{
  "abstract": "Abstract 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 0.84 to 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.",
  "authors": [
    {
      "affiliations": [
        "Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK"
      ],
      "name": "John Allotey"
    },
    {
      "affiliations": [
        "WHO Collaborating Centre for Global Women’s Health, Department of Metabolism and Systems Science, College of Medicine and Health, University of Birmingham, Birmingham, UK"
      ],
      "name": "Dyuti Coomar"
    },
    {
      "affiliations": [
        "Department of Applied Health Science, College of Medical and Health, University of Birmingham, Birmingham, UK",
        "National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, UK"
      ],
      "name": "Joie Ensor"
    },
    {
      "affiliations": [
        "Unidad de Bioestadística Clínica del Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain"
      ],
      "name": "Gabriel Ruiz-Calvo"
    },
    {
      "affiliations": [
        "Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK"
      ],
      "name": "Anna Boath"
    },
    {
      "affiliations": [
        "Department of Applied Health Science, College of Medical and Health, University of Birmingham, Birmingham, UK"
      ],
      "name": "Chidubem Okeke Ogwulu"
    },
    {
      "affiliations": [
        "Department of Applied Health Science, College of Medical and Health, University of Birmingham, Birmingham, UK"
      ],
      "name": "Mark Monahan"
    },
    {
      "affiliations": [
        "WHO Collaborating Centre for Global Women’s Health, Department of Metabolism and Systems Science, College of Medicine and Health, University of Birmingham, Birmingham, UK"
      ],
      "name": "Valencia Kabeya"
    },
    {
      "affiliations": [
        "Yunnan Maternal and Child Health Care Hospital, Kunming, Yunnan, China"
      ],
      "name": "Min Zheng"
    },
    {
      "affiliations": [
        "Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK"
      ],
      "name": "Rachel McNeill"
    },
    {
      "affiliations": [
        "WHO Collaborating Centre for Global Women’s Health, Department of Metabolism and Systems Science, College of Medicine and Health, University of Birmingham, Birmingham, UK"
      ],
      "name": "Hollie Meacham"
    },
    {
      "affiliations": [
        "WHO Collaborating Centre for Global Women’s Health, Department of Metabolism and Systems Science, College of Medicine and Health, University of Birmingham, Birmingham, UK"
      ],
      "name": "Ghadir Mahmoud"
    },
    {
      "affiliations": [
        "School of Health and Wellbeing, University of Glasgow, Glasgow, UK"
      ],
      "name": "Sharon Anne Simpson"
    },
    {
      "affiliations": [
        "Centre for Genomics and Child Health, Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK"
      ],
      "name": "Graham A Hitman"
    },
    {
      "affiliations": [
        "School of Life Course and Population Sciences, King’s College London, London, UK"
      ],
      "name": "Krish Nirantharakumar"
    },
    {
      "affiliations": [
        "Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK"
      ],
      "name": "Nicola Heslehurst"
    },
    {
      "affiliations": [
        "Universidad Europea del Atlántico, Santander, Spain"
      ],
      "name": "Mireia Pelaez"
    },
    {
      "affiliations": [
        "Serena Tonstad, Oslo University Hospital, Oslo, Norway"
      ],
      "name": "Serena Tonstad"
    },
    {
      "affiliations": [
        "University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC, USA"
      ],
      "name": "SeonAe Yeo"
    },
    {
      "affiliations": [
        "Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil"
      ],
      "name": "Jose G Cecatti"
    },
    {
      "affiliations": [
        "University of Modena and Reggio Emilia, Modena, Italy"
      ],
      "name": "Fabio Facchinetti"
    },
    {
      "affiliations": [
        "Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran"
      ],
      "name": "Narges Sadat  Motahari-Tabari"
    },
    {
      "affiliations": [
        "Department of Gynecology, Fertility and Obstetrics, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark",
        "Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark"
      ],
      "name": "Kristina M Renault"
    },
    {
      "affiliations": [
        "School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia"
      ],
      "name": "Kym J Guelfi"
    },
    {
      "affiliations": [
        "Steno Diabetes Center, Odense University Hospital, Odense, Denmark",
        "Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark",
        "Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark"
      ],
      "name": "Dorte Møller Jensen"
    },
    {
      "affiliations": [
        "Monash Centre for Health Research and Implementation, School of Public Health, Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Cheryce Harrison"
    },
    {
      "affiliations": [
        "Monash Centre for Health Research and Implementation, School of Public Health, Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Mahnaz Bahri Khomami"
    },
    {
      "affiliations": [
        "Endocrinology and Nutrition Department, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain",
        "Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CI-BERDEM), Madrid, Spain"
      ],
      "name": "Alfonso L Calle-Pascual"
    },
    {
      "affiliations": [
        "UCD Perinatal Research Centre, University College Dublin, National Maternity Hospital, Dublin, Ireland"
      ],
      "name": "Fionnuala M McAuliffe"
    },
    {
      "affiliations": [
        "Institute of Nutritional Medicine, School of Medicine and Health, Technical University of Munich, Munich, Germany"
      ],
      "name": "Hans Hauner"
    },
    {
      "affiliations": [
        "Universidad Politécnica de Madrid, Madrid, Spain"
      ],
      "name": "Ruben Barakat"
    },
    {
      "affiliations": [
        "The Centre for Childhood Health, Nono Nordisk, Denmark"
      ],
      "name": "Nina Rica Wium Geiker"
    },
    {
      "affiliations": [
        "Steno Diabetes Center, Odense University Hospital, Odense, Denmark",
        "Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark",
        "Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark"
      ],
      "name": "Christina Anne Vinter"
    },
    {
      "affiliations": [
        "Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA"
      ],
      "name": "Suzanne Phelan"
    },
    {
      "affiliations": [
        "Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland"
      ],
      "name": "Tarja I Kinnunen"
    },
    {
      "affiliations": [
        "Redcliffe Hospital, Redcliffe, Queensland, Australia",
        "Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia"
      ],
      "name": "Alka Kothari"
    },
    {
      "affiliations": [
        "Monash Centre for Health Research and Implementation, School of Public Health, Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Helena Teede"
    },
    {
      "affiliations": [
        "Division of Women’s Health, Women’s Health Academic Centre, King’s College London, St Thomas’ Hospital, London, UK"
      ],
      "name": "Lucilla Poston"
    },
    {
      "affiliations": [
        "Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK",
        "WHO Collaborating Centre for Global Women’s Health, Department of Metabolism and Systems Science, College of Medicine and Health, University of Birmingham, Birmingham, UK",
        "Department of Applied Health Science, College of Medical and Health, University of Birmingham, Birmingham, UK",
        "National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, UK",
        "Unidad de Bioestadística Clínica del Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain",
        "Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK",
        "Yunnan Maternal and Child Health Care Hospital, Kunming, Yunnan, China",
        "School of Health and Wellbeing, University of Glasgow, Glasgow, UK",
        "Centre for Genomics and Child Health, Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK",
        "School of Life Course and Population Sciences, King’s College London, London, UK",
        "Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK",
        "Universidad Europea del Atlántico, Santander, Spain",
        "Serena Tonstad, Oslo University Hospital, Oslo, Norway",
        "University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC, USA",
        "Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil",
        "University of Modena and Reggio Emilia, Modena, Italy",
        "Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran",
        "Department of Gynecology, Fertility and Obstetrics, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark",
        "Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark",
        "School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia",
        "Steno Diabetes Center, Odense University Hospital, Odense, Denmark",
        "Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark",
        "Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark",
        "Monash Centre for Health Research and Implementation, School of Public Health, Monash University, Melbourne, Victoria, Australia",
        "Endocrinology and Nutrition Department, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain",
        "Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CI-BERDEM), Madrid, Spain",
        "UCD Perinatal Research Centre, University College Dublin, National Maternity Hospital, Dublin, Ireland",
        "Institute of Nutritional Medicine, School of Medicine and Health, Technical University of Munich, Munich, Germany",
        "Universidad Politécnica de Madrid, Madrid, Spain",
        "The Centre for Childhood Health, Nono Nordisk, Denmark",
        "Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA",
        "Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland",
        "Redcliffe Hospital, Redcliffe, Queensland, Australia",
        "Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia",
        "Division of Women’s Health, Women’s Health Academic Centre, King’s College London, St Thomas’ Hospital, London, UK",
        "Department of Reproductive and Health Research, World Health Organization, Geneva, Switzerland",
        "Katies Team, Patient and Public Representative, London, UK",
        "Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK",
        "Women's and Children's Health Services, Barts Health NHS Trust, London, UK",
        "CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain",
        "Liverpool Women's NHS Foundation Trust, Liverpool, UK",
        "NIHR Northwest Coast Applied Research Collaboration, Liverpool, UK"
      ],
      "name": "Ana Pilar Betrán"
    },
    {
      "affiliations": [
        "Katies Team, Patient and Public Representative, London, UK"
      ],
      "name": "Ngawai Moss"
    },
    {
      "affiliations": [
        "Department of Reproductive and Health Research, World Health Organization, Geneva, Switzerland"
      ],
      "name": "Stamatina Iliodromiti"
    },
    {
      "affiliations": [
        "Women's and Children's Health Services, Barts Health NHS Trust, London, UK"
      ],
      "name": "Frances Austin"
    },
    {
      "affiliations": [
        "Department of Applied Health Science, College of Medical and Health, University of Birmingham, Birmingham, UK"
      ],
      "name": "Tracy Roberts"
    },
    {
      "affiliations": [
        "Unidad de Bioestadística Clínica del Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain",
        "CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain"
      ],
      "name": "Javier Zamora"
    },
    {
      "affiliations": [
        "Department of Applied Health Science, College of Medical and Health, University of Birmingham, Birmingham, UK",
        "National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, UK"
      ],
      "name": "Richard D Riley"
    },
    {
      "affiliations": [
        "Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK",
        "Liverpool Women's NHS Foundation Trust, Liverpool, UK",
        "NIHR Northwest Coast Applied Research Collaboration, Liverpool, UK"
      ],
      "name": "Shakila Thangaratinam"
    },
    {
      "affiliations": [],
      "name": "on behalf of the i-WIP Collaborative Group"
    }
  ],
  "title": "Effects of lifestyle interventions in pregnancy on gestational diabetes: individual participant data and network meta-analysis",
  "uid": "82932667-1b37-5848-9e4d-a6acd45d009c"
}