Influence of omega-3 fatty acid and vitamin co-supplementation on metabolic status in gestational diabetes: A meta-analysis of randomized controlled studies

  • Fujie Li
    Affiliations
    Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Reproductive and Genetics Institute, Chongqing Health Center for Women and Children, Chongqing, China
    Search for articles by this author
  • Li Pei
    Affiliations
    Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Reproductive and Genetics Institute, Chongqing Health Center for Women and Children, Chongqing, China
    Search for articles by this author
  • Guoning Huang
    Affiliations
    Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Reproductive and Genetics Institute, Chongqing Health Center for Women and Children, Chongqing, China
    Search for articles by this author
  • Hong Ye
    Correspondence
    Corresponding author at: 64 Jintang ST., Yuzhong District, Chongqing, 40013, China.
    Affiliations
    Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Reproductive and Genetics Institute, Chongqing Health Center for Women and Children, Chongqing, China
    Search for articles by this author
Published:February 26, 2020DOI:https://doi.org/10.1016/j.ejogrb.2020.02.024

      Abstract

      Introduction

      Omega-3 fatty acid and vitamin E or D co-supplementation may be an important approach to improve metabolic status in gestational diabetes, but the results are conflicting. This systematic review and meta-analysis was conducted to evaluate the effect of omega-3 fatty acid and vitamin co-supplementation on metabolic status in gestational diabetes.

      Methods

      PubMed, Embase and the Cochrane Central Register of Controlled Trials were searched. Randomized controlled trials (RCTs) assessing the influence of omega-3 fatty acid and vitamin co-supplementation compared with placebo on metabolic status in gestational diabetes were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies.

      Results

      Four RCTs were included in the meta-analysis. Compared with control interventions for gestational diabetes, omega-3 fatty acid and vitamin E or D co-supplementation was associated with significantly reduced fasting plasma glucose [mean difference (MD) -10.47, 95 % confidence interval (CI) -15.33 to -5.61, p < 0.0001], homeostasis model of assessment-insulin resistance (MD -1.6, 95 % CI=-2.44 to -0.77, p = 0.0002), malondialdehyde (MD -1.00, 95 % CI -1.05 to -0.95, p < 0.00001) and triglycerides (MD 26.22, 95 % CI -38.94 to -13.51, p < 0.0001), as well as increased antioxidant capacity (MD 173.51, 95 % CI 164.72–182.30, p < 0.00001), but showed no obvious effect on nitric oxide (MD 5.95, 95 % CI -7.48 to 19.37, p = 0.39) or total cholesterol (MD 1.63, 95 % CI -13.46 to 16.72, p = 0.83).

      Conclusions

      Omega-3 fatty acid and vitamin co-supplementation may have a favourable effect on metabolic status in gestational diabetes.

      Keywords

      To read this article in full you will need to make a payment

      References

        • Abariga S.A.
        • Whitcomb B.W.
        Periodontitis and gestational diabetes mellitus: a systematic review and meta-analysis of observational studies.
        BMC Pregnancy Childbirth. 2016; 16: 344
        • Schneider S.
        • Hoeft B.
        • Freerksen N.
        • Fischer B.
        • Roehring S.
        • Yamamoto S.
        • et al.
        Neonatal complications and risk factors among women with gestational diabetes mellitus.
        Acta Obstet Gynecol Scand. 2011; 90: 231-237
        • Ali S.
        • Dornhorst A.
        Diabetes in pregnancy: health risks and management.
        Postgrad Med J. 2011; 87: 417-427
        • Coustan D.R.
        Gestational diabetes mellitus.
        Clin Chem. 2013; 59: 1310-1321
        • Hanna F.W.
        • Duff C.J.
        • Shelley-Hitchen A.
        • Hodgson E.
        • Fryer A.A.
        Diagnosing gestational diabetes mellitus: implications of recent changes in diagnostic criteria and role of glycated haemoglobin (HbA1c).
        Clin Med. 2017; 17: 108-113
        • Ozyer S.
        • Engin-Ustun Y.
        • Uzunlar O.
        • Katar C.
        • Danisman N.
        Inflammation and glycemic tolerance status in pregnancy: the role of maternal adiposity.
        Gynecol Obstet Invest. 2014; 78: 53-58
        • Pantham P.
        • Aye I.L.
        • Powell T.L.
        Inflammation in maternal obesity and gestational diabetes mellitus.
        Placenta. 2015; 36: 709-715
        • Evangelista A.F.
        • Collares C.V.
        • Xavier D.J.
        • Macedo C.
        • Manoel-Caetano F.S.
        • Rassi D.M.
        • et al.
        Integrative analysis of the transcriptome profiles observed in type 1, type 2 and gestational diabetes mellitus reveals the role of inflammation.
        BMC Med Genomics. 2014; 7: 28
        • Teler J.
        • Tarnowski M.
        • Safranow K.
        • Maciejewska A.
        • Sawczuk M.
        • Dziedziejko V.
        • et al.
        CCL2, CCL5, IL4 and IL15 gene polymorphisms in women with gestational diabetes mellitus.
        Horm Metab Res. 2017; 49: 10-15
        • Haidari F.
        • Jalali M.-T.
        • Shahbazian N.
        • Haghighizadeh M.-H.
        • Azadegan E.
        Comparison of serum levels of vitamin D and inflammatory markers between women with gestational diabetes mellitus and healthy pregnant control.
        J Fam Plann Reprod Health Care. 2016; 10: 1
        • Bitsanis D.
        • Ghebremeskel K.
        • Moodley T.
        • Crawford M.A.
        • Djahanbakhch O.
        Gestational diabetes mellitus enhances arachidonic and docosahexaenoic acids in placental phospholipids.
        Lipids. 2006; 41: 341-346
        • Sobki S.H.
        • Al-Senaidy A.M.
        • Al-Shammari T.A.
        • Inam S.S.
        • Al-Gwiser A.A.
        • Bukhari S.A.
        Impact of gestational diabetes on lipid profiling and indices of oxidative stress in maternal and cord plasma.
        Saudi Med J. 2004; 25: 876-880
        • Asemi Z.
        • Karamali M.
        • Esmaillzadeh A.
        Favorable effects of vitamin D supplementation on pregnancy outcomes in gestational diabetes: a double blind randomized controlled clinical trial.
        Horm Metab Res. 2015; 47: 565-570
        • Jamilian M.
        • Samimi M.
        • Kolahdooz F.
        • Khalaji F.
        • Razavi M.
        • Asemi Z.
        Omega-3 fatty acid supplementation affects pregnancy outcomes in gestational diabetes: a randomized, double-blind, placebo-controlled trial.
        J Matern Fetal Neonat Med. 2016; 29: 669-675
        • de Santis Nobile M.
        • Radaelli T.
        • Taricco E.
        • Bertini S.
        • Cetin I.
        Excess of amniotic fluid: pathophysiology, correlated diseases and clinical management.
        Acta Biomed. 2004; 75: 53-55
        • Makishima M.
        • Lu T.T.
        • Xie W.
        • Whitfield G.K.
        • Domoto H.
        • Evans R.M.
        • et al.
        Vitamin D receptor as an intestinal bile acid sensor.
        Science. 2002; 296: 1313-1316
        • Rossi A.
        • Kapahi P.
        • Natoli G.
        • Takahashi T.
        • Chen Y.
        • Karin M.
        • et al.
        Anti-inflammatory cyclopentenone prostaglandins are direct inhibitors of IκB kinase.
        Nature. 2000; 403: 103
        • Jamilian M.
        • Dizaji S.H.
        • Bahmani F.
        • Taghizadeh M.
        • Memarzadeh M.R.
        • Karamali M.
        • et al.
        A randomized controlled clinical trial investigating the effects of omega-3 fatty acids and vitamin E co-supplementation on biomarkers of oxidative stress, inflammation and pregnancy outcomes in gestational diabetes.
        Can J Diabetes. 2017; 41: 143-149
        • Jamilian M.
        • Samimi M.
        • Ebrahimi F.A.
        • Hashemi T.
        • Taghizadeh M.
        • Razavi M.
        • et al.
        The effects of vitamin D and omega-3 fatty acid co-supplementation on glycemic control and lipid concentrations in patients with gestational diabetes.
        J Clin Lipidol. 2017; 11: 459-468
        • Razavi M.
        • Jamilian M.
        • Samimi M.
        • Ebrahimi F.A.
        • Taghizadeh M.
        • Bekhradi R.
        • et al.
        The effects of vitamin D and omega-3 fatty acids co-supplementation on biomarkers of inflammation, oxidative stress and pregnancy outcomes in patients with gestational diabetes.
        Nutr Metab. 2017; 14: 80
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • PRISMA Group
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        BMJ. 2009; 339: b2535
        • Higgins G.S.
        Cochrane handbook for systematic reviews of interventions. Version 5.1.0.
        (Available at:) Cochrane Collaboration, Oxford2011
        www.cochrane-handbook.org
        • Higgins J.P.
        • Altman D.G.
        • Gotzsche P.C.
        • Juni P.
        • Moher D.
        • Oxman A.D.
        • et al.
        The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials.
        BMJ. 2011; 343: d5928
        • Guyatt G.H.
        • Oxman A.D.
        • Vist G.E.
        • Kunz R.
        • Falck-Ytter Y.
        • Alonso-Coello P.
        • et al.
        GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.
        BMJ. 2008; 336: 924-926
        • Higgins J.P.
        • Thompson S.G.
        Quantifying heterogeneity in a meta-analysis.
        Stat Med. 2002; 21: 1539-1558
        • Taghizadeh M.
        • Jamilian M.
        • Mazloomi M.
        • Sanami M.
        • Asemi Z.
        A randomized-controlled clinical trial investigating the effect of omega-3 fatty acids and vitamin E co-supplementation on markers of insulin metabolism and lipid profiles in gestational diabetes.
        J Clin Lipidol. 2016; 10: 386-393
        • Aramesh M.R.
        • Dehdashtian M.
        • Malekian A.
        • ShahAli S.
        • Shojaei K.
        Relation between fetal anthropometric parameters and cord blood adiponectin and high-sensitivity C-reactive protein in gestational diabetes mellitus.
        Arch Endocrinol Metab. 2017; 61: 228-232
        • Marseille‐Tremblay C.
        • Ethier‐Chiasson M.
        • Forest J.C.
        • Giguere Y.
        • Masse A.
        • Mounier C.
        • et al.
        Impact of maternal circulating cholesterol and gestational diabetes mellitus on lipid metabolism in human term placenta.
        Mol Reprod Dev. 2008; 75: 1054-1062
        • Reece E.A.
        The fetal and maternal consequences of gestational diabetes mellitus.
        J Matern Fetal Neonat Med. 2010; 23: 199-203
        • Schneider C.
        Chemistry and biology of vitamin E.
        Mol Nutr Food Res. 2005; 49: 7-30
        • Milczarek R.
        • Klimek J.
        • Źelewski L.
        The effects of ascorbate and α-tocopherol on the NADPH-dependent lipid peroxidation in human placental mitochondria.
        Mol Cell Biochem. 2000; 210: 65-73
        • Nachvak S.M.
        • Neyestani T.R.
        • Mahboob S.A.
        • Sabour S.
        • Keshawarz S.A.
        • Speakman J.
        α-Tocopherol supplementation reduces biomarkers of oxidative stress in children with Down syndrome: a randomized controlled trial.
        Eur J Clin Nutr. 2014; 68: 1119
        • Gao L.
        • Lin L.
        • Shan N.
        • Ren C.Y.
        • Long X.
        • Sun Y.H.
        • et al.
        The impact of omega-3 fatty acid supplementation on glycemic control in patients with gestational diabetes: a systematic review and meta-analysis of randomized controlled studies.
        J Matern Fetal Neonat Med. 2018; ([Epub ahead of print]): 1-7https://doi.org/10.1080/14767058.2018.1526916
        • Baidal D.
        • Ricordi C.
        • Garcia-Contreras M.
        • Sonnino A.
        • Fabbri A.
        Combination high-dose omega-3 fatty acids and high-dose cholecalciferol in new onset type 1 diabetes: a potential role in preservation of beta-cell mass.
        Eur Rev Med Pharmacol Sci. 2016; 20: 3313-3318
        • Gurol A.
        • Okten-Kursun A.
        • Kasapoglu P.
        • Suzergoz F.
        • Kucuksezer U.C.
        • Cevik A.
        • et al.
        The synergistic effect of ω3 and Vit D3 on glycemia and TNF-α in islet transplantation.
        Cell Mol Biol. 2016; 62: 90-98