TY  - JOUR
ID  - uneatlantico27155
AV  - public
JF  - BMJ
A1  - Allotey, John
A1  - Coomar, Dyuti
A1  - Ensor, Joie
A1  - Ruiz-Calvo, Gabriel
A1  - Boath, Anna
A1  - Ogwulu, Chidubem Okeke
A1  - Monahan, Mark
A1  - Kabeya, Valencia
A1  - Zheng, Min
A1  - McNeill, Rachel
A1  - Meacham, Hollie
A1  - Mahmoud, Ghadir
A1  - Simpson, Sharon Anne
A1  - Hitman, Graham A
A1  - Nirantharakumar, Krish
A1  - Heslehurst, Nicola
A1  - Peláez, Mireia
A1  - Tonstad, Serena
A1  - Yeo, SeonAe
A1  - Cecatti, Jose G
A1  - Facchinetti, Fabio
A1  - Motahari-Tabari, Narges Sadat
A1  - Renault, Kristina M
A1  - Guelfi, Kym J
A1  - Jensen, Dorte Mĝller
A1  - Harrison, Cheryce
A1  - Khomami, Mahnaz Bahri
A1  - Calle-Pascual, Alfonso L
A1  - McAuliffe, Fionnuala M
A1  - Hauner, Hans
A1  - Barakat, Ruben
A1  - Geiker, Nina Rica Wium
A1  - Vinter, Christina Anne
A1  - Phelan, Suzanne
A1  - Kinnunen, Tarja I
A1  - Kothari, Alka
A1  - Teede, Helena
A1  - Poston, Lucilla
A1  - Betrán, Ana Pilar
A1  - Moss, Ngawai
A1  - Iliodromiti, Stamatina
A1  - Austin, Frances
A1  - Roberts, Tracy
A1  - Zamora, Javier
A1  - Riley, Richard D
A1  - Thangaratinam, Shakila
N2  - Objectives To assess the effects of lifestyle interventions on gestational diabetes, determine whether the effects vary by maternal body mass index, age, parity, ethnicity, education level, or intervention, and rank interventions by effectiveness.

Design Individual participant data (IPD) and network meta-analysis.

Data sources Major electronic databases (January 1990 to April 2025).

Methods This meta-analysis included randomised trials on the effects of lifestyle interventions (physical activity based, diet based, or mixed) in pregnancy on gestational diabetes. Main outcomes were gestational diabetes defined by any criteria and by UK NICE (National Institute for Health and Care Excellence) criteria; other outcomes included IADPSG (International Association of Diabetes in Pregnancy Study Group) and modified IADPSG defined gestational diabetes. A two stage IPD meta-analysis estimated summary odds ratios and 95% confidence intervals and interactions (subgroup effects), along with absolute risk reduction estimates. Aggregate data from non-IPD trials were added to the meta-analysis when possible. Intervention effects were ranked using network meta-analysis.

Results 104 randomised trials (35?993 women) were included, with IPD for 68% of participants (24?391 women; 54 studies). Lifestyle interventions reduced gestational diabetes defined by any criteria by 10% in IPD trials (odds ratio 0.90, 95% confidence interval (CI) 0.80 to 1.02; absolute risk reduction 1.3%, 95% CI ?0.3% to 2.6%), and by 20% when combining IPD and non-IPD trials (odds ratio 0.80, 95% CI 0.73 to 0.88; absolute risk reduction 2.6%, 95% CI 1.6% to 3.6%), and no reduction was observed using NICE criteria (odds ratio 0.98, 95% CI 0.84to 1.13). Lifestyle interventions reduced gestational diabetes defined using IADPSG criteria by 14% in IPD trials (odds ratio 0.86, 95% CI 0.75 to 0.97; absolute risk reduction 2.7%, 95% CI 0.6% to 5.0%) and by 18% when combining IPD and non-IPD trials (odds ratio 0.82, 95% CI 0.72 to 0.93; absolute risk reduction 3.5%, 95% CI 1.3% to 5.7%). Effects did not vary by maternal characteristics, except for education. Although women of all educational levels benefited from the intervention, the benefit was less in those with low education (low v middle interaction: odds ratio 0.68, 95% CI 0.51 to 0.90; low v high interaction: odds ratio 0.71, 95% CI 0.54 to 0.93). Benefits did not vary by intervention characteristics, except for greater effectiveness with group format (odds ratio 0.81, 95% CI 0.68 to 0.97; absolute risk reduction 2.5%, 95% CI 0.4% to 4.3%) and newly trained facilitators (odds ratio 0.82, 95% CI 0.69 to 0.96; absolute risk reduction 2.4%, 95% CI 0.5% to 4.2%). Physical activity based interventions ranked highest (mean rank 1.1, 95% CI 1 to 2) in preventing gestational diabetes.

Conclusions 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.
SN  - 1756-1833
Y1  - 2026/01//
UR  - http://doi.org/10.1136/bmj-2025-084159
VL  - 392
TI  - Effects of lifestyle interventions in pregnancy on gestational diabetes: individual participant data and network meta-analysis
ER  -