Effects of omega-3 supplementation on glucose and lipid metabolism in patients with gestational diabetes: A meta-analysis of randomized controlled trials

Gestational diabetes mellitus (GDM) is described as an impairment of glucose tolerance and insulin resistance that first begins during pregnancy. The estimated prevalence of GDM is up to 14.0 %,1 making it one of the most common complications of pregnancy, which is harmful to the mother and the fetus. Pregnant women with GDM are at a much higher risk of developing pre-eclampsia and type 2 diabetes in the future,2 and up to 70 % of these women eventually develop diabetes within 22–28 years of giving birth.3 Fetuses exposed to hyperglycemia in utero are prone to fetal complications, such as shoulder dystocia, macrosomia, and neonatal infection.4., 5. Additionally, offspring have a higher risk of obesity, impaired glucose tolerance in children, and diabetes in adults.6 Late-stage GDM patients may develop hyperlipidemia, particularly hypertriglyceridemia, which might lead to adverse pregnancy outcomes such as macrosomia, pre-eclampsia, and preterm birth.7 Therefore, by improving glycolipid metabolism in GDM patients, the occurrence of adverse outcomes in pregnant women and fetuses caused by glycolipid metabolism disorder might be reduced.

Omega-3 fatty acid (omega-3) is a type of polyunsaturated fatty acid that mainly contains eicosapentaenoic acid and docosahexaenoic acid from marine organisms along with α-linolenic acid. As it has several biological actions, omega-3 has received a lot of attention. Some studies have shown that omega-3 can improve atherosclerosis by increasing adiponectin levels and suppressing the expression of proinflammatory cytokines and nuclear factor-KB protein.8., 9. Omega-3 can also improve metabolic syndrome and obesity by decreasing insulin resistance, regulating lipid metabolism, and reducing inflammation of the adipose tissue.10 The European and American nutrition and food agencies recommend omega-3 fatty acids as triglyceride-lowering agents to reduce the risk of cardiovascular diseases.11., 12.

Insulin resistance is promoted by an increase in placental hormones and local hormones, such as estrogen and progesterone, and placental lactogen. Insulin resistance, which is an important pathogenesis of GDM, occurs when cells become insensitive to insulin.13 Additionally, chronic low-grade inflammation accompanied by insulin resistance also plays an important role in the development of GDM.14 Given that omega-3 can improve insulin resistance, regulate lipids metabolism, and have anti-inflammatory effects, it is hypothesized that omega-3 might improve glucose and lipid metabolism during pregnancy. According to one randomized controlled trial, omega-3 supplementation (1000 mg/day) in GDM patients improved insulin resistance without significantly affecting glucose and lipid metabolism.15 However, Jamilian et al. showed that omega-3 supplementation in pregnant women with GDM could improve blood glucose and lipid levels.16

The effect of omega-3 supplementation on blood glucose and lipid metabolism in patients with GDM is not known. Therefore, in this study, we conducted a meta-analysis of randomized controlled trials to evaluate the effects of omega-3 supplements on glucose and lipid metabolism in GDM.

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