Lifestyle Behaviors and Gestational Diabetes Mellitus: A Narrative Review
Abstract
1. Introduction
2. Methods
3. Diet and GDM
4. Physical Activity and GDM
5. Sedentary Behavior and GDM
Study | Study Design and Participants | SB Assessment | Main Outcomes |
---|---|---|---|
Aburezq et al., 2020 [117] | Cross-sectional 653 postpartum women with no history of diabetes mellitus | Pregnancy Physical Activity Questionnaire (PPAQ) | No association between PA or SB and GDM |
Anjana et al., 2016 [80] | Quasi-experimental 1086 pregnant women, <28 GW | Pedometer | Women with GDM were more sedentary than women without GDM (86.2 vs. 61.2%, p < 0.001) |
Camargo et al., 2021 [81] | Case–control 68 women with GDM participated in a cross-sectional study of PA and SB (20–35 GW) | Longitudinal Aging Study Amsterdam Sedentary Behavior Questionnaire (LASA-SBQ) | No association of SB with adverse maternal–fetal outcomes (including GDM) |
do Nascimento et al., 2019 [22] | Cross-sectional 544 pregnant women with low income (≤1025 USD), ≤20 GW, age 18–45 years, Recife metropolitan area residency | Pregnancy Physical Activity Questionnaire (PPAQ) | Sedentary PA pattern was associated with higher odds of GDM (OR 1.8, 95% CI 1.1–2.9), which did not change after adjusting for several covariates: age, race/ethnicity, sociodemographic characteristics, and reproductive and medical history (OR 1.9, 95% CI 1.2–3.1) |
Leng et al., 2016 [21] | Cross-sectional 11,450 pregnant women, 12th GW | Self-reported | Sitting at home for either 2–4 h or >4 h per day was associated with increased GDM risk Sitting time 2–4 h vs. <2 h (OR 1.59, 95% CI 1.18–2.15 Sitting time > 4 h vs. <2 h (OR 1.73, 95% CI 1.22–2.43) |
Nasiri Amiri et al., 2016 [118] | Case–control study 200 pregnant women: 100 with GDM as the case group, 100 as a control group | A modified version of the pregnancy physical activity questionnaire (PPAQ), a semi-quantitative questionnaire validated for pregnancy | Pregnant women with low intensity of sedentary behavior were at higher risk of developing GDM compared with women with higher intensity of sedentary behavior |
Nguyen et al., 2018 [82] | Cohort study 1987 pregnant women: 1. Permanent residents in study locations; 2. ≥18 years of age; 3. 24–28 GW 4. Singleton pregnancy; 5. Not having serious health conditions; 6. Able to read the information sheet and sign the consent form | Self-reported | No association between sitting time and GDM |
Oken et al., 2006 [66] | Cohort study 1805 women attending their initial prenatal visit | Self-reported | No association between television viewing before or during pregnancy and the risk of GDM |
Padmapriya et al., 2017 [12] | Cohort study 1083 pregnant women aged ≥18 years, major ethnic groups: Chinese, Malay, Indian, permanent residents to stay in Singapore for at least 5 years, and agreed to donate birth tissues | Self-reported | SB was not associated with FG, 2 h PG, or GDM SB before pregnancy was not associated with the risk of GDM SB during pregnancy was uncertain about the risk of GDM |
van der Ploeg et al., 2011 [119] | Cohort study 14,247 women in 3 age cohorts: younger (18–23 years), mid-age (45–50 years), and older (70–75 years) selected from the Medicare database | Self-reported | SB was not associated with the development of GDM in the subsequent three years |
Wagnild et al., 2019 [83] | Cross-sectional study 188 pregnant women, age ≥ 18 years, singleton pregnancy, fluent in English, no pre-existing diabetes, at least one risk factor for GDM: BMI ≥ 30 kg/m2, first-degree relative with diabetes, previous GDM, ethnic origin with a high prevalence of diabetes, or a macrosomic baby (≥4.5 kg) | Accelerometer | Total sedentary time (h/d) was not associated with incident GDM (OR 1.00, 95% CI 1.00-1.01) Prolonged sedentary time was associated with higher fasting glucose concentrations regardless of GDM status [β 0.15, (0.01–0.30)] Television time was associated with the development of GDM (OR 3.03, 95% CI 1.21–7.96) The effect size for the association between television time and GDM was larger than the effect size for the association between total sedentary time and GDM |
Yong et al., 2020 [19] | Cohort study 452 women in 10–13 GW | Pregnancy Physical Activity Questionnaire (PPAQ) | Identification of two trajectories:
|
Zhang et al., 2006 [67] | Cohort study 21,765 women, age 24–44 years, ≥1 singleton pregnancy lasting ≥6 months | Self-reported | Watching television was associated with higher GDM risk after adjustments for age and time spent on other sedentary behaviors, total PA score, and dietary factors Women who spent ≥20 h/wk watching television but did not perform vigorous activity had a higher GDM risk than women who spent <2 h/wk watching television and were physically active (RR 2.30, 95% CI 1.06–4.97) |
6. Lifestyle Behaviors and GDM
Study | Study Design and Participants | Diet and PA Interventions | Main Outcomes |
---|---|---|---|
Bruno et al., 2016 [127] | Randomized controlled trial 191 pregnant women with BMI ≥ 25 kg/m2, age > 18 years, singleton pregnancy | Intervention group (I): healthy diet and physical activity counseling vs. Standard care group (SC): lifestyle advice on healthy nutrition and exercise. | GDM prevalence 18.8% (I) vs. 37.1% (SC group), p = 0.019 |
Ding et al., 2021 [128] | Randomized controlled trial 215 overweight/obese pregnant women | 3 face-to-face sessions about personalized dietary and exercise intervention vs. a general advice session about pregnancy nutrition and weight management | GDM prevalence 24.5% (intervention group) vs. 37.8% (control group), p < 0.05 |
Herring et al., 2016 [129] | Randomized controlled trial 66 socioeconomically disadvantaged African American pregnant women with gestational age < 20 weeks, BMI: 25–45 kg/m2 | Intervention group: 1. Empirically supported behavior change goals 2. Interactive self-monitoring text messages 3. Biweekly health coach calls 4. Skills training and support through Facebook. vs. Standard care group | GDM prevalence 4% (intervention group) vs. 4% (standard care), p = 1.00 |
Koivusalo et al., 2016 [130] | Randomized controlled trial 293 pregnant women aged ≥ 18 years, <20 gestational weeks, GDM history, pre-pregnancy BMI of ≥30 kg/m2 | Intervention group: individualized counseling on diet, physical activity, and weight control vs. Control group: standard antenatal care | GDM prevalence: 13.9% (intervention group) vs. 21.6% (control) (95% CI 0.40–0.98%, p = 0.044) after adjustment for age, pre-pregnancy BMI, previous GDM, and gestational week |
Korpi-Hyovalti et al., 2011 [131] | Randomized controlled trial 60 pregnant women at high risk for GDM | Counseling intervention: six one-to-one personalized diet advice sessions; six exercise encouragement sessions vs. Close follow-up: standard Care | GDM prevalence: 11.1% (intervention group) vs. 3.7% (close follow-up) |
Lin et al., 2020 [132] | Randomized controlled trial Pregnant women aged ≥18 years with at least one GDM risk factor: age ≥ 35 years, pre-pregnancy BMI ≥ 25 kg/m2, family history of diabetes, history of PCOS, or GDM | Intervention group: counseling on diet, physical activity, and weight control through one face-to-face education session and continuous educational messages via the WeChat public account twice per week vs. usual prenatal care | GDM prevalence: 14.4% (intervention group) vs. 24.6% control group (p = 0.03) |
Petrella et al., 2013 [133] | Randomized controlled trial 63 pregnant women from antenatal clinics with a pre-pregnancy BMI ≥ 25 kg/m2, aged over 18 years and single | Therapeutic lifestyle changes (TLC) group: 1700 or 1800 kcal/day for overweight and obese women, respectively, mild exercise (30 min/day, three times/week) vs. Control group: nutritional booklet standard care | GDM prevalence: 23.3% (TLC) vs. 57.1% (control group), p = 0.009 |
Phelan et al., 2011 [134] | Randomized controlled trial 401 women, >18 years old, 10–16 gestational weeks, BMI 19.8–40 kg/m2, non-smoking, fluent in English, access to a telephone, singleton pregnancy | Intervention group: diet and PA counseling: one face-to-face visit; weekly mailed materials promoting appropriate weight gain, healthy eating, and exercise vs. Standard care | GDM prevalence: Normal weight: 8.9% (intervention) vs. 6.5% (control) Overweight: 13.6% (intervention) vs. 8.1% (control) |
Sagedal et al., 2017 [135] | Randomized controlled trial 606 healthy, non-diabetic, nulliparous women, aged ≥ 18 years, BMI ≥ 19 kg/m2, singleton pregnancy, ≤20 gestational weeks | Norwegian Fit for Delivery (NFFD) intervention: dietary counseling twice by telephone and access to exercise groups twice/week vs. Control group: standard prenatal care | GDM prevalence: 12.9% (intervention) vs. 9.1% (control) (OR 1.33; 95% CI 0.77–2.32, p = 0.330) |
Renault et al., 2014 [136] | Randomized controlled trial 425 obese pregnant women, age ≥ 18 years, singleton pregnancy, normal scan in weeks 11–14, <16 gestational weeks, ability to read/speak Danish | PA group: encouragement to increase physical activity, monitored by pedometer on 7 consecutive days every 4 weeks. vs. PA + diet group: PA intervention and healthy diet instructions every 2 weeks vs. Control group (C): standard care, diet counseling session | GDM prevalence: 1.6% (PA) vs. 3.8% (PA + D) vs. 5.2% (C), p = non-significant |
Simmons et al., 2017 [137] | Randomized controlled trial 436 pregnant women, aged ≥ 18 years, <20 gestational weeks, pre-pregnancy BMI ≥ 29 kg/m2 | PA Group: promoting aerobic and resistance physical activity vs. HE Group: promoting healthy eating vs. PA + HE Group: Combination PA and HE vs. Control: Standard care | GDM prevalence: 21% (PA) vs. 25% (HE) vs. 20% (PA + HE) vs. 19% (C), p = non-significant |
Vesco et al., 2014 [138] | Randomized controlled trial 114 English-speaking, obese (BMI ≥ 30 kg/m2, age ≥ 18 years, prenatal care at Kaiser Permanente, Northwest (KPNW) | Intervention group: diet and PA counseling, provision of pedometers vs. Control: standard care, single dietary advice session | GDM prevalence: 11% (intervention) vs. 12% (control) (OR 0.87, 95% CI 0.28-2.78), p = non-significant |
7. Strengths and Limitations
8. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Taousani, E.; Papaioannou, K.-G.; Mintziori, G.; Grammatikopoulou, M.G.; Antonakou, A.; Tzitiridou-Chatzopoulou, M.; Veneti, S.; Goulis, D.G. Lifestyle Behaviors and Gestational Diabetes Mellitus: A Narrative Review. Endocrines 2025, 6, 6. https://doi.org/10.3390/endocrines6010006
Taousani E, Papaioannou K-G, Mintziori G, Grammatikopoulou MG, Antonakou A, Tzitiridou-Chatzopoulou M, Veneti S, Goulis DG. Lifestyle Behaviors and Gestational Diabetes Mellitus: A Narrative Review. Endocrines. 2025; 6(1):6. https://doi.org/10.3390/endocrines6010006
Chicago/Turabian StyleTaousani, Eleftheria, Konstantinos-Georgios Papaioannou, Gesthimani Mintziori, Maria G. Grammatikopoulou, Angeliki Antonakou, Maria Tzitiridou-Chatzopoulou, Stavroula Veneti, and Dimitrios G. Goulis. 2025. "Lifestyle Behaviors and Gestational Diabetes Mellitus: A Narrative Review" Endocrines 6, no. 1: 6. https://doi.org/10.3390/endocrines6010006
APA StyleTaousani, E., Papaioannou, K.-G., Mintziori, G., Grammatikopoulou, M. G., Antonakou, A., Tzitiridou-Chatzopoulou, M., Veneti, S., & Goulis, D. G. (2025). Lifestyle Behaviors and Gestational Diabetes Mellitus: A Narrative Review. Endocrines, 6(1), 6. https://doi.org/10.3390/endocrines6010006