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BMJ Open. 2017 Jun 24;7(6):e015557. doi: 10.1136/bmjopen-2016-015557.

Treatments for gestational diabetes: a systematic review and meta-analysis.

Author information

1
Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK.
2
Centre for Reviews and Dissemination, University of York, York, UK.
3
Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, West Yorkshire, UK.
4
Hull York Medical School, University of York, York, UK.
5
Bradford Women's and Newborn Unit, Bradford Teaching Hospitals NHS Foundation, Bradford, UK.
6
Department of Health Sciences, University of York, York, UK.
7
MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK.

Abstract

OBJECTIVE:

To investigate the effectiveness of different treatments for gestational diabetes mellitus (GDM).

DESIGN:

Systematic review, meta-analysis and network meta-analysis.

METHODS:

Data sources were searched up to July 2016 and included MEDLINE and Embase. Randomised trials comparing treatments for GDM (packages of care (dietary and lifestyle interventions with pharmacological treatments as required), insulin, metformin, glibenclamide (glyburide)) were selected by two authors and double checked for accuracy. Outcomes included large for gestational age, shoulder dystocia, neonatal hypoglycaemia, caesarean section and pre-eclampsia. We pooled data using random-effects meta-analyses and used Bayesian network meta-analysis to compare pharmacological treatments (ie, including treatments not directly compared within a trial).

RESULTS:

Forty-two trials were included, the reporting of which was generally poor with unclear or high risk of bias. Packages of care varied in their composition and reduced the risk of most adverse perinatal outcomes compared with routine care (eg, large for gestational age: relative risk0.58 (95% CI 0.49 to 0.68; I2=0%; trials 8; participants 3462). Network meta-analyses suggest that metformin had the highest probability of being the most effective treatment in reducing the risk of most outcomes compared with insulin or glibenclamide.

CONCLUSIONS:

Evidence shows that packages of care are effective in reducing the risk of most adverse perinatal outcomes. However, trials often include few women, are poorly reported with unclear or high risk of bias and report few outcomes. The contribution of each treatment within the packages of care remains unclear. Large well-designed and well-conducted trials are urgently needed.

TRIAL REGISTRATION NUMBER:

PROSPERO CRD42013004608.

KEYWORDS:

gestational diabetes; glibenclamide (glyburide); insulin; meta-analysis; metformin; network analysis; packages of care; systematic review; treatments

PMID:
28647726
PMCID:
PMC5734427
DOI:
10.1136/bmjopen-2016-015557
[Indexed for MEDLINE]
Free PMC Article

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