Objective. Lifestyle interventions have been shown to be both effective and cost-effective in reducing diabetes and metabolic risk in high-risk populations. We systematically reviewed the effectiveness and cost-effectiveness of lifestyle interventions on anthropometric, glycemic and cardiovascular outcomes in women with previous gestational diabetes mellitus (GDM).
Method. We identified relevant randomized control trials (RCT) by searching multiple electronic databases through 20th June 2018. Data were pooled using random-effects models. The review protocol was registered (PROSPERO 2016: CRD42018108870).
Results. Twenty-one studies met the inclusion criteria and 16 studies with outcome data were analyzed in the meta-analysis. The main lifestyle interventions involved diet, physical activity, and education/counseling. Most studies were conducted in Western countries. No RCT studies included cost-effectiveness data on lifestyle interventions. The pooled estimate for postpartum weight change showed a significant mean reduction in the intervention arm, 1.8 kg (95% CI: -2.9, -0.6; p = 0.002; I2 = 92.2%; p < 0.05). Greater effects were seen in longer studies and with lifestyle education aiming for weight loss. Most of the other endpoints had modest improvements but only anthropometric endpoints were statistically significant. However, there was high heterogeneity between the studies.
Conclusions. Lifestyle interventions that primarily combine physical activity and diet or lifestyle education with counseling are effective in improving anthropometric outcomes to reduce diabetes risk in women with a history of GDM. However, more research is needed to explore lifestyle effects on glycemic and cardiovascular risk factors and to establish cost-effectiveness. Methodologically sound, large-scale studies on diverse ethnicities and with longer follow-up would establish the real effect of lifestyle interventions to reduce diabetes risk in women with previous GDM.