Photo Credit: Natalia Kuzina
The following is a summary of “Systematic Review of Interventions in Early Pregnancy Among Pregnant Individuals at Risk for Hyperglycemia,” published in the January 2025 issue of Obstetrics and Gynecology by Calancie et al.
The maternal metabolic environment during early pregnancy plays a critical role in shaping fetal growth trajectories. This study aimed to identify early pregnancy interventions initiated before 20 weeks gestation in pregnant individuals with risk factors for hyperglycemia and assess their impact on primary outcomes such as neonatal adiposity, small for gestational age, large for gestational age, and macrosomia, along with secondary outcomes like gestational weight gain, maternal hypertensive disorders, birth injuries, NICU admissions, preterm delivery, and emergency cesarean sections.
Researchers conducted a comprehensive search across Cochrane Central, Medline, Embase, CINAHL databases, and clinicaltrials.gov up to September 2024. The search encompassed clinical trials published from 2009 to 2024, using keywords related to early pregnancy, gestation, insulin resistance, metabolic health, diabetes, body composition, obesity, weight gain, gestational diabetes, hyperglycemia, metabolic syndrome, and clinical trials.
The inclusion criteria focused on RCTs and other clinical trials that initiated interventions before 20 weeks gestation in participants with singleton pregnancies at risk for hyperglycemia due to factors such as overweight, obesity, a history of type 2 diabetes, or gestational diabetes mellitus. Studies had to report at least one primary outcome and be conducted in high-income countries, as defined by the World Bank, and written in English.
The methodological quality and risk of bias were assessed using the Downs and Black checklist. Data extraction was performed independently, with discrepancies resolved through group discussions. Interventions were categorized based on their type of synthesis.
Out of 21,924 records identified, 70 full-text articles met the inclusion criteria, with 65 being RCTs. Eight categories of interventions were identified: diet only, physical activity or exercise only, combined diet and physical activity, lifestyle counseling, supplements, pharmaceuticals, early GDM screening, and mixed interventions. Only 12 studies reported statistically significant effects on primary neonatal outcomes.
Early pregnancy interventions aimed at individuals at risk for hyperglycemia that incorporate strategies such as goal-setting, motivational techniques to improve diet and physical activity, lifestyle coaching with behavioral techniques to foster autonomy, structured group exercise classes, and personalized dietary recommendations were found to significantly reduce the risk of neonatal adiposity, macrosomia, LGA, and SGA. These findings highlight the importance of early, targeted interventions in managing maternal hyperglycemia to improve neonatal outcomes.
Source: sciencedirect.com/science/article/pii/S2589933325000072
