Lifestyle intervention to prevent type 2 diabetes after a pregnancy complicated by gestational diabetes mellitus: a systematic review and meta-analysis update.

Summary

Across 24 RCTs (n=9017), postpartum lifestyle interventions reduced incident type 2 diabetes by 19% overall (RR 0.81) and more strongly in high-risk women (RR 0.78), with NNT 31 in high-risk subgroups. Benefits occurred despite only modest weight differences, underscoring glycemic benefits beyond weight loss.

Key Findings

• Lifestyle interventions after GDM reduced incident type 2 diabetes by 19% in lower-bias trials (RR 0.81, 95% CI 0.71–0.93).
• Greater benefit in high-risk women (RR 0.78) versus unselected GDM populations (RR 0.85; not statistically significant).
• Number needed to treat was 31 in high-risk women versus 71 in unselected GDM populations.
• Weight change was modest (−0.88 kg overall), indicating benefits beyond substantial weight loss.

Clinical Implications

Postpartum care should include structured lifestyle programs soon after GDM pregnancy, with risk stratification to target women at highest risk where NNT is lowest. Even modest weight changes confer meaningful diabetes risk reduction.

Limitations

• Heterogeneity in timing, intensity, and components of interventions across trials.
• Follow-up durations and ascertainment methods vary; some trials had risk of bias.

Future Directions

Design pragmatic, culturally tailored postpartum programs integrated into obstetric and primary care workflows, with cost-effectiveness and implementation evaluations focusing on high-risk women.