Pregnancy Health: Lifestyle Interventions to Reduce the Risk of Gestational Diabetes
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) recommends lifestyle interventions delivered during the first two trimesters of pregnancy to reduce the risk of gestational diabetes. The CPSTF finds:
- Strong evidence of effectiveness for lifestyle interventions that provide supervised exercise classes, either alone or in combination with other components
- Sufficient evidence of effectiveness for lifestyle interventions that provide education and counseling for diet or physical activity, diet activities, or a combination of these components
The full CPSTF Finding and Rationale Statement and supporting documents for Pregnancy Health: Lifestyle Interventions to Reduce the Risk of Gestational Diabetes are available in The Community Guide Collection on CDC Stacks.
Intervention
Lifestyle interventions delivered during the first two trimesters of pregnancy aim to prevent gestational diabetes by actively encouraging women to eat a healthy diet and be physically active. Programs include one or more of the following components:
- Supervised exercise classes
- Diet education and counseling
- Physical activity education and counseling
- Diet activity (e.g., meal plan, food diary, individualized support)
About The Systematic Review
The CPSTF uses recently published systematic reviews to conduct accelerated assessments. The following published review was selected and evaluated by a team of specialists:
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).
Study Characteristics
Intervention settings:
- Interventions 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)
- Settings included hospitals (16 studies) and clinics (12 studies); one study did not report setting
Participant characteristics:
- Women had a median age of 30 years (28 studies) and median BMI of 26.8 kg/m² (28 studies)
- Most studies recruited women with mean or median gestational age ≤15 weeks (19 studies)
Intervention characteristics:
- Programs 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)
- Delivered by one (17 studies) or two (9 studies) types of professionals
- Intervention types: education and counseling for diet alone (3 studies); education and counseling for diet and physical activity (7 studies); meal plan for diet alone (2 studies); supervised exercise classes (10 studies); combination of components (6 studies)
Summary of Results
Compared to usual care, lifestyle interventions reduced the overall risk of developing gestational diabetes by 32% (29 studies).
- Interventions providing supervised exercise classes alone or in combination with other lifestyle components reduced risk by 32% (13 studies)
- Interventions providing education and counseling for diet and physical activity reduced risk by 31% (16 studies)
The CPSTF recommendation is reinforced by another published systematic review that reported similar findings (Shepherd et al., 2017).
Summary of Economic Evidence
A systematic review of economic evidence has not been conducted.
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), or risk level for developing gestational diabetes (though interventions were more effective for participants with higher risk levels).
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?
Implementation Considerations and Resources
- All pregnant women could potentially benefit from these lifestyle interventions. If resources are limited, evidence suggests interventions are more effective among women at higher risk for developing gestational diabetes.
- Programs should encourage women to continue participating throughout their pregnancy.
- Lifestyle interventions that included supervised exercise classes led to consistent reductions in risk for developing gestational diabetes.
- Interventions typically provided 50-60 minute, supervised exercise classes three times per week
- Classes were of moderate intensity and included land or aquatic exercises
- Classes can be resource-intensive. Implementers should consider:
- Trained personnel to supervise participants
- Possibility of work compensation for time spent in classes
- Availability of childcare
- Established protocols for classes offering intense exercise during pregnancy to prevent injury and adverse pregnancy outcomes
- Need for reimbursement if healthcare professionals are involved
- Facilities where classes will be held—selected settings should take into account distance and accessibility; settings could range from free or low-priced community centers to private gyms
- Support elements to help participants adopt a sustainable exercise routine, especially for patients who did not engage in regular exercise prior to the intervention
Crosswalks
Healthy People 2030 includes the following objectives related to this CPSTF recommendation.