Gestational diabetes & diabetes in pregnancy
Effects of lifestyle interventions in pregnancy on gestational diabetes: individual participant data and network meta-analysis
Authors' conclusion
Lifestyle interventions in pregnancy are likely to prevent gestational diabetes, with effects varying according to diagnostic criteria. Implementation strategies should address inequalities by maternal education, and consider group formats, provider training, and physical activity based interventions to prevent gestational diabetes.
Study context
- Population
- Pregnant women in randomised trials of lifestyle interventions (databases January 1990 to April 2025)
- Participants
- 35,993 women104 RCTs
- Comparison
- Lifestyle interventions in pregnancy vs control
- Outcome
- GDM defined by any criteria and by UK NICE criteria
Methodological detailstwo stage individual participant data (IPD) meta-analysis
- Two stage IPD meta-analysis
Pooled result
As reported in the abstract
GDM
Lifestyle interventions vs ControlOdds ratio (95% CI)
Any criteria, IPD trials; absolute risk reduction 1.3% (95% CI −0.3% to 2.6%)
0.90(0.80–1.02)
Any criteria, IPD and non-IPD trials; absolute risk reduction 2.6% (95% CI 1.6% to 3.6%)
0.80(0.73–0.88)
NICE criteria; no reduction
0.98(0.84to 1.13)
Further pooled results
| Outcome | OR (95% CI) | |
|---|---|---|
| GDM by IADPSG criteriaLifestyle interventionsvs Control | 0.86 (0.75–0.97) | |
| GDM by IADPSG criteriaLifestyle interventionsvs Control | 0.82 (0.72–0.93) | |
| 0.512Odds ratio (log scale) |
- GDM by IADPSG criteria: IPD trials; absolute risk reduction 2.7% (95% CI 0.6% to 5.0%)
- GDM by IADPSG criteria: IPD and non-IPD trials; absolute risk reduction 3.5% (95% CI 1.3% to 5.7%)
Subgroup effects by maternal education
- Low v middle interaction: OR
- 0.68 (0.51 to 0.90) (95% CI)
- Low v high interaction: OR
- 0.71 (0.54 to 0.93) (95% CI)
- Effects did not vary by maternal characteristics, except for education; benefit less with low education
Subgroup effects by intervention characteristics
- Group format: OR (95% CI); absolute risk reduction
- 0.81 (0.68 to 0.97); 2.5% (0.4% to 4.3%) (95% CI)
- Newly trained facilitators: OR (95% CI); absolute risk reduction
- 0.82 (0.69 to 0.96); 2.4% (0.5% to 4.2%) (95% CI)
Network ranking
- Physical activity based interventions ranked highest: mean rank
- 1.1 (1 to 2) (95% CI)
Original publication
Effects of lifestyle interventions in pregnancy on gestational diabetes: individual participant data and network meta-analysis. BMJ. Published 6 January 2026. doi:10.
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