Effects of lifestyle education interventions on quality of life and fbg in women with gestational diabetes: a systematic review and meta-analysis

INTRODUCTION: Gestational diabetes mellitus (GDM) is a prevalent condition with significant maternal and fetal health implications. Lifestyle education is a promising non-pharmacological intervention to improve quality of life (QoL) and FBG (FBG) in affected women. For the purposes of this review, lifestyle education interventions are defined as structured programs including dietary counseling, physical activity guidance, and/or self-management education (e.g., blood glucose monitoring), delivered through planned sessions with defined frequency, duration, and content. This systematic review and meta-analysis evaluates its efficacy. METHODS: A comprehensive search of PubMed, Embase, Cochrane CENTRAL, Scopus, and Web of Science was conducted up to October 2025, following PRISMA guidelines. Studies were included if they involved women with GDM, evaluated lifestyle education (structured, curriculum-based programs with multiple sessions, specified learning objectives, and follow-up components), and reported QoL or FBG outcomes. Randomized controlled trials and quasi-experimental studies with comparators were eligible. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane tool. Meta-analyses used a random effects model, with heterogeneity assessed via I² statistics. Subgroup analyses explored intervention types, and publication bias was evaluated using Egger's and Begg's tests. RESULTS: From 304 records identified, 20 studies (19 randomized controlled trials and 1 quasi-experimental study) involving 4,777 women were included. Overall meta-analysis demonstrated a statistically significant effect of lifestyle interventions on quality of life and fasting blood glucose (FBG) outcomes (Hedges' g = - 0.31, 95% CI: -0.57 to - 0.05, p = 0.02), although substantial heterogeneity was observed (I² = 91.94%). For FBG outcomes, the overall pooled effect estimate was - 4.01 mg/dL (95% CI: -8.13 to 0.10), with high heterogeneity (I² = 97.42%). Subgroup analyses showed that combined individual and group-based interventions significantly reduced FBG levels (pooled effect estimate = - 2.60 mg/dL, 95% CI: -4.90 to - 0.31; I² = 0%), whereas individual-only and group-only interventions were not statistically significant. For quality of life outcomes, the overall pooled effect was not statistically significant (pooled effect estimate = 3.42, 95% CI: -0.55 to 7.39; I² = 91.28%). Exploratory subgroup analyses indicated that combined interventions significantly improved quality of life (pooled effect estimate = 5.20, 95% CI: 3.76 to 6.64; I² = 0%), while standalone individual and group interventions showed no statistically significant effects. Egger's (p = 0.12) and Begg's (p = 0.19) tests suggested no significant publication bias. Sensitivity analyses confirmed the robustness of the findings. CONCLUSION: Lifestyle education interventions effectively reduce FBG in women with GDM, with group and combined interventions showing most consistent benefits. However, the impact on QoL remains uncertain; while combined individual and group approaches showed some promise in exploratory subgroup analyses, the overall pooled effect on QoL was non-significant with substantial heterogeneity. These subgroup findings should be considered hypothesis-generating rather than definitive. Tailored, scalable interventions integrating individual and group components may optimize GDM management, but further high-quality research is needed to confirm efficacy for QoL improvement.