OBJECTIVES: We aimed to review the effect of lifestyle interventions in women with a history of gestational diabetes mellitus (GDM) based on the participants and intervention characteristics. METHODS: We systematically searched seven databases for RCTs of lifestyle interventions published up to 24 July 2024. We included 30 studies that reported the incidence of type 2 diabetes mellitus (T2DM) or body weight. A random effects model was used to calculate the relative risk and mean difference with a 95% confidence interval. Subgroup analyses were conducted for participants' characteristics (age, body mass index (BMI)) and intervention characteristics according to the Template for Intervention Description and Replication (TIDieR). RESULTS: A greater T2DM risk reduction was seen in trials that started within one year postpartum, in participants with a mean baseline BMI of 30 kg/m 2 or more, or based on behavioral change theory. For body weight reduction, studies on participants with a mean baseline BMI of 25 kg/m 2 or more or ones that included electronic/mobile delivery (text message, web, phone call) were more effective. CONCLUSIONS: Diabetes prevention trials in women with a history of GDM are more effective when commencing within one year postpartum, underpinned by behavior change theory, and in participants with overweight or obesity.

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