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Evidence summaries

Lifestyle Interventions for the Treatment of Women with Gestational Diabetes

Lifestyle interventions in women with gestational diabetes appear to be effective in decreasing large for gestational age (LGA) babies. Level of evidence: "B"

Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding of outcome assessment).

Clinical comment: In most studies the intervention was started late in gestation or the time was not stated.

Summary

A Cochrane review [Abstract] 1 included 15 studies with a total of 4501 women and 3768 infants. The lifestyle interventions included a wide variety of components such as education, diet, exercise and self-monitoring of blood glucose. The control group included usual antenatal care or diet alone. There was no clear evidence of a difference between lifestyle intervention and control groups for the risk of hypertensive disorders of pregnancy (pre-eclampsia), caesarean section, development of type 2 diabetes, perineal trauma/tearing, or induction of labour T1. More women in the lifestyle intervention group had met postpartum weight goals one year after birth than in the control group T1. Lifestyle interventions were associated with a reduction in the risk of being born large-for-gestational age (LGA) T2. There was a trend for lower birthweight, neonatal fat mass, and the incidence of macrosomia in the lifestyle intervention group T2.

Lifestyle interventions versus control - Maternal outcomes

OutcomesRelative effect(95% CI)Risk with usual care/controlRisk with lifestyle intervention (95% CI)of participants(studies) Quality of evidence
Hypertensive disorders of pregnancy (pre-eclampsia)RR 0.70(0.40 to 1.22)129 per 100090 per 1000(51 to 157)(4 2796) Low
Perineal trauma/tearRR 1.04(0.93 to 1.18)498 per 1000518 per 1000(463 to 588)1000(1) Moderate
Caesarean sectionRR 0.90(0.78 to 1.05)380 per 1000342 per 1000(296 to 399)3545(10) Low
Induction of labourRR 1.20(0.99 to 1.46)211 per 1000252 per 1000(220 to 285)2699(4) High
Postnatal depressionRR 0.49(0.31 to 0.78)169 per 100083 per 1000(53 to 132)573(1) Low
Postnatal weight retention or return to pre-pregnancy weightRR 1.75(1.05 to 2.90)214 per 1000375 per 1000(225 to 621)156(1) Low
Development of type 2 diabetes (follow-up)RR 0.98(0.54 to 1.76)83 per 100081 per 1000(45 to 146)486(2) Low

Lifestyle versus control - Neonatal and later outcomes

OutcomesRelative effect(95% CI)Risk with usual care/controlRisk with lifestyle intervention (95% CI)of participants(studies) Quality of evidence
Large-for-gestational ageRR 0.60(0.50 to 0.71)189 per 1000113 per 1000(95 to 134)2994(6) Moderate
Perinatal (fetal and neonatal death) and later infant mortalityRR 0.09(0.01 to 1.70)5 per 10000 per 1000(0 to 9)1988(2) Low
Neonatal hypoglycaemiaRR 0.99(0.65 to 1.52)75 per 100074 per 1000(49 to 114)3000(6) Moderate
Adiposity (neonatal) - Mean neonatal fat mass (g)-427 g37.30 g fewer (63.97 fewer to 10.63 fewer) -958(1) Low
Adiposity (child) - Childhood BMI > 85th percentileRR 0.91(0.75 to 1.11)350 per 1000318 per 1000(262 to 388)767(3) Moderate

Clinical comments

Note

Date of latest search:

References

  • Brown J, Alwan NA, West J et al. Lifestyle interventions for the treatment of women with gestational diabetes. Cochrane Database Syst Rev 2017;(5):CD011970. [PubMed]

Primary/Secondary Keywords