Ethnic differences in the effects of lifestyle interventions on adverse pregnancy outcomes among women with gestational diabetes mellitus: A systematic review and meta-analysis

Lifestyle interventions are widely used among women with gestational diabetes mellitus (GDM). This study aimed to assess the ethnic disparities in the effectiveness of lifestyle interventions on reducing adverse pregnancy outcomes, particularly macrosomia and neonatal hypoglycemia among women with GDM. We systematically searched the PubMed/MEDLINE, Web of Science, and Cochrane Library databases from January 1, 2000, up to March 31, 2024, to identify randomized controlled trials (RCTs) examining the effects of lifestyle interventions in GDM patients. Subgroup analysis was performed to investigate heterogeneity across different ethnic groups (including Asians, Whites/Caucasians, Hispanics/ Latinos, and Unknown ethnicity). The random effects model was used to calculate the relative risk (RR) and 95% confidence interval (CI). After applying inclusion and exclusion criteria, twenty-one studies comprising 4567 participants were included. Lifestyle interventions significantly reduced the incidence of macrosomia ((RR = 0.54; 95 % CI: 0.42–0.70, P < 0.001), with consistent effects observed across racial groups. Conversely, lifestyle interventions were associated with a significant reduction in the risk of neonatal hypoglycemia only among Asians (RR = 0.56; 95 % CI: 0.38–0.84, P = 0.004), while no significant effects were observed in Whites/Caucasians or Hispanics/Latinos (all P > 0.05). Sensitivity analyses confirmed the robustness of the findings. Regardless of ethnic background, this study emphasizes the significant benefits of lifestyle interventions in reducing the risk of macrosomia among women with GDM. However, lifestyle interventions seem to reduce the risk of neonatal hypoglycemia only among Asians, which warrants further studies.