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Pregnancy Health: Lifestyle Interventions to Reduce the Risk of Gestational Diabetes

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What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from 29 studies identified in a recently published systematic review (Song et al. 2016). The Community Guide review team examined each of the studies included in the systematic review and abstracted information about study results and intervention and population characteristics. The review team also prepared a new intervention definition, calculated effect estimates for each included study, and produced summary effect estimates and stratified analyses.

Context

The United States Preventive Services Task Force (USPSTF) recommends screening for gestational diabetes mellitus in asymptomatic pregnant women after 24 weeks of gestation (Grade B recommendation; USPSTF 2016).

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

Compared to usual care, lifestyle interventions reduced the overall risk of developing gestational diabetes by 32% (29 studies).

  • Interventions that provided supervised exercise classes alone or in combination with other lifestyle reduced the risk by 32% (13 studies).
  • Interventions that provided education and counseling for diet and physical activity reduced the risk by 31% (16 studies).

The CPSTF recommendation is reinforced by another published systematic review that reported similar findings (Shepherd et al., 2017).

Applicability

Based on results for interventions in different settings and populations, findings should be applicable to interventions in clinical or hospital settings in high income countries.

The intervention should be effective with participants recruited before their second trimester (any gestational age), regardless of pre-pregnancy BMI, maternal age (though interventions were more effective for participants 30 years and older), or risk level for developing gestational diabetes (though interventions were more effective for participants with higher risk levels).

Evidence Gaps

Additional research and evaluation are needed to answer the following questions and fill existing gaps in the evidence base.

  • Among those who did not develop gestational diabetes, did lifestyle interventions lead to other health benefits?
  • Besides education and counseling, what else needs to be covered (e.g. goal setting, action plan, follow-up monitoring of progress)?
  • Does intervention effectiveness vary in different populations, including low-income and predominantly racial or ethnic minority populations?

Study Characteristics

Intervention settings:

  • Interventions were implemented in the United States (6 studies), the European Union (16 studies), Australia (2 studies), Canada (2 studies), the United Kingdom (1 study), and India (1 study).
  • Intervention settings included hospitals (16 studies), and clinics (12 studies); one study did not report setting.

Participant characteristics:

  • The women who participated in the included studies had a median age of 30 years (28 studies), and a median BMI of 26.8 kg/m2 (28 studies).
  • Most of the studies recruited women with mean or median gestational age ≤ 15 weeks (19 studies).

Intervention characteristics:

  • Programs were delivered by dieticians (11 studies), fitness specialists (5 studies), health coaches or trainers (4 studies), obstetricians or gynecologists (3 studies), a food technologist (1 study), or a nutritionist (1 study).
  • Studies were delivered by one (17 studies) or two (9 studies) types of professionals.
  • Intervention types included the following:
    • Education and counseling for diet alone (3 studies)
    • Education and counseling for diet and physical activity (7 studies)
    • Constructing and maintaining meal plan for diet alone (2 studies)
    • Supervised exercise classes for physical activity (10 studies)
    • Combination of any of the above components (6 studies)