不同饮食模式对妊娠期糖尿病血糖及妊娠结局影响的网状Meta分析

Effects of Different Dietary Patterns on Blood Glucose and Pregnancy Outcomes in Patients with Gestational Diabetes Mellitus:A Network Meta-Analysis

目的:运用网状Meta分析评价7种不同饮食模式对妊娠期糖尿病血糖及妊娠结局的影响。方法:对中国知网(CNKI)、万方、维普网(VIP)、SinoMed、PubMed、Embase、Web of Science、Cochrane Library等中英文数据库进行系统检索,检索时间为建库至2023年3月。由2名研究者独自进行文献的筛选与资料的提取,采用Cochrane偏倚风险评估工具进行质量评价,运用Review Manager5.4.1、Stata15.1软件进行数据分析。结果:共纳入25项研究,从空腹血糖方面看,网状Meta分析排序结果从优到劣依次为:低血糖指数饮食>低血糖指数饮食联合常规饮食>终止高血糖饮食(DASH)>低血糖负荷饮食>低碳水化合物饮食>低碳水化合物饮食联合DASH>常规饮食;从餐后2h血糖方面看,网状Meta分析排序结果从优到劣依次为:低血糖指数饮食>低血糖指数饮食联合常规饮食>低血糖负荷饮食>低碳水化合物饮食>常规饮食;从胰岛素抵抗方面看,网状Meta分析排序结果从优到劣依次为:DASH>低血糖指数饮食联合常规饮食>低血糖指数饮食>常规饮食;从不良妊娠结局发生率方面看,网状Meta排序结果从优到劣依次为:低血糖指数饮食>DASH>低血糖指数饮食联合常规饮食>低碳水化合物饮食>低血糖负荷饮食>常规饮食>低碳水化合物饮食联合DASH。结论:从空腹血糖、餐后2h血糖、不良妊娠结局发生率方面来看,低血糖指数饮食可达到良好的效果,在7种方法中概率排名第一。胰岛素抵抗方面,DASH排名第一。但是,还需更多有质量的随机对照试验予以进一步验证。

【Objective】To evaluate the effects of different dietary patterns on blood glucose and pregnancy outcomes in patients with gestational diabetes mellitus by network Meta-analysis.【Method】CNKI,Wanfang,VIP,SinoMed,PubMed,Embase,Web of Science,Cochrane Library and other Chinese and English databases were searched from the establishment of the database to March 2023.Two researchers screened the literature and extracted the data back-to-back.The Cochrane bias risk assessment tool was used to evaluate the quality of the literature.Review Manager5.4.1 and Stata15.1 software were used for data analysis.【Result】A total of 25 studies were included.The results showed that in terms of fasting blood glucose,the ranking of Network Meta-analysis from best to worst was low glycemic index diet>low glycemic index combined with conventional diet>DASH>low glycemic load diet>low carbohydrate diet>low carbohydrate diet combined with DASH>conventional diet.In terms of 2-hour postprandial blood glucose,the ranking of network Metaanalysis from best to worst was low glycemic index diet>low glycemic index diet combined with conventional diet>low glycemic load diet>low carbohydrate diet>conventional diet.In terms of insulin resistance,the result of network Meta-analysis ranking from best to worst was DASH>low glycemic index diet combined with regular diet>low glycemic index diet>regular diet.In terms of the incidence of adverse pregnancy outcomes,the ranking of network Meta-analysis from best to worst was low glycemic index Diet>DASH>low glycemic index diet combined with conventional diet>low carbohydrate diet>low glycemic load iet>conventional diet>low carbohydrate diet combined with DASH.【Conclusion】In terms of fasting blood glucose,2-hour postprandial blood glucose,and the incidence of adverse pregnancy outcomes,low glycemic index diet can achieve good results,ranking first among the 7 methods.In terms of insulin resistance,DASH had the best effect.However,more high-quality RCT are still needed to further confirm the results.