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Lookup NU author(s): Professor Nicola HeslehurstORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. See rights and permissions. Published by BMJ. 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. STUDY REGISTRATION: PROSPERO CRD42020212884.
Author(s): Allotey J, Coomar D, Ensor J, Ruiz-Calvo G, Boath A, Ogwulu CO, Monahan M, Kabeya V, Zheng M, McNeill R, Meacham H, Mahmoud G, Simpson SA, Hitman GA, Nirantharakumar K, Heslehurst N, Pelaez M, Tonstad S, Yeo S, Cecatti JG, Facchinetti F, Motahari-Tabari NS, Renault KM, Guelfi KJ, Jensen DM, Harrison C, Khomami MB, Calle-Pascual AL, McAuliffe FM, Hauner H, Barakat R, Geiker NRW, Vinter CA, Phelan S, Kinnunen TI, Kothari A, Teede H, Poston L, Betran AP, Moss N, Iliodromiti S, Austin F, Roberts T, Zamora J, Riley RD, Thangaratinam S
Publication type: Article
Publication status: Published
Journal: BMJ
Year: 2026
Volume: 392
Online publication date: 07/01/2026
Acceptance date: 23/10/2025
Date deposited: 19/01/2026
ISSN (print): 0959-535X
ISSN (electronic): 1756-1833
Publisher: BMJ Publishing Group
URL: https://doi.org/10.1136/bmj-2025-084159
DOI: 10.1136/bmj-2025-084159
Data Access Statement: All data requests should be submitted to the corresponding author. Access to available anonymised data may be granted after review and appropriate agreements being in place.
PubMed id: 41494781
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