The Impact of Conservative Versus Pharmacological Management on Maternal and Neonatal Outcomes in Gestational Diabetes: A Systematic Review and Meta-Analysis

TL;DR

This study compares lifestyle changes and medication for managing gestational diabetes and finds lifestyle changes lead to better outcomes for mothers and babies.

Contribution

The study provides new evidence comparing conservative and pharmacological management of gestational diabetes through a systematic review and meta-analysis.

Findings

Conservative management reduces adverse maternal outcomes by 30% compared to pharmacological therapy.

Conservative management reduces adverse neonatal outcomes by 26% compared to pharmacological therapy.

No significant differences were found between different pharmacological therapies.

Abstract

Gestational diabetes mellitus (GDM) is a common complication in pregnancy. Its early identification through targeted screening and timely management with lifestyle or pharmacological interventions is essential to optimise outcomes. Current evidence on GDM management is limited, with few studies directly comparing conservative measures with pharmacological therapy. This review evaluates the impact of conservative versus pharmacological management on maternal and neonatal outcomes. Databases and grey literature were searched, and identified studies were screened using pre-defined eligibility criteria. Data were extracted from the included studies, and study quality was appraised using the Critical Appraisal Skills Programme (CASP) tool. Maternal and neonatal outcomes were pooled in a meta-analysis. Conservative management was associated with a 30% reduction in adverse maternal outcomes (risk ratio (RR) 0.70, 95% confidence interval (CI): 0.50-0.98, p=0.04) and a 26% reduction in adverse neonatal outcomes (RR: 0.74, 95% CI: 0.60-0.96, p=0.02). Subgroup analyses revealed no significant differences between pharmacological therapies. Overall, conservative management of GDM appears to improve both maternal and neonatal outcomes compared to pharmacological management. These findings support lifestyle-based interventions as a safe and effective option, though further research is needed to confirm clinical benefits and refine clinical guidance.

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