Optimal treatments and experiences for women with gestational diabetes mellitus (GDM): improving health for mothers and babies

Abstract

Aims: To provide insights into optimal treatments, glycaemic targets, and experiences of women with gestational diabetes mellitus (GDM) to guide clinical management. Optimal treatments for women with GDM Method: An overview of Cochrane systematic reviews to synthesise evidence on treatments for women with GDM. Findings: Eight systematic reviews were eligible and included a total of 62 randomised trials involving 9133 women, 8373 babies and 767 children. High-quality evidence suggested that lifestyle interventions were ineffective for reducing the likelihood of induction of labour compared with usual diet/diet alone. Exercise compared with control was ineffective in improving the return to pre-pregnancy weight. No other high-quality evidence was found. Promising interventions included lifestyle interventions (reduced risk of large for gestational age) and the DASH diet (reduced rate of caesarean section). Glycaemic treatment targets for women with GDM Method: A Cochrane systematic review to synthesise evidence from randomised controlled trials on the effect of different glycaemic targets for women with GDM and their children. Findings: One randomised trial with 180 women was eligible and included. Based on limited data it remains unclear which glycaemic targets to recommend for women with GDM for improving their health and that of their babies. Views, experiences, barriers, and enablers of women with GDM on achieving optimal glycaemic control Methods: Sixty women with GDM completed the survey and semi-structured interview. Findings: The survey highlighted how the 60 women viewed adherence to their glycaemic targets and identified ten enablers and nine barriers. Thematic analysis using the Theoretical Domains Framework from the semi-structured interviews provided insights of the women’s first reaction to a diagnosis of GDM and identified multiple barriers and enablers for women with GDM trying to achieve optimal glycaemic control within ten relevant Theoretical Domains. Conclusions This thesis found limited evidence for effective treatments and glycaemic targets for women with GDM. A need for high-quality research with long-term follow-up was identified. Women with GDM in New Zealand identified multiple enablers and barriers to achieving optimal glycaemic control that need to be considered when providing health care.