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Cited by 18Gestational Diabetes Research and ManagementDiabetes, Cardiovascular Risks, and LipoproteinsDiabetes Treatment and Management

Lifestyle intervention to prevent type 2 diabetes after a pregnancy complicated by gestational diabetes mellitus: a systematic review and meta-analysis update

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Bracco, Paula Andreghetto, Reichelt, Angela Jacob, Alves, Luísia Feichas, Vidor, Pedro Rodrigues, Oppermann, Maria Lúcia Rocha, Duncan, Bruce Bartholow, Schmidt, Maria Inês·2025·Diabetology & Metabolic Syndrome
DOI 10.1186/s13098-025-01606-xPMC PMC11844165
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Abstract

Background: Women with prior gestational diabetes mellitus (GDM) are at increased risk of type 2 diabetes, and lifestyle intervention (LSI) offered a decade after pregnancy is effective in preventing diabetes. However, since diabetes frequently onsets in the initial years following pregnancy, preventive actions should be implemented closer to pregnancy. We aimed to assess the effect of lifestyle interventions, compared to standard care, in reducing the incidence of diabetes following a pregnancy complicated by GDM. Methods: We searched the Cochrane Library, Embase, MEDLINE, and Web of Science from inception to July 21, 2024, to identify randomized controlled trials (RCTs) testing LSI to prevent diabetes following gestational diabetes. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We evaluated the risk of bias with the Cochrane Collaboration Risk of Bias tool RoB-2 and the certainty of the evidence with GRADE methodology. We used the DerSimonian-Laird random effects pooling method and evaluated heterogeneity with the I 2 statistic and the Chi 2 test. Results: We identified 24 studies involving 9017 women. In studies without high risk of bias (18 studies; 8,357 women), LSI reduced the incidence of diabetes by 19% (RR = 0.81; 95%CI 0.71.0.93). The effect was significant and more protective (RR = 0.78; 0.65, 0.94) in studies evaluating women with GDM identified specifically as at a higher risk of diabetes, compared to those intervening on women with GDM irrespective of risk (RR = 0.85; 0.70, 1.04). Similarly, when expressed in absolute terms, the overall number needed to treat (NNT) was 56 considering all studies, 71 for women with GDM irrespective of risk, and 31 for women with GDM at high risk. The intervention produced a lower weight gain (mean difference=-0.88 kg;-1.52, -0.23 for all studies; -0.62 kg;-1.22, -0.02 for studies without high risk of bias). The effects were robust in sensitivity analyses and supported by evidence of moderate certainty for diabetes and weight change. Conclusions: LSI offered to women with GDM following pregnancy is effective in preventing type 2 diabetes, despite the small postpartum weight change. The impact of LSI on incidence reduction was greater for women with GDM at a higher diabetes risk. PROSPERO: Registration number CRD42024555086, Jun 28, 2024.

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  • Among women with impaired glucose tolerance and a history of GDM, postpartum improvements in lifestyle behaviors and metformin use have been reported to delay or prevent the onset of T2DM.

    “among women with impaired glucose tolerance and a history of GDM, postpartum improvements in lifestyle behaviors and metformin use have been reported to delay or prevent the onset of T2DM [20,31].”

    From Postpartum Body Mass Index Change Is Associated with Incident Dysglycemia in Women with a History of Gestational Diabetes Mellitus: A Prospective Cohort Study (2026) · cites this paper as [31]

    The Discussion (Summary of findings; page not provided) reports that postpartum lifestyle interventions reduced diabetes incidence among women with prior GDM, including a higher-risk subgroup with intermediate hyperglycemia and/or pharmacologic treatment during pregnancy. The review does not report a postpartum metformin effect, and its study population was not limited to women with impaired glucose tolerance. Metformin appears in a cited study’s title in the References, not in the review’s reported findings. (LLM, conf=0.88)

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Cited by

Sorted by citations

Authors
Bracco, P. A., Reichelt, A. J., Alves, L. F., Vidor, P. R., Oppermann, M. L. R., Duncan, B. B., & Schmidt, M. I.
Affiliations
  • Universidade Federal do Rio Grande do Sul (BR)
  • Hospital de Clínicas de Porto Alegre (BR)
Corresponding author
Reichelt, Angela Jacob
ORCID
Venue
Diabetology & Metabolic Syndrome
Publisher
Springer Science and Business Media LLC
Published
2025-02-21
Volume
17
Issue
1
Pages
66-66
ISSN
1758-5996 (ISSN-L)
DOI
10.1186/s13098-025-01606-x
PMC
PMC11844165
OpenAlex
W4407831080
Cited by
18
References
12
Citations by year
2026: 12 · 2025: 6
FWCI
3.94
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetology & Metabolic Syndrome (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by-nc-sa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Conselho Nacional de Desenvolvimento Científico e Tecnológico
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 › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
lifestyle intervention, type 2 diabetes prevention, gestational diabetes mellitus, postpartum women, weight gain, high-risk women, number needed to treat, risk of bias, quality of evidence, diabetes self-management education, glycemic control, glycemic variability

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