Effects of lifestyle interventions in pregnancy on gestational diabetes: individual participant data and network meta-analysis.

Methods

Individual participant data (IPD) and network meta-analysis.

个体参与者数据（IPD）和网络荟萃分析。

data_sources

Major electronic databases (January 1990 to April 2025).

主要电子数据库（1990年1月至2025年4月）。

Methods

This meta-analysisincluded randomised trials on the effects of lifestyle interventions (physical activity based, diet based, or mixed) in pregnancy on gestational diabetes.

这项荟萃分析包括了关于生活方式干预（基于体力活动、基于饮食或混合型）对孕期妊娠糖尿病影响的随机试验。

Main outcomes were gestational diabetes defined by any criteria and by UK NICE (National Institute for Health and Care Excellence) criteria; other outcomes included IADPSG (International Association of Diabetes in Pregnancy Study Group) and modified IADPSG defined gestational diabetes.

主要结果是根据任何标准和英国NICE（国家卫生与护理卓越研究所）标准定义的妊娠糖尿病；其他结果包括IADPSG（国际妊娠糖尿病研究组）和修改后的IADPSG定义的妊娠糖尿病。

A two stage IPD meta-analysisestimated summary odds ratios and 95% confidence intervals and interactions (subgroup effects), along with absolute risk reduction estimates.

两阶段的个体患者数据（IPD）荟萃分析估计了汇总的比值比和95%置信区间以及交互作用（亚组效应），以及绝对风险降低的估计值。

Aggregate data from non-IPD trials were added to the meta-analysiswhen possible.

在可能的情况下，将非个体患者数据(IPD)试验的汇总数据添加到荟萃分析中。

Intervention effects were ranked using network meta-analysis.

使用网络荟萃分析对干预效果进行排名。

Results

104 randomised trials (35 993 women) were included, with IPD for 68% of participants (24 391 women; 54 studies).

纳入了104项随机试验（共35,993名女性），其中68%的参与者（24,391名女性；54项研究）有IPD数据。

Lifestyle interventions reduced gestational diabetes defined by any criteria by 10% in IPD trials (odds ratio 0.90, 95% confidence interval(CI) 0.80 to 1.02; absolute risk reduction 1.3%, 95% CI -0.3% to 2.6%), and by 20% when combining IPD and non-IPD trials (odds ratio 0.80, 95% CI 0.73 to 0.88; absolute risk reduction 2.6%, 95% CI 1.6% to 3.6%), and no reduction was observed using NICE criteria (odds ratio 0.98, 95% CI 0.84to 1.13).

生活方式干预措施在IPD试验中将妊娠期糖尿病的发病率降低了10%（比值比0.90，95%置信区间（CI）0.80至1.02；绝对风险降低1.3%，95% CI -0.3%至2.6%），并且在结合IPD和非IPD试验时降低了20%（比值比0.80，95% CI 0.73至0.88；绝对风险降低2.6%，95% CI 1.6%至3.6%），而使用NICE标准时未观察到降低（比值比0.98，95% CI 0.84至1.13）。

Lifestyle interventions reduced gestational diabetes defined using IADPSG criteria by 14% in IPD trials (odds ratio 0.86, 95% CI 0.75 to 0.97; absolute risk reduction 2.7%, 95% CI 0.6% to 5.0%) and by 18% when combining IPD and non-IPD trials (odds ratio 0.82, 95% CI 0.72 to 0.93; absolute risk reduction 3.5%, 95% CI 1.3% to 5.7%).

生活方式干预措施在使用IADPSG标准定义的妊娠糖尿病中，IPD试验降低了14%（比值比0.86，95%置信区间0.75至0.97；绝对风险降低2.7%，95%置信区间0.6%至5.0%），当结合IPD和非IPD试验时降低了18%（比值比0.82，95%置信区间0.72至0.93；绝对风险降低3.5%，95%置信区间1.3%至5.7%）。

Effects did not vary by maternal characteristics, except for education.

效果并未因母亲特征而异，除了教育水平。

Although women of all educational levels benefited from the intervention, the benefit was less in those with low education (low v middle interaction: odds ratio 0.68, 95% CI 0.51 to 0.90; low v high interaction: odds ratio 0.71, 95% CI 0.54 to 0.93).

尽管所有教育水平的女性都从干预中受益，但在受教育程度较低的女性中，受益较少（低对中等教育水平的交互作用：比值比为0.68，95%置信区间为0.51至0.90；低对高等教育水平的交互作用：比值比为0.71，95%置信区间为0.54至0.93）。

Benefits did not vary by intervention characteristics, except for greater effectiveness with group format (odds ratio 0.81, 95% CI 0.68 to 0.97; absolute risk reduction 2.5%, 95% CI 0.4% to 4.3%) and newly trained facilitators (odds ratio 0.82, 95% CI 0.69 to 0.96; absolute risk reduction 2.4%, 95% CI 0.5% to 4.2%).

除了团体形式（比值比为0.81，95%置信区间为0.68至0.97；绝对风险降低为2.5%，95%置信区间为0.4%至4.3%）和新培训的引导者（比值比为0.82，95%置信区间为0.69至0.96；绝对风险降低为2.4%，95%置信区间为0.5%至4.2%）的干预效果更佳外，干预效果并未因干预特征而异。

Physical activity based interventions ranked highest (mean rank 1.1, 95% CI 1 to 2) in preventing gestational diabetes.

基于身体活动的干预措施在预防妊娠糖尿病方面排名最高（平均排名1.1，95%置信区间1至2）。

Conclusions

Lifestyle interventions in pregnancy are likely to prevent gestational diabetes, with effects varying according to diagnostic criteria.

孕期生活方式干预措施可能会预防妊娠糖尿病，其效果会根据诊断标准的不同而有所变化。

Implementation strategies should address inequalities by maternal education, and consider group formats, provider training, and physical activity based interventions to prevent gestational diabetes.

实施策略应通过母亲教育解决不平等，并考虑团体形式、提供者培训和基于身体活动的干预措施，以预防妊娠糖尿病。

study_registration

PROSPERO CRD42020212884.

PROSPERO CRD42020212884。