C. (2025). Medical nutrition therapy for women with gestational diabetes: Current practice and future perspectives. Nutrients, 17(7), 1210.
https://doi.org/10.3390/nu17071210 DOI: https://doi.org/10.3390/nu17071210
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
