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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 uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision makers with additional, effective options. The following published review was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to pregnancy health:

Song C, Li J, Leng J, Ma R C, and Yang X. Lifestyle intervention can reduce the risk of gestational diabetes: a meta-analysis of randomized controlled trials. Obesity Reviews 2016;17:960–9.

The published review included 29 studies. The CPSTF finding is based on results from the published review, additional analyses of data from included studies, and expert input from team members and the CPSTF.

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

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • 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)