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Lifestyle interventions for the treatment of women with gestational diabetes
Open accessAbstract
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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“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]
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“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]
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“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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Satkunanathan, P., Azizi, S., Talbo, M. K., & Peters, T. M. (2026) · Maternal and Children s Health · doi:10.1159/000552380
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Shamery, H. T. A., & Sait, N. S. (2026) · International Journal of Community Medicine and Public Health · doi:10.18203/2394-6040.ijcmph20262764
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Nielsen, A., Hollis‐Hansen, K., Jain, S., Ranjit, N., Tice, N., Berg, A. V. D., Yamal, J., Berens, P., & Sharma, S. (2026) · Research Square · doi:10.21203/rs.3.rs-11119375/v1
Metadata
- 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
- 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
- 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
- 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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