A need for more research on how lifestyle interventions could help high-risk pregnant populations

The prevalence of chronic hypertension (CH) and type 1 diabetes (DM) or type 2 diabetes (T2DM) has increased significantly in the pregnant population over recent decades. In particular, its incidence continues to rise due to increasing obesity rates and increasing maternal age. Obesity is an important risk factor affecting CH or DM/T2DM.

Study: Evidence for Lifestyle Interventions in Pregnant Populations with Chronic Hypertension and/or Pre-existing Diabetes: A Systematic Review and Synthesis of Narratives. Image credit: Kzenon / Shutterstock


Compared with the general population, women with chronic CH are at increased risk of developing severe pre-eclampsia and experiencing adverse neonatal outcomes. Women with a history of diabetes have almost four times the risk of fetal death and obstetric and neonatal complications compared to the general population. Women with CH and/or pre-existing diabetes are prone to developing cardiovascular disease (CVD). Therefore, examining these groups during pregnancy is essential to reduce short- and long-term risks.

Weight control is highly effective in managing CH and diabetes. Although weight loss during pregnancy is not recommended, avoiding excessive gestational weight gain (GWG) is essential as it increases the likelihood of adverse pregnancy outcomes. Lifestyle interventions have been observed to improve quality of life in nonpregnant hypertensive populations. For example, significant reductions in systolic blood pressure were seen after implementing a healthy diet.

Although it is established that pregnant women should seek to avoid elevated blood pressure, the impact of lifestyle interventions on blood pressure in pregnant women with pre-existing diabetes or CH is unclear.

Pregnancy is usually perceived as a “teaching moment” that keeps most women motivated to adopt practices that reduce the risks associated with pregnancy outcomes. A meta-analysis of 12,526 women found that proper diet and physical activity reduced her GWG. However, this study failed to provide conclusive evidence as to whether these interventions improve maternal and fetal outcomes. Furthermore, there are few studies on the effect of weight change on blood pressure levels in pregnant women.

Recently, scientists reviewed the effects of lifestyle interventions in pregnant women with CH and/or pre-existing DM and T2DM.The authors also highlighted the evidence associated with the effects of lifestyle interventions on blood pressure and gestational weight in this group.This review is available in the journal Gestational Hypertension: International Journal of Cardiovascular Health in Women.

About research

In this study, data on randomized controlled trials (RCTs) involving pregnant women with CH and/or pre-existing DM/T2DM were obtained from Embase, CINHAL, PsycINFO, Medline, and Web of Science.

Studies related to lifestyle interventions practiced during the antenatal period were included in this study. In addition, we analyzed dietary patterns, gestational weight, and physical activity in pregnant women with CH and/or pre-existing DM and T2DM. Importantly, whenever possible, we investigated fetal, maternal, and neonatal outcomes of focus group lifestyle interventions.

Investigation result

A total of 1,464 articles were screened for eligibility for study inclusion, of which 7 were standard RCTs and 2 were cluster RCTs. These studies were conducted in Australia, the United Kingdom, Brazil, and his nine European countries. The nine included studies comprised a total of 7,438 pregnant women who were diagnosed with CH and/or had pre-existing her DM/T2DM.

Of the nine studies, eight were found to be at low risk of bias and one was at unclear risk. The current review found that most studies have focused on interventions to support lifestyle changes during pregnancy.However, no studies have evaluated its effects on pregnant women with CH was. In one study that analyzed women with pre-existing diabetes, the cohort included a mixed population: pregnant and non-pregnant women with diabetes. Therefore, it lacked information focused solely on pregnant women.

Interestingly, we observed that most trials excluded pregnant women with chronic diseases. However, subgroup analysis cannot be performed for some trials that include this group. Data on weight changes during pregnancy were readily found, but similar frequency data on blood pressure changes in this group were not found.


The authors claim that this study is the first to systematically review the effects of lifestyle interventions in a pregnant population with CH or pre-existing diabetes. The authors successfully identified existing research gaps for researchers to consider in the future. Another strength of this review is its methodology, which includes double screening and data extraction based on discrepancy arguments to increase reliability.

Due to insufficient data on eligibility criteria in many studies, the authors made some assumptions. For example, many times the authors did not clarify whether certain pregnant women with preexisting diabetes also suffer from CH.

The current study has gathered information and helped to develop a guide that will serve as a foundation for future research. and lack of data.

Journal reference:

  • Goddard, L. et al. (2023) Evidence for lifestyle interventions in a pregnant population with chronic hypertension and/or pre-existing diabetes: a systematic review and narrative synthesis. Gestational Hypertension: International Journal of Cardiovascular Health in Women32, pp.60–72, https://www.sciencedirect.com/science/article/pii/S2210778922001337

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