Postpartum Dietary Interventions and Cardiometabolic Profiles After Pregnancies Complicated by Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis.

Abstract

Background: Gestational diabetes mellitus (GDM) confers substantial long-term cardiometabolic risk. The postpartum period represents a critical window for intervention, but the benefits of dietary interventions on cardiometabolic profiles in women with prior GDM remain unclear.

Purpose: To evaluate whether postpartum dietary interventions improved cardiometabolic profiles in women with GDM.

Data sources: Six databases were searched from 1 January 1980-31 December 2025.

Study selection: Twenty-one randomized controlled trials (RCTs) met inclusion criteria.

Data extraction: Data extraction and risk-of-bias assessment followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data synthesis: Meta-analyses pooled mean differences (MDs) with 95% CIs using a random-effects model. Intermediate cardiometabolic surrogate markers, such as BMI, waist circumference, weight, fasting and 2-h blood glucose, HOMA of insulin resistance (HOMA-IR), hemoglobin A1c (HbA1c), systolic and diastolic blood pressure, lipids, and inflammatory biomarkers were evaluated. The meta-analysis included 19 RCTs (participants were aged 18-45 years; sample size: 23 to 1,639; follow-up: 12 weeks-3 years). Compared with standard care, postnatal dietary interventions significantly reduced BMI (MD -0.46 kg/m2; 95% CI -0.71, -0.20), waist circumference (-1.47 cm; -2.39, -0.55), weight (-0.73 kg; -1.19, -0.27), HOMA-IR (-0.55; -1.04, -0.06), and HbA1c (-0.24%; -0.46, -0.02). No improvements were found for other markers.

Limitations: Heterogeneity across studies, variable adherence to counseling-based interventions, and comprehensive standard postpartum care may have limited observed effects.

Conclusions: Postpartum dietary interventions yield modest but statistically significant improvements in key cardiometabolic indicators among women with prior GDM without overt disease, highlighting the postpartum period as an important window to optimize intermediate cardiometabolic markers.