Impact of Lifestyle Interventions Delivered in Primary Care on Gestational Diabetes Prevention among High-Risk Women in Saudi Arabia: A Systematic Review

Abstract

Background
Gestational diabetes mellitus (GDM) is one of the most common and clinically consequential metabolic disorders of pregnancy, disproportionately affecting women in the Middle East, including Saudi Arabia, where rapid urbanization, rising obesity rates, and increasingly sedentary lifestyles have created conditions highly conducive to the development of glucose intolerance during pregnancy. Lifestyle interventions
encompassing dietary modification, physical activity promotion, weight management, and behavioral counseling have been proposed as safe, cost-effective, and sustainable preventive strategies, and primary care settings represent an optimal platform for their systematic delivery to high-risk women. However, the effectiveness of primary care-based lifestyle interventions for GDM prevention in the Saudi Arabian context has not been comprehensively synthesized.
Objective
To systematically review and critically evaluate the available evidence regarding the effectiveness of lifestyle interventions delivered in primary care settings for preventing gestational diabetes mellitus among high-risk women, with particular reference to the Saudi Arabian healthcare context.
Methods
A systematic search of PubMed/MEDLINE, Scopus, Embase, the Cochrane Library, Web of Science, CINAHL, and Google Scholar was performed from database inception to December 2025, following PRISMA 2020 guidelines. Randomized controlled trials, quasi-experimental studies, cohort studies, and systematic reviews evaluating lifestyle interventions — including dietary counseling, physical activity programs, weight management, and behavioral modification — for GDM prevention among high-risk pregnant women, with studies conducted in Saudi Arabia or providing evidence applicable to the Saudi primary care context, were eligible for inclusion. Data on intervention type, GDM incidence, maternal and neonatal outcomes, adherence, and knowledge-related outcomes were extracted and synthesized narratively and in tabular form.
Results
Thirteen studies met the inclusion criteria, comprising five systematic reviews or meta-analyses, four randomized controlled trials or interventional studies, two epidemiological or knowledge assessment studies conducted in Saudi Arabia, one prospective cohort study from Saudi Arabia, and one large-scale individual participant data network meta-analysis, collectively encompassing hundreds of thousands of women across multiple healthcare settings internationally, including Saudi Arabia. Combined dietary and physical activity interventions demonstrated the most consistent GDM risk reduction, with relative risks ranging from 0.71 to 0.79 across meta-analytic estimates. The largest network meta-analysis (136 RCTs, 67,982 women) confirmed that combined lifestyle interventions reduced GDM risk by 29% (RR 0.71; 95% CI 0.61–0.82). GDM prevalence in Saudi Arabia was documented at 23.7% in a major Riyadh cohort. Significant knowledge gaps regarding GDM prevention among Saudi women attending primary care were consistently identified.
Conclusion
Lifestyle interventions — particularly combined dietary counseling and physical activity programs — delivered in primary care settings consistently reduce the incidence of gestational diabetes among high-risk women, with the strongest evidence supporting early implementation before 20 weeks of gestation. The high GDM prevalence documented in Saudi Arabia, combined with identified knowledge gaps and limited synthesized Saudi-specific evidence, underscores the urgent need for structured, culturally adapted lifestyle intervention programs integrated into Saudi primary healthcare antenatal services. Future prospective trials conducted specifically within Saudi primary care are needed to confirm these findings in the local contextKeywords: affective filter hypothesis; oral English performance; primary ESL learners; psychological factors; speaking anxiety