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Volume 34 2018
RESULTS: Themes identified revealed the difficulties encoun-
tered with access, enrollment and psychosocial needs during
recovery. Themes for CR attenders included: 1) difficult
navigation with referral pathways; 2) fear of the unknown; 3)
woman as nurturer; 4) taking on a new identity; 5) emotional
support in the recovery journey. For nonattenders, themes
included: 1) feelings of uncertainty, confusion about the
system; 2) periods of adjustment, and; 3) necessity of care
provider endorsement.
CONCLUSIONS: Participants reported that living with CAD
involves a new identity "that changes their life forever." Our
findings suggest that although significant progress has been
made in reducing access barriers, a paradigm shift that in-
cludes gender-sensitive approaches to supportive strategies in
referral and programming may promote improved participa-
tion in CR for women.
48
ASSESSING THE CONSISTENCY AND QUALITY
OF THE EVIDENCE FOR THE ASSOCIATION
BETWEEN DIETARY FACTORS AND GESTATIONAL
DIABETES MELLITUS: A SYSTEMATIC REVIEW
AND META-ANALYSIS OF PROSPECTIVE
COHORT STUDIES AND RANDOMIZED
CONTROLLED TRIALS
V Ha, B Keating, R Arora, T Tieu, A Noori, L Banfield, J Beyene,
S Anand, R de Souza
Hamilton, Ontario, Canada
BACKGROUND: Women who had gestational diabetes mellitus
(GDM) have increased lifetime cardiovascular risk, a rela-
tionship that is partly mediated by lifestyle habits. We con-
ducted a metaanalysis of prospective cohort studies and
randomized controlled trials (RCTs) that assessed the rela-
tionship of diet with GDM.
METHODS: We searched MEDLINE, EMBASE, and Cochrane
and reviewed the references of included reports. Eligible reports
included prospective cohort studies or RCTs lasting
2 weeks.
We pooled multivariable-relative risks (RR) using fixed-
effects meta-analysis. The Grading of Recommendations,
Assessment, Development and Evaluation Guidelines
(GRADE) Approach was used to assess evidence quality.
RESULTS: Our synthesis included 22 cohort studies and 30
RCTs. Data from both cohort studies and RCTs were available
for healthy eating (high intakes of fruits, vegetables, nuts, le-
gumes, white-to-red meat ratio, cereal fibre, and low intakes of
trans fat), low glycemic index, and high fibre diets. These dietary
factors were protective against GDM in cohort studies, but not in
RCTs (most were of very low quality). In cohort studies, red meat
(high quality; RR¼ 2.05 [95% CIs: 1.56, 2.70]; p<0.00001),
fried food (moderate quality), and cholesterol (moderate quality)
Canadian Journal of Cardiology
increased GDM risk. In RCTs, diets that reduced energy intake
decreased GDM risk, but a lowcarbohydrate diet combined with
lower energy intake did not (both moderate quality).
CONCLUSIONS: Red meat intake may increase GDM risk. Most
associations between diet and GDM are inconsistent between
study designs and are of low quality. As RCTs offer the highest level
of evidence for causal inference, higher quality RCTs are needed.
49
DIET, PRE-ECLAMPSIA AND GESTATIONAL
HYPERTENSION: A SYSTEMATIC REVIEW AND
META-ANALYSIS OF PROSPECTIVE COHORT
STUDIES AND RANDOMIZED CONTROLLED
TRIALS
V Ha,* B Keating,* R Arora, T Tieu, A Noori, L Banfield,
J Beyene, S Anand, R de Souza
*Contributed equally
Hamilton, Ontario, Canada
BACKGROUND: Women with hypertensive disorders of preg-
nancy (HDP; pre-eclampsia [PE] or gestational hypertension
[GH]) have increased chronic hypertension risk, a relationship
that may be reduced by a healthy lifestyle. We conducted a
systematic review and meta-analysis of prospective cohort
studies and randomized controlled trials (RCTs) that assessed
the relationship between diet and HDP.
METHODS: We searched MEDLINE, EMBASE, and Cochrane
and reviewed the references of included reports. Eligible reports
included prospective cohort studies or RCTs lasting
2 weeks.
We pooled multivariable-relative risks (RR) using fixed-
effects meta-analysis. The Grading of Recommendations,
Assessment, Development and Evaluation Guidelines
(GRADE) Approach was used to assess evidence quality.
RESULTS: Our analysis included eight cohort studies and 18
RCTs. The Dietary Approach to Stop Hypertension (DASH)
diet, reported in both study designs, reduced PE risk in cohort
studies (very low quality), but not in RCTs (low quality). In
cohort studies, energy reduction (high quality; RR¼0.27
[95% CIs: 0.11, 0.65]; p¼0.004), fibre (very low quality),
healthy eating (very low quality), Nordic diet (moderate
quality), and fruits (low quality) reduced PE risk, but pro-
cessed foods and sugary beverages increased PE risk (both very
low quality). Dairy intake did not reduce PE risk (very low
quality). In RCTs, a low-carbohydrate, energy-restricted diet
decreased PE and GH risks (both moderate quality), and
healthy eating with energy reduction reduced PE incident
(moderate quality).
CONCLUSIONS: Energy reduction may lower PE risk. Most
dietary associations are of low quality.
Higher quality RCTs are needed to better elucidate the
effects of diet on HDP.