Effects of lifestyle education on glycemic control in women with gestational diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials
- 1School of Physical Education, Shanghai University of Sport
- 2College of Sports Science, Shenyang Normal University
Abstract
Background: This review evaluated the effects of lifestyle education on fasting blood glucose (FBG), 2-hour postprandial plasma glucose (2-h PPG), and glycated hemoglobin (HbA1c) in women with gestational diabetes mellitus (GDM) and explored between-study heterogeneity.
Methods: PubMed, Web of Science, Embase, Scopus, CINAHL, and the Cochrane Library were searched from inception to July 1, 2026. Eligible randomized controlled trials (RCTs) compared lifestyle education with usual care or standard management in women diagnosed with GDM during the current pregnancy and reported FBG, 2-h PPG, or HbA1c. Analyses used R software and random-effects models to pool between-group differences in changes from baseline as Hedges’ g and mean differences (MDs), with 95% confidence intervals (CIs). MDs were expressed in mmol/L for FBG and 2-h PPG and as absolute differences in HbA1c (%). Heterogeneity was assessed using I ² , τ ² , and 95% prediction intervals. Prespecified and exploratory subgroup analyses, univariable meta-regression, sensitivity analyses, and small-study effect assessments were performed. Certainty of evidence was assessed using GRADE.
Results: Twenty-three RCTs included 3,197 women. Lifestyle education may reduce FBG (21 RCTs, n=2,382; Hedges’ g=−0.78, 95% CI −0.99 to −0.57; MD=−0.64 mmol/L, 95% CI −0.88 to −0.40; low-certainty evidence) and may reduce 2-h PPG (12 RCTs, n=1,546; Hedges’ g=−0.95, 95% CI −1.17 to −0.74; MD=−1.26 mmol/L, 95% CI −1.73 to −0.79; low-certainty evidence). The evidence is very uncertain about the effect of lifestyle education on HbA1c (9 RCTs, n=1,433; Hedges’ g=−0.72, 95% CI −1.28 to −0.16; MD=−0.80%, 95% CI −1.59 to −0.01; very low-certainty evidence). FBG effects differed by delivery mode and, in exploratory analyses, by body mass index (BMI) category. Study-level meta-regression showed associations of baseline BMI with FBG effects (β=0.101, 95% CI 0.028 to 0.173) and baseline gestational age with 2-h PPG effects (β=0.078, 95% CI 0.025 to 0.131).
Conclusions: Lifestyle education may improve glycemic control in women with GDM, although effects varied across outcomes. The 2-h PPG findings appeared relatively more consistent, but evidence certainty was low. Further large, rigorous RCTs are needed to address heterogeneity and establish targeted lifestyle management strategies.
Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420261459872.
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BibTeX
@article{wang2026effects,
title = {{Effects of lifestyle education on glycemic control in women with gestational diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials}},
author = {Jie Wang and Jiwei Chen and Chen Wei and Feng Ding and Simin Xu and Lingbei Chen and Yueyu Long},
journal = {Frontiers in Endocrinology},
year = {2026},
month = nov,
doi = {10.3389/fendo.2026.2004864},
url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.2004864/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Effects of lifestyle education on glycemic control in women with gestational diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials
AU - Jie Wang
AU - Jiwei Chen
AU - Chen Wei
AU - Feng Ding
AU - Simin Xu
AU - Lingbei Chen
AU - Yueyu Long
PY - 2026
DA - 2026/11/11
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.2004864
UR - https://www.frontiersin.org/articles/10.3389/fendo.2026.2004864/full
AB - Background: This review evaluated the effects of lifestyle education on fasting blood glucose (FBG), 2-hour postprandial plasma glucose (2-h PPG), and glycated hemoglobin (HbA1c) in women with gestational diabetes mellitus (GDM) and explored between-study heterogeneity. Methods: PubMed, Web of Science, Embase, Scopus, CINAHL, and the Cochrane Library were searched from inception to July 1, 2026. Eligible randomized controlled trials (RCTs) compared lifestyle education with usual care or standard management in women diagnosed with GDM during the current pregnancy and reported FBG, 2-h PPG, or HbA1c. Analyses used R software and random-effects models to pool between-group differences in changes from baseline as Hedges’ g and mean differences (MDs), with 95% confidence intervals (CIs). MDs were expressed in mmol/L for FBG and 2-h PPG and as absolute differences in HbA1c (%). Heterogeneity was assessed using I ² , τ ² , and 95% prediction intervals. Prespecified and exploratory subgroup analyses, univariable meta-regression, sensitivity analyses, and small-study effect assessments were performed. Certainty of evidence was assessed using GRADE. Results: Twenty-three RCTs included 3,197 women. Lifestyle education may reduce FBG (21 RCTs, n=2,382; Hedges’ g=−0.78, 95% CI −0.99 to −0.57; MD=−0.64 mmol/L, 95% CI −0.88 to −0.40; low-certainty evidence) and may reduce 2-h PPG (12 RCTs, n=1,546; Hedges’ g=−0.95, 95% CI −1.17 to −0.74; MD=−1.26 mmol/L, 95% CI −1.73 to −0.79; low-certainty evidence). The evidence is very uncertain about the effect of lifestyle education on HbA1c (9 RCTs, n=1,433; Hedges’ g=−0.72, 95% CI −1.28 to −0.16; MD=−0.80%, 95% CI −1.59 to −0.01; very low-certainty evidence). FBG effects differed by delivery mode and, in exploratory analyses, by body mass index (BMI) category. Study-level meta-regression showed associations of baseline BMI with FBG effects (β=0.101, 95% CI 0.028 to 0.173) and baseline gestational age with 2-h PPG effects (β=0.078, 95% CI 0.025 to 0.131). Conclusions: Lifestyle education may improve glycemic control in women with GDM, although effects varied across outcomes. The 2-h PPG findings appeared relatively more consistent, but evidence certainty was low. Further large, rigorous RCTs are needed to address heterogeneity and establish targeted lifestyle management strategies. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420261459872.
SN - 1664-2392
ER -