NIHR Signal | January 2019 | Diet and exercise can reduce the risk of developing diabetes during pregnancy
A recent NIHR Signal underlines a systematic review which found that any form of lifestyle intervention reduced the risk of gestational diabetes by 23%, with similar effects for diet, exercise or both. Interventions were most successful when targeted at high-risk populations, though body mass index alone was not associated with an effect.
Diet and exercise are effective ways of preventing the development of diabetes during pregnancy, known as gestational diabetes.
Gestational diabetes is becoming more common and is associated with poorer outcomes for mother and baby. Diet, physical activity and weight are modifiable risk factors, but trials published to date have shown inconsistent results.
As the authors suggest, comprehensive risk assessments that consider body mass index alongside other risk factors may help to identify women who could benefit most from structured lifestyle interventions during pregnancy
BACKGROUND: Diet and exercise during pregnancy have been used to prevent gestational diabetes mellitus (GDM) with some success.
OBJECTIVES: To examine the effectiveness of lifestyle intervention on GDM prevention and to identify key effectiveness moderators to improve prevention strategy.
SEARCH STRATEGY: Pubmed, Scopus, Cochrane and cross-references were searched.
SELECTION CRITERIA: Randomized controlled trials (RCTs) evaluating lifestyle interventions during pregnancy for GDM prevention.
DATA COLLECTION AND ANALYSIS: Two independent reviewers extracted data. Random-effects model was used to analyze the relative risk and 95% confidence interval (RR and 95% CI). Meta-regressions and subgroup analyses were used to investigate important moderators of effectiveness.
MAIN RESULTS: 47 RCTs involving 15745 participants showed that diet and exercise during pregnancy were preventive of GDM (RR 0.77, 95% CI [0.69; 0.87]). Four key aspects were identified to improve the preventive effect: targeting on the high-risk population, early initiation of intervention, proper intensity and frequency of exercise, and gestational weight gain management. Although 24 RCTs targeted on overweight or obese women, BMI failed to predict the effectiveness of an intervention. Instead, interventions are most effective in high-incidence population rather than simply overweight or obese women. Furthermore, exercise of moderate intensity for 50-60 minutes twice a week could lead to about 24% reduction in GDM.
CONCLUSIONS: The best strategy to prevent GDM is to target on high-risk population predicted by risk evaluation models and to control their gestational weight gain through intensified diet and exercise modifications early in their pregnancy. This article is protected by copyright. All rights reserved.
Guo, X. et al | 2018| Improving the effectiveness of lifestyle interventions for gestational diabetes prevention: a meta-analysis and meta-regression| Bjog | doi.org/10.1111/1471-0528.15467
The full article is available to Rotherham NHS staff here