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BACKGROUND: Women with prior gestational diabetes mellitus (GDM) are at increased risk of type 2 diabetes, and lifestyle intervention (LSI) offered a decade after pregnancy is effective in preventing diabetes. However, since diabetes frequently onsets in the initial years following pregnancy, preventive actions should be implemented closer to pregnancy. We aimed to assess the effect of lifestyle interventions, compared to standard care, in reducing the incidence of diabetes following a pregnancy complicated by GDM. METHODS: test. RESULTS: We identified 24 studies involving 9017 women. In studies without high risk of bias (18 studies; 8,357 women), LSI reduced the incidence of diabetes by 19% (RR = 0.81; 95%CI 0.71.0.93). The effect was significant and more protective (RR = 0.78; 0.65, 0.94) in studies evaluating women with GDM identified specifically as at a higher risk of diabetes, compared to those intervening on women with GDM irrespective of risk (RR = 0.85; 0.70, 1.04). Similarly, when expressed in absolute terms, the overall number needed to treat (NNT) was 56 considering all studies, 71 for women with GDM irrespective of risk, and 31 for women with GDM at high risk. The intervention produced a lower weight gain (mean difference=-0.88 kg;-1.52, -0.23 for all studies; -0.62 kg;-1.22, -0.02 for studies without high risk of bias). The effects were robust in sensitivity analyses and supported by evidence of moderate certainty for diabetes and weight change. CONCLUSIONS: LSI offered to women with GDM following pregnancy is effective in preventing type 2 diabetes, despite the small postpartum weight change. The impact of LSI on incidence reduction was greater for women with GDM at a higher diabetes risk. PROSPERO: Registration number CRD42024555086, Jun 28, 2024.
Bracco et al. (Fri,) studied this question.