Lifestyle interventions for the treatment of women with gestational diabetes

Brown, Julie; Alwan, Nisreen A; West, Jane; Brown, Stephen; McKinlay, Christopher JD; Farrar, Diane; Crowther, Caroline A

doi:10.1002/14651858.cd011970.pub2

Cited by 284Gestational Diabetes Research and ManagementDiabetes, Cardiovascular Risks, and LipoproteinsPregnancy and Medication Impact

Lifestyle interventions for the treatment of women with gestational diabetes

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Brown, Julie, Alwan, Nisreen A, West, Jane, Brown, Stephen, McKinlay, Christopher JD, Farrar, Diane, Crowther, Caroline A·2017·Cochrane Database of Systematic Reviews

DOI 10.1002/14651858.cd011970.pub2PMC PMC6481373

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Abstract

BACKGROUND: Gestational diabetes (GDM) is glucose intolerance, first recognised in pregnancy and usually resolving after birth. GDM is associated with both short- and long-term adverse effects for the mother and her infant. Lifestyle interventions are the primary therapeutic strategy for many women with GDM. OBJECTIVES: To evaluate the effects of combined lifestyle interventions with or without pharmacotherapy in treating women with gestational diabetes. SEARCH METHODS: We searched the Pregnancy and Childbirth Group's Trials Register (14 May 2016), ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP) (14th May 2016) and reference lists of retrieved studies. SELECTION CRITERIA: We included only randomised controlled trials comparing a lifestyle intervention with usual care or another intervention for the treatment of pregnant women with GDM. Quasi-randomised trials were excluded. Cross-over trials were not eligible for inclusion. Women with pre-existing type 1 or type 2 diabetes were excluded. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by the Cochrane Collaboration. All selection of studies, data extraction was conducted independently by two review authors. MAIN RESULTS: = 0.12; moderate-quality evidence). Diabetes and adiposity in adulthood and neurosensory disability in later childhoodwere not prespecified or reported as outcomes for any of the trials included in this review. AUTHORS' CONCLUSIONS: Lifestyle interventions are the primary therapeutic strategy for women with GDM. Women receiving lifestyle interventions were less likely to have postnatal depression and were more likely to achieve postpartum weight goals. Exposure to lifestyle interventions was associated with a decreased risk of the baby being born LGA and decreased neonatal adiposity. Long-term maternal and childhood/adulthood outcomes were poorly reported.The value of lifestyle interventions in low-and middle-income countries or for different ethnicities remains unclear. The longer-term benefits or harms of lifestyle interventions remains unclear due to limited reporting.The contribution of individual components of lifestyle interventions could not be assessed. Ten per cent of participants also received some form of pharmacological therapy. Lifestyle interventions are useful as the primary therapeutic strategy and most commonly include healthy eating, physical activity and self-monitoring of blood glucose concentrations.Future research could focus on which specific interventions are most useful (as the sole intervention without pharmacological treatment), which health professionals should give them and the optimal format for providing the information. Evaluation of long-term outcomes for the mother and her child should be a priority when planning future trials. There has been no in-depth exploration of the costs 'saved' from reduction in risk of LGA/macrosomia and potential longer-term risks for the infants.

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MNT combined with physical activity significantly improves glycaemic control during pregnancy and reduces the risk of macrosomia and neonatal adiposity.
“A meta-analysis of randomised controlled trials demonstrated that MNT combined with physical activity significantly improves glycaemic control during pregnancy and reduces the risk of macrosomia and neonatal adiposity [9].”
From Medical Nutrition Therapy for Women with Gestational Diabetes: Current Practice and Future Perspectives (2025) · cites this paper as [9]
The review reports lower postprandial glucose and HbA1c, reduced macrosomia, and lower neonatal fat mass with lifestyle interventions (Glycaemic control during/after treatment; Neonatal death; Birthweight and z score; pages unavailable). But its pooled interventions were not uniformly MNT combined with physical activity, and it found no clear difference in fasting blood glucose. Neonatal fat mass was reported by only one trial, so the sentence overgeneralizes those results to the specified combination. (LLM, conf=0.88)
Experimental — accuracy not yet measured
In a Cochrane review, the average risk reduction from lifestyle interventions on HDP was 0.70 (95% CI 0.40-1.22; four trials, 2,796 women; I2 = 79%; low-quality evidence).
“In another Cochrane review248, the average risk reduction from lifestyle interventions on HDP was 0.70 (95% CI 0.40–1.22; four trials, 2,796 women; I2 = 79%; low-quality evidence).”
From A global view of hypertensive disorders and diabetes mellitus during pregnancy (2022) · cites this paper as [248]
Women receiving appropriate advice on diet and physical activity are more likely to meet postpartum weight goals one year after delivery.
“Furthermore, women receiving appropriate advice on diet and physical activity are more likely to meet postpartum weight goals one year after delivery [9].”
From Medical Nutrition Therapy for Women with Gestational Diabetes: Current Practice and Future Perspectives (2025) · cites this paper as [9]

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Julie Brown guarantees this review.
Julie Brown wrote the first version of this review and identified studies for inclusion along with Stephen Brown. She also was undertook data extraction and assessed risk of bias. She prepared the GRADE 'Summary of findings' tables. The remaining authors Nisreen A Alwan; Jane West, Stephen Brown, Christopher JD McKinlay, Diane Farrar and Caroline Crowther have all contributed to interpretation of the data from clinical, paediatric and expert opinions and have provided significant feedback to draft versions, including the GRADE 'Summary of findings' tables. Declarations of interest Julie Brown: none known.
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Effects of lifestyle intervention on long-term risk of diabetes in women with prior gestational diabetes: a systematic review and meta-analysis of randomized controlled trials
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Authors: Brown, J., Alwan, N. A., West, J., Brown, S., McKinlay, C. J., Farrar, D., & Crowther, C. A.
Affiliations: University of Auckland (NZ)
Southampton General Hospital (GB)
Bradford Teaching Hospitals NHS Foundation Trust (GB)
Auckland University of Technology (NZ)
Bradford Royal Infirmary (GB)
ORCID: Brown, Julie
Alwan, Nisreen A
West, Jane
Brown, Stephen
McKinlay, Christopher JD
Farrar, Diane
Crowther, Caroline A
Venue: Cochrane Database of Systematic Reviews
Publisher: Wiley
Published: 2017-05-04
Volume: 2017
Issue: 5
Pages: CD011970-CD011970
ISSN: 1361-6137 (ISSN-L)
1465-1858
DOI: 10.1002/14651858.cd011970.pub2
PMC: PMC6481373
OpenAlex: W2268674176
Cited by: 284
References: 167
Citations by year: 2026: 9 · 2025: 26 · 2024: 27 · 2023: 26 · 2022: 33 · 2021: 37 · 2020: 37 · 2019: 29 · 2018: 37 · 2017: 14 · 2016: 4 · 2015: 4 · 2013: 1
FWCI: 5.49
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Cochrane Database of Systematic Reviews (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
ePrints Soton (University of Southampton) (acceptedVersion)
Tuwhera (Auckland University of Technology) (submittedVersion, other-oa)
ResearchSpace (University of Auckland) (submittedVersion)
Funders: National Institute for Health and Care Research (13/89/05)
Medical Research Council (MR/K021656/1)
National Health and Medical Research Council
Evidence Synthesis Programme
Topics: Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
Keywords: gestational diabetes mellitus, lifestyle intervention, pharmacotherapy, postpartum depression, postpartum weight, large for gestational age, neonatal adiposity, maternal glucose control, healthy eating, physical activity, self-monitoring of blood glucose, low- and middle-income countries, ethnic differences, infant neurodevelopmental outcomes
MeSH terms: Body Weight, Cesarean Section, Diabetes Mellitus, Type 2, Diet, Diabetic, Female, Humans, Infant, Newborn, Infant, Postmature, Labor, Induced, Life Style, Patient Education as Topic, Perineum, Pre-Eclampsia, Pregnancy, Blood Glucose Self-Monitoring, Exercise, Body Mass Index, Randomized Controlled Trials as Topic, Diabetes, Gestational, Depression, Postpartum

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