Dietary Recommendations for Women with Gestational Diabetes Mellitus: A Systematic Review of Clinical Practice Guidelines ^†

Abstract

Dietary intervention is key in the management of gestational diabetes mellitus (GDM). However, the ideal diet to reduce the adverse health outcomes associated with GDM is unknown. The aim of this systematic review is to identify and compare the international dietary recommendations made for the management of GDM, to assess the evidence base behind the recommendations, to identify any research gaps, and to assess the guideline quality. A systematic search between 2000 and 2019 of international and national guidelines on the dietary management of GDM was conducted in six databases. Two reviewers independently assessed the guidelines using the AGREE II tool, assessed the evidence base, and identified research gaps. Of the 31 guidelines included in this systematic review, 68% of guidelines were of low quality, 22% were of moderate quality and 10% were of high quality. All 31 guidelines recommended dietary advice as the first line treatment for GDM management. The remaining dietary recommendations were inconsistent and sometimes contradictory. Most guidelines made strong dietary recommendations but were based on very low quality or low quality evidence. Research gaps were identified for all diet related topics, including effective dietary interventions, the ideal distribution of meals and snacks, and effective follow-up during and after pregnancy. Future research on the dietary management of GDM should be of high quality to address the research gaps identified and improve the evidence base. Most guidelines were of low quality and needed to improve editorial independence and rigour of development to help reduce bias, standardise dietary recommendations, and improve the treatment of women with GDM.