John Allotey,Dyuti Coomar,Joie Ensor,Gabriel Ruiz-Calvo,Anna Boath,Chidubem Okeke Ogwulu,Mark Monahan,Valencia Kabeya,Min Zheng,Rachel McNeill,Hollie Meacham,Ghadir Mahmoud,Sharon Anne Simpson,Graham A Hitman,Krish Nirantharakumar,Nicola Heslehurst,Mireia Pelaez,Serena Tonstad,SeonAe Yeo,Jose G Cecatti,Fabio Facchinetti,Narges Sadat Motahari-Tabari,Kristina M Renault,Kym J Guelfi,Dorte Møller Jensen,Cheryce Harrison,Mahnaz Bahri Khomami,Alfonso L Calle-Pascual,Fionnuala M McAuliffe,Hans Hauner,Ruben Barakat,Nina Rica Wium Geiker,Christina Anne Vinter,Suzanne Phelan,Tarja I Kinnunen,Alka Kothari,Helena Teede,Lucilla Poston,Ana Pilar Betrán,Ngawai Moss,Stamatina Iliodromiti,Frances Austin,Tracy Roberts,Javier Zamora,Richard D Riley,Shakila Thangaratinam,
OBJECTIVESTo assess the effects of lifestyle interventions on gestational diabetes, determine whether the effects vary by maternal body mass index, age, parity, ethnicity, education level, or intervention, and rank interventions by effectiveness.DESIGNIndividual participant data (IPD) and network meta-analysis.DATA SOURCESMajor electronic databases (January 1990 to April 2025).METHODSThis meta-analysis included randomised trials on the effects of lifestyle interventions (physical activity based, diet based, or mixed) in pregnancy on gestational diabetes. 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. A two stage IPD meta-analysis estimated summary odds ratios and 95% confidence intervals and interactions (subgroup effects), along with absolute risk reduction estimates. Aggregate data from non-IPD trials were added to the meta-analysis when possible. Intervention effects were ranked using network meta-analysis.RESULTS104 randomised trials (35 993 women) were included, with IPD for 68% of participants (24 391 women; 54 studies). 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). 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%). Effects did not vary by maternal characteristics, except for education. 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). 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%). Physical activity based interventions ranked highest (mean rank 1.1, 95% CI 1 to 2) in preventing gestational diabetes.CONCLUSIONSLifestyle interventions in pregnancy are likely to prevent gestational diabetes, with effects varying according to diagnostic criteria. Implementation strategies should ad
目的评估生活方式干预对妊娠期糖尿病的影响，确定其影响是否因产妇体重指数、年龄、胎次、种族、教育水平或干预而异，并根据干预的有效性对干预进行排序。设计个体参与者数据（IPD）和网络元分析。主要电子数据库（1990年1月至2025年4月）。方法本荟萃分析纳入了对妊娠期生活方式干预（以身体活动为基础、以饮食为基础或混合）对妊娠期糖尿病影响的随机试验。主要结局是根据任何标准和英国NICE（国家健康与护理卓越研究所）标准定义的妊娠糖尿病；其他结果包括国际妊娠糖尿病协会研究组（IADPSG）和修改后的IADPSG对妊娠糖尿病的定义。两阶段IPD荟萃分析估计了总优势比、95%置信区间和相互作用（亚组效应），以及绝对风险降低估计。在可能的情况下，将非ipd试验的汇总数据添加到meta分析中。采用网络元分析对干预效果进行排名。结果纳入104项随机试验（35 993名女性），68%的参与者（24 391名女性；54项研究）患有IPD。在IPD试验中，生活方式干预使任何标准定义的妊娠糖尿病减少10%(优势比0.90,95%可信区间（CI） 0.80至1.02；绝对风险降低1.3%,95% CI -0.3%至2.6%)，当IPD和非IPD联合试验时，绝对风险降低20%（优势比0.80,95% CI 0.73至0.88；绝对风险降低2.6%,95% CI 1.6%至3.6%），使用NICE标准未观察到降低（优势比0.98,95% CI 0.84至1.13）。在IPD试验中，生活方式干预使使用IADPSG标准定义的妊娠糖尿病降低了14%（优势比0.86,95% CI 0.75至0.97；绝对风险降低2.7%,95% CI 0.6%至5.0%），在IPD和非IPD联合试验中降低了18%（优势比0.82,95% CI 0.72至0.93；绝对风险降低3.5%,95% CI 1.3%至5.7%）。除了受教育程度外，母亲的性格特征对效果没有影响。尽管所有受教育程度的妇女都从干预中获益，但受教育程度较低的妇女获益较少（低与中相互作用：优势比0.68,95% CI 0.51至0.90；低与高相互作用：优势比0.71,95% CI 0.54至0.93）。除了组形式（优势比0.81,95% CI 0.68至0.97；绝对风险降低2.5%,95% CI 0.4%至4.3%）和新培训的辅导员（优势比0.82,95% CI 0.69至0.96；绝对风险降低2.4%,95% CI 0.5%至4.2%）外，获益没有因干预特征而变化。以身体活动为基础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%可信区间1至2）。结论妊娠期生活方式干预有可能预防妊娠期糖尿病，其效果因诊断标准不同而不同。实施战略应通过孕产妇教育解决不平等问题，并考虑群体形式、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。研究注册号：crd42020212884。
{"title":"Effects of lifestyle interventions in pregnancy on gestational diabetes: individual participant data and network meta-analysis.","authors":"John Allotey,Dyuti Coomar,Joie Ensor,Gabriel Ruiz-Calvo,Anna Boath,Chidubem Okeke Ogwulu,Mark Monahan,Valencia Kabeya,Min Zheng,Rachel McNeill,Hollie Meacham,Ghadir Mahmoud,Sharon Anne Simpson,Graham A Hitman,Krish Nirantharakumar,Nicola Heslehurst,Mireia Pelaez,Serena Tonstad,SeonAe Yeo,Jose G Cecatti,Fabio Facchinetti,Narges Sadat Motahari-Tabari,Kristina M Renault,Kym J Guelfi,Dorte Møller Jensen,Cheryce Harrison,Mahnaz Bahri Khomami,Alfonso L Calle-Pascual,Fionnuala M McAuliffe,Hans Hauner,Ruben Barakat,Nina Rica Wium Geiker,Christina Anne Vinter,Suzanne Phelan,Tarja I Kinnunen,Alka Kothari,Helena Teede,Lucilla Poston,Ana Pilar Betrán,Ngawai Moss,Stamatina Iliodromiti,Frances Austin,Tracy Roberts,Javier Zamora,Richard D Riley,Shakila Thangaratinam, ","doi":"10.1136/bmj-2025-084159","DOIUrl":"https://doi.org/10.1136/bmj-2025-084159","url":null,"abstract":"OBJECTIVESTo assess the effects of lifestyle interventions on gestational diabetes, determine whether the effects vary by maternal body mass index, age, parity, ethnicity, education level, or intervention, and rank interventions by effectiveness.DESIGNIndividual participant data (IPD) and network meta-analysis.DATA SOURCESMajor electronic databases (January 1990 to April 2025).METHODSThis meta-analysis included randomised trials on the effects of lifestyle interventions (physical activity based, diet based, or mixed) in pregnancy on gestational diabetes. 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. A two stage IPD meta-analysis estimated summary odds ratios and 95% confidence intervals and interactions (subgroup effects), along with absolute risk reduction estimates. Aggregate data from non-IPD trials were added to the meta-analysis when possible. Intervention effects were ranked using network meta-analysis.RESULTS104 randomised trials (35 993 women) were included, with IPD for 68% of participants (24 391 women; 54 studies). 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). 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%). Effects did not vary by maternal characteristics, except for education. 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). 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%). Physical activity based interventions ranked highest (mean rank 1.1, 95% CI 1 to 2) in preventing gestational diabetes.CONCLUSIONSLifestyle interventions in pregnancy are likely to prevent gestational diabetes, with effects varying according to diagnostic criteria. Implementation strategies should ad","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"29 1","pages":"e084159"},"PeriodicalIF":0.0,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"NHS \"online hospital\": Menopause, prostate, and eye conditions to be prioritised.","authors":"Jacqui Wise","doi":"10.1136/bmj.s21","DOIUrl":"https://doi.org/10.1136/bmj.s21","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"38 1","pages":"s21"},"PeriodicalIF":0.0,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Why listening to learners matters in medical education reform.","authors":"Michal Ordak","doi":"10.1136/bmj.r2676","DOIUrl":"https://doi.org/10.1136/bmj.r2676","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"29 1","pages":"r2676"},"PeriodicalIF":0.0,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Is the chickenpox vaccine safe, and why is it now being offered to UK children?","authors":"Katharine Lang","doi":"10.1136/bmj.s16","DOIUrl":"https://doi.org/10.1136/bmj.s16","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"30 1","pages":"s16"},"PeriodicalIF":0.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"How do I deal with a difficult colleague?","authors":"Elisabeth Mahase","doi":"10.1136/bmj.r2594","DOIUrl":"https://doi.org/10.1136/bmj.r2594","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"2 1","pages":"r2594"},"PeriodicalIF":0.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Effective obesity care? Doctors could ask more about people's lives and less about their weight.","authors":"Ellen Fallows","doi":"10.1136/bmj.s1","DOIUrl":"https://doi.org/10.1136/bmj.s1","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"22 1","pages":"s1"},"PeriodicalIF":0.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Why the approval of two new gonorrhoea treatments is a game changer.","authors":"Katharine Lang","doi":"10.1136/bmj.r2684","DOIUrl":"https://doi.org/10.1136/bmj.r2684","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"24 1","pages":"r2684"},"PeriodicalIF":0.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"\"It became a joke\"-how Poland's government lost the battle over health literacy to the church and right wing groups.","authors":"Anna Caldwell","doi":"10.1136/bmj.r2392","DOIUrl":"https://doi.org/10.1136/bmj.r2392","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"24 1","pages":"r2392"},"PeriodicalIF":0.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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