{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T14:44:15Z","timestamp":1791989055204,"version":"4.4.0"},"reference-count":68,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pregnancy"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Pregnant women with diabetes and their babies are at increased risk of adverse maternal and neonatal outcomes. Non\u2010pharmacological interventions, such as diabetes education, dietary and physical activity advice, and weight management, may improve pregnancy and infant outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic review with meta\u2010analysis of randomized controlled trials (RCTs) that evaluate antenatal diabetes\u2010specific education, dietary interventions, physical activity interventions, and weight management programs in pregnant women with type 1, type 2, or gestational diabetes mellitus (T1DM, T2DM, GDM). We extracted data for outcomes prioritized for development of all World Health Organization (WHO) guidelines on maternal and perinatal health, as well as intervention\u2010specific outcomes. The selected critical outcomes were maternal death, maternal functioning and well\u2010being, stillbirth\/fetal death, neonatal death, and perinatal death. We followed standard Cochrane methods. We assessed the trustworthiness of included trials using the Research Integrity Assessment (RIA) tool, methodological limitations using Cochrane Risk of Bias 2 tool (RoB2), and the certainty of the evidence with Grading of Recommendations Assessment, Development and Evaluation (GRADE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 78 relevant trials for inclusion, of which 44 reported on prioritized outcomes and were included in the analysis. Most trials only included women with GDM. Education compared to usual care (8 RCTs, 778 pregnant women with diabetes) may result in a reduction in the risk of caesarean birth, hyperbilirubinemia, and preterm birth; however, there was no difference in quality of life, satisfaction, maternal weight change, gestational age at birth, and low birth weight babies. Dietary advice compared to usual care (12 RCTs, 839 pregnant women with diabetes) may result in little to no difference in gestational weight change, risk of caesarean birth, birthweight, gestational age at birth, and small\u2010for\u2010gestational age babies. Physical activity compared to usual care (12 RCTs, 1064 pregnant women with GDM) likely results in little to no difference in gestational weight change and birth weight and may also result in little to no difference in the need for instrumental vaginal delivery, gestational age at birth, and risk of preterm birth. Similarly, comparisons between different dietary approaches (13 RCTs) and between different physical activity modalities (7 RCTs) generally showed little superiority of one approach over another. We do not know about the effect of weight management compared to usual care on pregnancy outcomes because the certainty of the evidence was very low for all outcomes. We rated most outcomes as low or very low certainty, which means that the true effects of the interventions may differ substantially from the estimates of effect, and new evidence is likely to change our confidence in the estimates of effect. The main reasons for downgrading the certainty of the evidence were risk of bias and imprecision.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The results from this systematic review suggest that antenatal diabetes education, diet and physical activity advice, and weight management may only lead to a modest benefit on maternal and neonatal outcomes. However, for most comparisons and outcomes the evidence is limited, and the certainty of the evidence is low or very low. High\u2010quality RCTs are needed to better understand the effects of these interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO Registration<\/jats:title>\n                    <jats:p>CRD42025630036<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pmf2.70218","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T16:51:40Z","timestamp":1772988700000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Maternal care interventions for pregnant women with diabetes: A systematic review of antenatal education, diet, physical activity, and weight management"],"prefix":"10.1002","volume":"2","author":[{"given":"Gemma","family":"Villanueva","sequence":"first","affiliation":[{"name":"Cochrane Response The Cochrane Collaboration  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Buckley","sequence":"additional","affiliation":[{"name":"Cochrane Response The Cochrane Collaboration  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrin","family":"Probyn","sequence":"additional","affiliation":[{"name":"Cochrane Response The Cochrane Collaboration  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Petkovic","sequence":"additional","affiliation":[{"name":"Cochrane Response The Cochrane Collaboration  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"McIntosh","sequence":"additional","affiliation":[{"name":"Cochrane Response The Cochrane Collaboration  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferruccio","family":"Pelone","sequence":"additional","affiliation":[{"name":"Cochrane Response The Cochrane Collaboration  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatema","family":"Kazi","sequence":"additional","affiliation":[{"name":"Cochrane Response The Cochrane Collaboration  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan","family":"Sebastianski","sequence":"additional","affiliation":[{"name":"Cochrane Response The Cochrane Collaboration  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Bergman","sequence":"additional","affiliation":[{"name":"Cochrane Response The Cochrane Collaboration  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanina","family":"Sguassero","sequence":"additional","affiliation":[{"name":"Cochrane Response The Cochrane Collaboration  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elise","family":"Cogo","sequence":"additional","affiliation":[{"name":"Cochrane Response The Cochrane Collaboration  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Henschke","sequence":"additional","affiliation":[{"name":"Cochrane Response The Cochrane Collaboration  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,6]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"IDF Diabetes Atlas 2021","author":"International Diabetes Federation (IDF)","year":"2021"},{"issue":"1","key":"e_1_2_10_3_1","first-page":"S27","article-title":"2. 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