Optimizing maternal and neonatal outcomes in gestational diabetes mellitus (GDM) remains a major clinical challenge as GDM prevalence continues to increase globally. A meta-analysis published in Diabetology evaluated the effects of pharmacologic, nutritional, and physical activity interventions on metabolic control, pregnancy outcomes, and neonatal complications in women with GDM.

The analysis included 17 studies selected from 204 screened records. Outcomes assessed included glycemic parameters, gestational weight gain, blood pressure, lipid profiles, cesarean delivery, preeclampsia, neonatal hypoglycemia, birth outcomes, and neonatal intensive care unit (NICU) admission. Study quality was assessed using the Cochrane Risk of Bias tool, and pooled analyses were performed using random-effects models.

Findings

• Pharmacologic, nutritional, and physical activity interventions significantly reduced gestational weight gain and cesarean delivery rates in women with GDM.
• No statistically significant pooled effects were observed for fasting blood glucose, 2-hour postprandial glucose, HbA1c, lipid profiles, or blood pressure outcomes.
• Preeclampsia, neonatal hypoglycemia, neonatal complications, and NICU admission showed nonsignificant trends toward benefit.
• No meaningful effects were observed for gestational age at delivery, neonatal birth weight, preterm birth, Apgar score at 5 minutes, or macrosomia.
• Substantial heterogeneity was observed across several metabolic outcomes, limiting interpretation of pooled estimates.

Combined nutritional, physical activity, and pharmacologic interventions improved selected maternal outcomes in GDM, particularly gestational weight gain and cesarean delivery rates. However, inconsistent metabolic findings and substantial heterogeneity highlight the need for more individualized and multimodal management approaches.