Nursing Care in Obstetrics and Breastfeeding Practices in Gestational Diabetic Mothers in China: A Systematic Review and Meta-Analysis
Abstract
Background: Despite the fact that nursing care and breastfeeding practices are among the most important aspects of effective GDM management, the impact of these practices is still underexplored. We aimed to assess the effectiveness of obstetric nursing care and the impact on the outcomes of breastfeeding among gestational diabetes mothers.
Methods: A total of 522 records were found after conducting exhaustive searches in the databases of PubMed, Web of Knowledge, and the Cochrane Library. After eliminating duplicates and screening criteria, there were five studies with 3180 participants, 1377 of whom were experimental and 1803 of whom were control. The effects of nursing interventions on body mass index (BMI), fasting plasma glucose (FPG), and HbA1c levels, subgroup analyses were carried out.
Results: Individual studies suggested benefits in breastfeeding practices, but the study found no significant difference between the nursing and control groups (0.27, 95% CI: 0.05–1.57, P = 0.14). Studies showed that general care worked best for mothers with normal body mass indexes yet mothers with hyperglycemia needed more specific treatments. The findings demonstrate the necessity to interpret results with caution because they appeared affected by heterogeneity along with publication bias.
Conclusion: The nursing interventions which support breastfeeding practices and glycemic management perform best when they target mothers with gestational diabetes by monitoring their body mass index and blood glucose levels. Future research needs to accomplish a clear confirmation of these results involving HbA1c and FPG metrics because of their ambiguous nature.
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14. Kim C, Newton KM, Knopp RH (2002). Gestational diabetes and the incidence of type 2 diabetes: a systematic re-view. Diabetes Care, 25(10): 1862-1868.
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24. Waiswa P, Okuga M, Kabwijamu L, et al (2019). Using research priority-setting to guide bridging the implementation gap in countries - a case study of the Uganda newborn research priorities in the SDG era. Health Res Policy Syst, 17(1): 54.
25. Khatib MN, Gaidhane A, Upadhyay S, et al (2023). Interventions for promoting and optimizing breastfeeding practices: An overview of systematic review. Front Pub-lic Health, 11: 984876.
26. Yehuda I (2016). Implementation of pre-conception care for women with diabe-tes. Diabetes Spectr, 29(2): 105-14.
27. Martis R, Brown J, Alsweiler J, et al (2016). Different intensities of glycaemic con-trol for women with gestational diabetes mellitus. Cochrane Database Syst Rev, 4(4): CD011624.
28. Sweeting A, Wong J, Murphy HR, et al (2022). Clinical Update on Gestational Diabetes Mellitus. Endocr Rev, 43(5): 763-793.
29. Lemaitre M, Ternynck C, Bourry J, et al (2022). Association Between HbA1c Lev-els on Adverse Pregnancy Outcomes During Pregnancy in Patients with Type 1 Diabetes. J Clin Endocrinol Metab, 107(3): e1117-e1125.
30. Mañé L, Navarro H, Pedro-Botet J, et al (2024). Early HbA1c Levels as a Predic-tor of Adverse Obstetric Outcomes: A Systematic Review and Meta-Analysis. J Clin Med, 13(6): 1732.
31. de Siqueira CD, Borges L, Dal Mora T, et al (2025). Early postnatal effects of mater-nal obesity on breast milk composition and breastfeeding outcomes. Clin Nutr ESPEN, 65: 365-374.
32. Mu Y, Huang J, Yang J, et al (2024). Ethnic differences in the effects of lifestyle in-terventions on adverse pregnancy out-comes among women with gestational diabetes mellitus: A systematic review and meta-analysis. Diabetes Res Clin Pract. 217: 111875.
33. Martis R, Crowther CA, Shepherd E, et al (2018). Treatments for women with ges-tational diabetes mellitus: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev, 8(8): CD012327.
34. Raets L, Beunen K, Benhalima K (2021). Screening for Gestational Diabetes Mellitus in Early Pregnancy: What Is the Evidence? J Clin Med, 10(6): 1257.
35. Huang Y, Li Z, Zhu J, et al (2025). Construc-tion of a risk prediction model for ad-verse pregnancy outcomes in primipara with gestational diabetes mellitus com-bined with pregnancy-induced hyper-tension syndrome. Clin Exp Hypertens, 47(1): 2492621.
36. Immanuel J, Cheung NW, Mohajeri M, et al (2025). TOBOGM Research Group. As-sociation Between Glycemia, Glycemic Variability, and Pregnancy Complica-tions in Early GDM. Diabetes Care, 48(2):285-291.
37. Tarrant M, Chooniedass R, Fan HSL, et al (2020). Breastfeeding and postpartum glucose regulation among women with prior gestational diabetes: A Systematic Review. J Hum Lact, 36(4): 723-738.
38. MacQuillan E, Curtis A, Baker K, et al (2019). Geospatial analysis of birth rec-ords to target programming for mothers with gestational diabetes mellitus in Michigan, 2013. Public Health Rep, 134(1): 27-35.
2. David AL, Spencer RN (2022). Clinical As-sessment of Fetal Well-Being and Fetal Safety Indicators. J Clin Pharmacol, 62 Suppl 1(Suppl 1):S67-S78.
3. Juan J, Yang H (2020). Prevalence, Preven-tion, and Lifestyle Intervention of Ges-tational Diabetes Mellitus in China. Int J Environ Res Public Health, 17(24): 9517.
4. Xu T, He Y, Dainelli L, et al (2017). Healthcare interventions for the preven-tion and control of gestational diabetes mellitus in China: a scoping review. BMC Pregnancy Childbirth,17(1): 171.
5. Yapicioglu H, Seckin SC, Yontem A, et al (2023). Infants with macrosomia and in-fants of diabetic mothers have in-creased carotid artery intima-media thickness in childhood. Eur J Pediatr, 182(1): 203-211.
6. Chowdhury R, Sinha B, Sankar MJ, et al (2015). Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatr, 104(467): 96-113.
7. Abou-Dakn M (2018). Health effects of breastfeeding on the mother. Bun-desgesundheitsblatt Gesundheitsforschung Ge-sundheitsschutz, 61(8):986-989.
8. Damm P, Houshmand-Oeregaard A, Kel-strup L, et al (2016). Gestational diabetes mellitus and long-term consequences for mother and offspring: a view from Denmark. Diabetologia, 59(7): 1396-1399.
9. Ko GT, Chan JC, Tsang LW, et al (1999). Glucose intolerance and other cardio-vascular risk factors in chinese women with a history of gestational diabetes mellitus. Aust N Z J Obstet Gynaecol, 39(4): 478-83.
10. Lin CH, Wen SF, Wu YH, et al (2005). The postpartum metabolic outcome of women with previous gestational diabe-tes mellitus. Chang Gung Med J, 28(11): 794-800.
11. Li P, Yin Y, Lin S, et al (2016). Utility of Pregestational Body Mass Index and Ini-tial Fasting Plasma Glucose in Predict-ing Gestational Diabetes Mellitus. Am J Med Sci, 351(4): 420-5.
12. Zhong H, Zhang J, Xia J, et al (2022). Influ-ence of gestational diabetes mellitus on lipid signatures in breast milk and asso-ciation with fetal physical development. Front Nutr, 9: 924301.
13. Li LJ, Zhang J, Shub A, et al (2020). Explor-ing abnormal glucose metabolism in pregnancy among Australian Chinese migrants. BMJ Open Diabetes Res Care, 8(1): e000903.
14. Kim C, Newton KM, Knopp RH (2002). Gestational diabetes and the incidence of type 2 diabetes: a systematic re-view. Diabetes Care, 25(10): 1862-1868.
15. Wang T, Shang M, Chow KM (2023). Ef-fects of breastfeeding training pro-grammes for midwives on breastfeeding outcomes: a systematic review and meta-analysis. BMC Pregnancy Childbirth, 23(1): 262.
16. Otter G, Davis D, Kurz E, et al (2024). Promoting breastfeeding in women with gestational diabetes mellitus in high-income settings: an integrative re-view. Int Breastfeed J, 19(1): 4.
17. Quotah OF, Nishku G, Hunt J, et al (2022). Prevention of gestational diabetes in pregnant women with obesity: protocol for a pilot randomised controlled tri-al. Pilot Feasibility Stud, 8(1): 70.
18. Bider-Canfield Z, Martinez MP, Wang X, et al (2017). Maternal obesity, gestational diabetes, breastfeeding and childhood overweight at age 2 years. Pediatr Obes, 12(2): 171-178.
19. Chapman DJ, Morel K, Bermúdez-Millán A, et al (2013). Breastfeeding education and support trial for overweight and obese women: a randomized tri-al. Pediatrics, 131(1): e162-e170.
20. HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, et al (2008). Hy-perglycemia and adverse pregnancy outcomes. N Engl J Med, 358(19): 1991-2002.
21. Higgins JP, Altman DG, Gøtzsche PC, et al (2011). The Cochrane Collaboration's tool for assessing risk of bias in ran-domised trials. BMJ, 343: d5928
22. Qian P, Duan L, Lin R, et al (2022). How breastfeeding behavior develops in women with gestational diabetes melli-tus: A qualitative study based on health belief model in China. Front Endocrinol (Lausanne), 13: 955484.
23. Kaur M (2016). Application of Mixed Method Approach in Public Health Re-search. Indian J Community Med, 41(2): 93-7.
24. Waiswa P, Okuga M, Kabwijamu L, et al (2019). Using research priority-setting to guide bridging the implementation gap in countries - a case study of the Uganda newborn research priorities in the SDG era. Health Res Policy Syst, 17(1): 54.
25. Khatib MN, Gaidhane A, Upadhyay S, et al (2023). Interventions for promoting and optimizing breastfeeding practices: An overview of systematic review. Front Pub-lic Health, 11: 984876.
26. Yehuda I (2016). Implementation of pre-conception care for women with diabe-tes. Diabetes Spectr, 29(2): 105-14.
27. Martis R, Brown J, Alsweiler J, et al (2016). Different intensities of glycaemic con-trol for women with gestational diabetes mellitus. Cochrane Database Syst Rev, 4(4): CD011624.
28. Sweeting A, Wong J, Murphy HR, et al (2022). Clinical Update on Gestational Diabetes Mellitus. Endocr Rev, 43(5): 763-793.
29. Lemaitre M, Ternynck C, Bourry J, et al (2022). Association Between HbA1c Lev-els on Adverse Pregnancy Outcomes During Pregnancy in Patients with Type 1 Diabetes. J Clin Endocrinol Metab, 107(3): e1117-e1125.
30. Mañé L, Navarro H, Pedro-Botet J, et al (2024). Early HbA1c Levels as a Predic-tor of Adverse Obstetric Outcomes: A Systematic Review and Meta-Analysis. J Clin Med, 13(6): 1732.
31. de Siqueira CD, Borges L, Dal Mora T, et al (2025). Early postnatal effects of mater-nal obesity on breast milk composition and breastfeeding outcomes. Clin Nutr ESPEN, 65: 365-374.
32. Mu Y, Huang J, Yang J, et al (2024). Ethnic differences in the effects of lifestyle in-terventions on adverse pregnancy out-comes among women with gestational diabetes mellitus: A systematic review and meta-analysis. Diabetes Res Clin Pract. 217: 111875.
33. Martis R, Crowther CA, Shepherd E, et al (2018). Treatments for women with ges-tational diabetes mellitus: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev, 8(8): CD012327.
34. Raets L, Beunen K, Benhalima K (2021). Screening for Gestational Diabetes Mellitus in Early Pregnancy: What Is the Evidence? J Clin Med, 10(6): 1257.
35. Huang Y, Li Z, Zhu J, et al (2025). Construc-tion of a risk prediction model for ad-verse pregnancy outcomes in primipara with gestational diabetes mellitus com-bined with pregnancy-induced hyper-tension syndrome. Clin Exp Hypertens, 47(1): 2492621.
36. Immanuel J, Cheung NW, Mohajeri M, et al (2025). TOBOGM Research Group. As-sociation Between Glycemia, Glycemic Variability, and Pregnancy Complica-tions in Early GDM. Diabetes Care, 48(2):285-291.
37. Tarrant M, Chooniedass R, Fan HSL, et al (2020). Breastfeeding and postpartum glucose regulation among women with prior gestational diabetes: A Systematic Review. J Hum Lact, 36(4): 723-738.
38. MacQuillan E, Curtis A, Baker K, et al (2019). Geospatial analysis of birth rec-ords to target programming for mothers with gestational diabetes mellitus in Michigan, 2013. Public Health Rep, 134(1): 27-35.
| Files | ||
| Issue | Vol 54 No 11 (2025) | |
| Section | Review Article(s) | |
| Keywords | ||
| Gestational diabetes mellitus Nursing care Breastfeeding practices Meta-analysis BMI Fasting plasma glucose | ||
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How to Cite
1.
Deng Y, Yang L, Li Y, Han H. Nursing Care in Obstetrics and Breastfeeding Practices in Gestational Diabetic Mothers in China: A Systematic Review and Meta-Analysis. Iran J Public Health. 2025;54(11):2379-2394.
