TY  - JOUR
SP  - 1
JF  - Health Technology Assessment
A1  - Allotey, John
A1  - Coomar, Dyuti
A1  - Ensor, Joie
A1  - Ogwulu, Chidubem Okeke
A1  - Calvo, Gabriel Ruiz
A1  - Monahan, Mark
A1  - Kabeya, Valencia
A1  - McNeill, Rachel
A1  - Boath, Anna
A1  - Mahmoud, Ghadir
A1  - Harrison, Cheryce
A1  - Khomami, Mahnaz Bahri
A1  - Teede, Helena
A1  - Heslehurst, Nicola
A1  - Hitman, Graham A
A1  - Simpson, Sharon Anne
A1  - Nirantharakumar, Krish
A1  - Dodds, Julie
A1  - Allison, Kelly C
A1  - Shen, Garry
A1  - Petrella, Elisabetta
A1  - Facchinetti, Fabio
A1  - Vinter, Christina
A1  - Peláez, Mireia
A1  - Jensen, Dorte Møller
A1  - Motahari-Tabari, Narges Sadat
A1  - Kinnunen, Tarja I
A1  - Ruiz, Jonatan R
A1  - Bogaerts, Annick
A1  - Renault, Kristina Martha
A1  - Kothari, Alka
A1  - Cecatti, Jose Guilherme
A1  - McAuliffe, Fionnuala M
A1  - Phelan, Suzanne
A1  - Poston, Lucilla
A1  - Betrán, Ana Pilar
A1  - Moss, Ngawai
A1  - Iliodromiti, Stamatina
A1  - Austin, Frances
A1  - de la Torre, Nuria García
A1  - Pascual, Alfonso Luis Calle
A1  - Zamora, Javier
A1  - Roberts, Tracy
A1  - Riley, Richard D
A1  - Thangaratinam, Shakila
UR  - http://doi.org/10.3310/GJST1327
N2  - Background
Physical inactivity and suboptimal diet in pregnancy are important modifiable risk factors for gestational diabetes, a major contributor to pregnancy complications.

Objectives
We aimed to assess the effects of physical activity and/or diet-based lifestyle interventions during pregnancy on gestational diabetes and if these vary by maternal (body mass index, age, parity, ethnicity, education) and intervention characteristics using individual participant data meta-analysis of randomised trials, and a cost-effectiveness analysis.

Data sources
International Weight Management in Pregnancy Collaborative Network database was updated by searching major databases from February 2017 to March 2022.

Review methods
The main outcomes were gestational diabetes by any criteria and by the National Institute for Health and Care Excellence. Other outcomes were gestational diabetes as per International Association of Diabetes in Pregnancy Study Group and maternal and perinatal outcomes. We performed a two-stage random-effects individual participant data meta-analysis to obtain summary estimates (odds ratio) with 95% confidence intervals. Study quality of included trials was assessed, and heterogeneity summarised using ?2. Where possible, we added the aggregate data from non-individual participant data trials to the meta-analysis. We ranked interventions by effectiveness using network meta-analysis and undertook model-based economic evaluation to assess cost-effectiveness. The cost-effectiveness analysis took an NHS cost perspective compared an overall lifestyle intervention versus usual care with a time horizon covering the beginning of pregnancy until the discharge of the mother and infant from the hospital following delivery.

Results
Ninety-two trials (32,284 women) were included; 54 (23,698 women) provided individual participant data. Lifestyle interventions reduced the odds of gestational diabetes (any criteria) by 10% in individual participant data trials (odds ratio 0.90, 95% confidence interval 0.80 to 1.02, 54 studies, 23,361 women), and the findings reached statistical significance when non-individual participant data were included (odds ratio 0.81, 95% confidence interval 0.73 to 0.89, 92 studies, 31,947 women). Physical activity significantly reduced the odds of gestational diabetes by 36% (odds ratio 0.64; 95% confidence interval 0.48 to 0.84), and diet by 19% (odds ratio 0.81; 0.69 to 0.96), but not mixed interventions. Women with middle (odds ratio 0.68, 95% confidence interval 0.51 to 0.90) and high educational level (odds ratio 0.71, 95% confidence interval 0.54 to 0.93) benefited more than those with low educational status, and no differences by maternal body mass index, age, parity or ethnicity. There was no significant reduction in gestational diabetes defined by National Institute for Health and Care Excellence criteria (odds ratio 0.98, 95% confidence interval 0.84 to 1.13) in individual participant data trials. For gestational diabetes defined using International Association of Diabetes in Pregnancy Study Group criteria, interventions reduced gestational diabetes by 14% (odds ratio 0.86, 95% confidence interval 0.75 to 0.97, ?2?=?0.00, 16 studies, 6174 women) in individual participant data trials and by 17% (odds ratio 0.83, 95% confidence interval 0.72 to 0.95, ?2?=?0.01, 25 studies, 7883 women) when non-individual participant data trials were added. Overall, physical activity reduced caesarean section (odds ratio 0.83; 0.72 to 0.96), small-for-gestational age (odds ratio 0.72; 0.56 to 0.92) and large-for-gestational age babies (odds ratio 0.81; 0.71 to 0.94); diet-based interventions reduced any preterm birth (odds ratio 0.37; 0.20 to 0.68) compared to controls. No differences were observed for other outcomes. Lifestyle interventions were on average more expensive and more effective at averted gestational diabetes and major outcome averted compared to usual care.

Limitations
We could not identify the specific intervention components and delivery methods associated with improved outcomes, due to variations in reporting.

Conclusion
Lifestyle interventions in pregnancy prevent gestational diabetes, and the effects vary according to the definition of gestational diabetes. Physical activity-based interventions may be the most effective.
TI  - Effects of physical activity and diet in pregnancy to prevent gestational diabetes: an individual participant data (IPD) meta-analysis on the differential effects of interventions with economic evaluation
AV  - public
SN  - 2046-4924
EP  - 252
Y1  - 2026/05//
ID  - uneatlantico28567
ER  -