Participant characteristics in the prevention of gestational diabetes as evidence for precision medicine: a systematic review and meta-analysis

Lim, S.; Takele, W. W.; Vesco, K. K.; Redman, L. M.; Hannah, W.; Bonham, M. P.; Chen, M.; Chivers, S. C.; Fawcett, A. J.; Grieger, J. A.; Habibi, N.; Leung, G. K. W.; Liu, K.; Mekonnen, E. G.; Pathirana, M.; Quinteros, A.; Taylor, R.; Ukke, G. G.; Zhou, S. J.; Franks, P. W.; Rich, S. S.; Wagner, R.; Vilsboll, T.; Udler, M. S.; Tuomi, T.; Sweeting, A.; Sims, E. K.; Sherr, J. L.; Semple, R. K.; Reynolds, R. M.; Redondo, M. J.; Pratley, R. E.; Pop-Busui, R.; Pollin, T. I.; Perng, W.; Pearson, E. R.; Ozanne, S. E.; Owen, K. R.; Oram, R.; Murphy, R.; Mohan, V.; Misra, S.; Meigs, J. B.; Mathioudakis, N.; Mathieu, C.; R. C. W., Ma; Loos, R. J. F.; Lim, S. S.; Laffel, L. M.; Kwak, S. H.; Hood, K. K.; Hivert, M. -F.; Hirsch, I. B.; Hattersley, A. T.; Griffin, K.; Greeley, S. A. W.; Gottlieb, P. A.; Gomez, M. F.; Gloyn, A. L.; Florez, J. C.; Dennis, J. M.; Costacou, T.; Boyle, K.; Billings, L. K.; Brown, R. J.; Philipson, L. H.; Nolan, J. J.; Eckel, R. H.; Sherifali, D.; Mixter, E.; Gruber, C.; Fawcett, A. J.; De Souza, R.; Auh, S.; Zhu, Y.; Zhang, C.; Saint-Martin, C.; Provenzano, M.; Pomares-Millan, H.; Njolstad, P. R.; Nakabuye, M.; Molnes, J.; Mcgovern, A.; Maloney, K. A.; Flanagan, S. E.; De Franco, E.; Aukrust, I.; Polak, M.; Beltrand, J.; Zhang, Y.; Yu, G.; White, S. L.; Hannah, W.; Wentworth, J. M.; Vatier, C.; Van Der Schueren, B.; Urazbayeva, M.; Ukke, G. G.; Tye, S. C.; Stoy, J.; Stefan, N.; Steck, A. K.; Steenackers, N.; Stanislawski, M. A.; Speake, C.; Sheu, W. H. -H.; Selvin, E.; Scholtens, D. M.; Monaco, G. S. F.; Sarkar, S.; Kanbour, S.; Santhakumar, V.; Saeed, Z.; Ried-Larsen, M.; Ray, D.; Jain, R.; Powe, C. E.; Petrie, J. R.; Perez, D.; Pazmino, S.; Pankow, J. S.; Onengut-Gumuscu, S.; Motala, A. A.; Morton, R. W.; Lowe, W. L.; Long, S. A.; Libman, I. M.; Leong, A.; Koivula, R. W.; Jones, A. G.; Johnson, R. K.; Hoag, B.; Ismail, H. M.; Harris-Kawano, A.; Huang, C.; Hansen, T.; Guasch-Ferre, M.; Goodarzi, M. O.; Gitelman, S. E.; Fitzpatrick, S. L.; Fitipaldi, H.; Fernandez-Balsells, M. M.; Evans-Molina, C.; Dudenhoffer-Pfeifer, M.; Dimeglio, L. A.; Dickens, L. T.; Deutsch, A. J.; Dawed, A. Y.; Dabelea, D.; Clemmensen, C.; Chikowore, T.; Cheng, F.; Andersen, M. K.; Amouyal, C.; Young, K.; Yamamoto, J. M.; Wong, J. J.; Wang, C. C.; Wallace, A. S.; Tosur, M.; Thuesen, A. C. B.; Tam, C. H. -T.; Svalastoga, P.; Sevilla-Gonzalez, M.; Semnani-Azad, Z.; Schon, M.; Rooney, M. R.; Raghavan, S.; Prystupa, K.; Pilla, S. J.; Patel, K. A.; Ozkan, B.; Naylor, R. N.; Most, J.; Morieri, M. L.; Miller, R. G.; Mclennan, N. -M.; Massey, R.; Mannisto, J. M. E.; Lim, L. -L.; Kreienkamp, R. J.; Kettunen, J. L. T.; Kahkoska, A. R.; Jacobsen, L. M.; Ikle, J. M.; Hughes, A.; Haider, E.; Gaillard, R.; Gingras, V.; Gillard, P.; Francis, E. C.; Felton, J. L.; Duan, D.; Cromer, S. J.; Corcoy, R.; Colclough, K.; Clark, A. L.; Bodhini, D.; Benham, J. L.; Aiken, C.; Ahmad, A.; Merino, J.; Tobias, D. K.; Josefson, J.

doi:10.1038/s43856-023-00366-x

Background: Precision prevention involves using the unique characteristics of a particular group to determine their responses to preventive interventions. This study aimed to systematically evaluate the participant characteristics associated with responses to interventions in gestational diabetes mellitus (GDM) prevention. Methods: We searched MEDLINE, EMBASE, and Pubmed to identify lifestyle (diet, physical activity, or both), metformin, myoinositol/inositol and probiotics interventions of GDM prevention published up to May 24, 2022. Results: From 10347 studies, 116 studies (n = 40940 women) are included. Physical activity results in greater GDM reduction in participants with a normal body mass index (BMI) at baseline compared to obese BMI (risk ratio, 95% confidence interval: 0.06 [0.03, 0.14] vs 0.68 [0.26, 1.60]). Combined diet and physical activity interventions result in greater GDM reduction in participants without polycystic ovary syndrome (PCOS) than those with PCOS (0.62 [0.47, 0.82] vs 1.12 [0.78–1.61]) and in those without a history of GDM than those with unspecified GDM history (0.62 [0.47, 0.81] vs 0.85 [0.76, 0.95]). Metformin interventions are more effective in participants with PCOS than those with unspecified status (0.38 [0.19, 0.74] vs 0.59 [0.25, 1.43]), or when commenced preconception than during pregnancy (0.21 [0.11, 0.40] vs 1.15 [0.86–1.55]). Parity, history of having a large-for-gestational-age infant or family history of diabetes have no effect on intervention responses. Conclusions: GDM prevention through metformin or lifestyle differs according to some individual characteristics. Future research should include trials commencing preconception and provide results disaggregated by a priori defined participant characteristics including social and environmental factors, clinical traits, and other novel risk factors to predict GDM prevention through interventions.