Evidence supports lifestyle programmes to prevent gestational diabetes

Lifestyle changes in pregnancy do have significant benefits in reducing the risk of gestational diabetes, researchers have reported.

Analysis of data from more than 100 randomised controlled trials of almost 36,000 women showed that lifestyle interventions reduced gestational diabetes defined by any criteria by 10% on an individual basis.

A reduction in gestational diabetes of 20% was seen when trials were included that did not include individual participant data.

Overall, the lifestyle intervention led to 26 fewer women with gestational diabetes per 1000 women.

Physical activity-based interventions, such as walking, aerobic and strength training, and swimming, were the most effective, the team at the University of Liverpool reported.

But it also highlighted that women from lower educational backgrounds benefited less from such interventions, suggesting inequalities in reach or engagement.

Group delivery formats and newly trained facilitators achieved greater benefits, they reported. No adverse effects from the interventions were observed, they said.

The impact of lifestyle interventions did vary depending on the diagnostic criteria used, the researchers noted.

Writing in the BMJ, the team said despite the investment of over £10m in trials on lifestyle interventions in pregnancy, none have been implemented in routine practice.

The research was funded by the National Institute of Health Research to help guide the type of interventions that need to be put in place or whether certain groups would benefit particularly.

Professor Shakila Thangaratinam, senior author and professor of women’s health at the University of Liverpool said: ‘Rates of gestational diabetes are increasing worldwide.

‘While lifestyle interventions are proven to prevent type 2 diabetes, their role in preventing gestational diabetes has been unclear – until now.

‘Our findings show these interventions should be integrated into routine antenatal care so all women can benefit.’

She added that the findings highlight the need for tailored approaches that ‘address barriers to engagement and ensure equitable access to support’.

But she noted that lifestyleinterventions in pregnancy are an ‘achievable, evidence-based approach to improving maternal and offspring health’.

Lead author Professor John Allotey said that the detailed data would help policy makers ‘design interventions that work for all women’.