Weight Loss Prior to Pregnancy and Early Gestational Glycemia: Prepare, a Randomized Clinical Trial
Open accessAbstract
CONTEXT: Women with elevated body mass index are encouraged to lose weight before pregnancy, but no trials have tested the effects of prepregnancy weight loss on risk of developing gestational diabetes. OBJECTIVE: This work aims to determine whether prepregnancy weight loss improved the early metabolic environment as measured by early gestational diabetes diagnosis. METHODS: This was a secondary analysis of a pragmatic randomized clinical trial conducted between May 2015 and October 2019 in an integrated health system that encouraged first-trimester gestational diabetes screening for high-risk women, including those with obesity. Women aged 18 to 40 years with a body mass index (BMI) greater than or equal to 27 who were planning pregnancy were randomly assigned to a behavioral weight loss intervention or usual care. Clinical care decisions and data collection were blind to condition assignment. We compared rates of diagnosis with gestational diabetes in early pregnancy between the groups using logistic regression. RESULTS: Of 326 participants, 168 (89 in the intervention and 79 in usual care) had singleton pregnancies during the study period. At baseline, mean age was 31.3 ± 3.5 years and BMI was 34.8 ± 5.8. Fifty-nine (66%) intervention participants and 57 (72%) usual care participants underwent early screening. Among those, intervention participants were 73% less likely to be diagnosed with gestational diabetes than usual care participants (adjusted odds ratio [aOR], 0.27; 95% CI, 0.09-0.80). There was no difference in diagnosis of gestational diabetes in later pregnancy (aOR, 1.08; 95% CI, 0.41-2.81). CONCLUSION: Participation in a prepregnancy weight loss intervention led to lower rates of gestational diabetes diagnosis in early pregnancy. This suggests positive effects of prepregnancy weight loss on the early metabolic environment, a critical factor in offspring metabolic risk.
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Pre-pregnancy diet and/or physical activity interventions were not associated with a statistically significant difference in rates of gestational diabetes mellitus compared with control or standard care (2 studies; n = 214; RR 1.19, 95% CI 0.81, 1.75).
“Pre‐pregnancy diet and/or physical activity interventions were not associated with a significant difference in rates of GDM (2 studies; n = 214; RR 1.19, 95% CI 0.81, 1.75).”
From Pre‐Pregnancy Diet and/or Physical Activity Interventions for the Prevention of Gestational Diabetes Mellitus: A Systematic Review and Meta‐Analysis (2025) · cites this paper as [37]
Five randomised trials assessing pre-pregnancy diet and/or physical activity interventions (n = 1924 women) were included in the meta-analysis.
“Five randomised trials assessing pre‐pregnancy diet and/or physical activity interventions (n = 1924 women) were included.”
From Pre‐Pregnancy Diet and/or Physical Activity Interventions for the Prevention of Gestational Diabetes Mellitus: A Systematic Review and Meta‐Analysis (2025) · cites this paper as [37]
A pre-pregnancy diet and/or physical activity intervention, compared with control, was associated with more weight loss over the time of the intervention (one study; 169 women; mean difference −3.10; 95% CI −0.63, −5.57).
“A pre‐pregnancy diet and/or physical activity intervention, in comparison to control, was associated with more weight loss over the time of the intervention (one study; 169 women; mean difference −3.10; 95% CI –0.63, −5.57); however, this finding was only reported by a single trial [37].”
From Pre‐Pregnancy Diet and/or Physical Activity Interventions for the Prevention of Gestational Diabetes Mellitus: A Systematic Review and Meta‐Analysis (2025) · cites this paper as [37]
One trial found that women randomised to the diet and physical activity intervention lost on average more weight prior to pregnancy compared with control, but subsequently had greater average gestational weight gain.
“One trial reported on the outcome of weight loss over the intervention [37] and found that women randomised to the diet and physical activity intervention lost on average more weight prior to pregnancy, compared with control, but subsequently had greater average GWG.”
From Pre‐Pregnancy Diet and/or Physical Activity Interventions for the Prevention of Gestational Diabetes Mellitus: A Systematic Review and Meta‐Analysis (2025) · cites this paper as [37]
The conclusions are limited by the small number of studies included; only two studies provided data for the primary outcome of gestational diabetes mellitus.
“Our conclusions are limited by the small number of studies included. Only two studies provided data for our primary outcome of GDM [34, 37].”
From Pre‐Pregnancy Diet and/or Physical Activity Interventions for the Prevention of Gestational Diabetes Mellitus: A Systematic Review and Meta‐Analysis (2025) · cites this paper as [37]
All but one study assessed a combined diet and physical activity intervention.
“All but one study assessed a combined diet and physical activity intervention [33, 34, 36, 37].”
From Pre‐Pregnancy Diet and/or Physical Activity Interventions for the Prevention of Gestational Diabetes Mellitus: A Systematic Review and Meta‐Analysis (2025) · cites this paper as [37]
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- Authors
- LeBlanc, E. S., Smith, N. X., Vesco, K. K., Hillier, T. A., & Stevens, V. J.
- Affiliations
- Kaiser Permanente Center for Health Research (US)
- Corresponding author
- LeBlanc, Erin S
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2021-07-27
- Volume
- 106
- Issue
- 12
- Pages
- e5001-e5010
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC8787851
- OpenAlex
- W3183531101
- Cited by
- 26
- References
- 44
- Citations by year
- 2026: 9 · 2025: 4 · 2024: 6 · 2023: 3 · 2022: 2 · 2021: 2
- FWCI
- 2.95
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R01/R56 KD099882)
- National Institutes of Health
- 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 › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Keywords
- gestational diabetes mellitus, obesity, behavioral weight loss, first-trimester screening, maternal obesity, offspring metabolic risk, pregnancy planning
- MeSH terms
- Adolescent, Adult, Behavior Therapy, Female, Follow-Up Studies, Humans, Obesity, Pregnancy, Pregnancy Trimester, First, Prognosis, Biomarkers, Weight Loss, Body Mass Index, Case-Control Studies, Diabetes, Gestational, Young Adult
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