Key Components of Prenatal Nutrition Education Interventions to Prevent Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis.

Objective: To investigate the association between key components of prenatal nutrition education interventions and the prevention of GDM in pregnant women. Methods: We systematically searched PubMed, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials from database inception to 18 January 2026, using search terms including "gestational diabetes mellitus," "glycemic control," "pregnancy," and "nutrition interventions"; only English-language publications were eligible. Eligible studies were randomized controlled trials (RCTs) assessing prenatal nutrition education interventions and reporting gestational diabetes mellitus (GDM) incidence. Of the initial 4961 retrieved records, 29 RCTs fulfilled the selection criteria. In accordance with PRISMA guidelines, two reviewers independently performed data extraction and risk-of-bias assessment using the Cochrane RoB 2.0 tool. Given expected clinical heterogeneity, pooled risk ratios (RRs) were synthesized via a random-effects model. The primary outcome was GDM incidence, expressed as a pooled RR comparing nutrition education intervention groups with control groups. Results: A total of 29 RCTs comprising 17,937 pregnant women were included. The pooled analysis showed that prenatal nutrition education interventions were associated with a statistically significant reduction in GDM risk (pooled RR, 0.88 [95% CI, 0.79-0.98]; p = 0.02). In absolute terms, the GDM incidence was 16.01% in the intervention group vs. 17.06% in the control group. Moderate between-study heterogeneity was observed (I2 = 51.1%; p for heterogeneity < 0.001), largely driven by variations in dietary protocols and intervention fidelity. Conclusions: In this meta-analysis of 29 RCTs, prenatal nutrition education was associated with a significantly lower GDM risk. Interventions grounded in nutritional theory, delivered in hospital settings, and achieving high fidelity were associated with the largest reductions in risk; delivery by healthcare professionals, high individualization, and balanced dietary content showed favorable but statistically nonsignificant trends. These findings support the systematic adoption of these core components in routine antenatal care to mitigate the GDM burden.