Researchers from the University of Liverpool, in collaboration with King's College London, have led the largest study to date demonstrating the significant benefits of lifestyle interventions in reducing the risk of gestational diabetes.
Gestational diabetes is a condition characterised by high blood sugar during pregnancy, posing serious risks to both mother and baby, including increased chances of stillbirth, preterm birth, and pre-eclampsia. Longer term, it increases the risk of obesity, type 2 diabetes, and cardiovascular disease for both mother and child.
Despite rising global rates of gestational diabetes, there has been limited evidence to guide policymakers on the most effective lifestyle interventions for prevention. Funded by the National Institute for Health and Care Research (NIHR), the team of global collaborators from across the UK, Europe, Australia, North America and Asia set out to address this.
The study, published in The BMJ, brings together data from more than 100 randomised trials involving nearly 36,000 pregnant women, including the largest international collection of individual participant data to date. King's contributed data from the UPBEAT study, led by Professor Lucilla Poston, which evaluated a dietary and physical activity intervention in 1,500 pregnant women with obesity living in inner-city settings across the UK.
These data allowed the researchers to assess whether lifestyle interventions, including diet and physical activity, prevent gestational diabetes, for whom they work best, and which components provide the greatest benefit.
The study found that lifestyle interventions in pregnancy can reduce the risk of gestational diabetes. Physical activity-based interventions, such as walking, aerobic and strength training, and swimming, were the most effective. It found that group delivery formats and newly trained facilitators achieved greater benefits.
Significantly, the study also found that although pregnant women benefitted overall, those from lower educational backgrounds benefited less, suggesting inequalities in reach or engagement.
Whilst the UPBEAT study did not show that the lifestyle intervention prevented gestational diabetes, the results of this individual patient data analysis overall did suggest some benefit, especially if the lifestyle intervention was based on increasing physical activity. However, the study showed that those from lower educations backgrounds benefited less; and as these women bear the greatest burden of gestational diabetes, future interventions should focus on ways to prevent gestational diabetes in this high-risk group.
Lucilla Poston, Professor of Maternal & Fetal Health at King's and co-author on the paper
Senior author and project lead, Shakila Thangaratinam, Professor of Women's Health at the University of Liverpool said: "Rates of gestational diabetes are increasing worldwide. While lifestyle interventions are proven to prevent type 2 diabetes, their role in preventing gestational diabetes has been unclear - until now. Our findings show these interventions should be integrated into routine antenatal care so all women can benefit.
"However, we observed that women with lower educational attainment benefitted less from these programmes. This highlights the need for tailored approaches that address barriers to engagement and ensure equitable access to support."
The research primarily drew on data from high-income countries, and the team emphasises the need for further studies on culturally adapted and technology-enabled interventions. Professor Thangaratinam concluded: "Lifestyle interventions in pregnancy are an achievable, evidence-based approach to improving maternal and offspring health and should be supported through policy and practice."
Lead author Professor John Allotey from the University of Liverpool also concluded: "By combining a large number of trials with detailed individual-level data, we were able to identify not just whether lifestyle interventions work, but which elements make them most effective. As gestational diabetes continues to rise globally, this kind of evidence is crucial for designing interventions that work for all women."
Physical activity-based interventions were found to be the most effective in preventing gestational diabetes, with no adverse effects observed. Women are encouraged to discuss any concerns or questions with their general practitioner or midwife.
