Aims: This systematic review examines the association between maternal lifestyle, diet and physical activity, and epigenetic changes in the offspring. Methods: A literature search was conducted using multiple science databases: PubMed, Embase and Cochrane Library, on 10 March 2021. RCT and Cohort studies in English or Scandinavian languages were included. Exposure variables included diet, lifestyle, meal patterns or physical activity. Studies using dietary supplements as exposure variables were excluded. Outcome variables included were DNA methylation, microRNA or histone changes in placenta, cord blood or offspring. Two independent authors screened, read and extracted data from the included papers. The Cochrane risk-of-bias tool for randomized trials (RoB2) and The Critical Appraisal Skills Program (CASP) Cohort Study Checklist were used to assess risk of bias in the included studies. A qualitative approach was employed due to heterogeneity of exposures and results of the studies. Results: 16 studies and 3617 participants were included in the final analysis. The exposure variables included physical activity, carbohydrate, low glycemic index diet, added sugar, fat, Mediterranean diet and pro-inflammatory diet. The outcome variables identified were differences in DNA methylation and microRNA. Most studies described epigenetic changes in either placenta or cord blood. Genes reported to be methylated were GR, HSD2, IGF-2, PLAG1, MEG-3, H19 and RXRA. However, not all studies found epigenetic changes strong enough to pass multiple testing, and the study quality varied. Conclusion: Despite the variable quality of the included studies, the results in this review suggest that there may be an association between the mother’s lifestyle, diet and level of physical activity during pregnancy and epigenetic changes in the offspring.

Research on gestational diabetes mellitus has mainly focused on glucose metabolism, but improving glycemic control has not eliminated the complication rate

We evaluated the fidelity of the Face-it intervention and its impact on behaviour change mechanisms among women with recent gestational diabetes mellitus (GDM). In this randomised controlled trial, 277 women were allocated to usual care or an intervention comprising three home visits, digital platform health coaching and cross-sectoral communication to support health behaviour change during the first year after delivery. Behaviour change mechanisms included social support, motivation, self-efficacy, risk perception and health literacy. High fidelity was defined as completing three home visits and ≥ 9 coaching contacts. Within the intervention group, 86.4 % completed ≥ 2 home visits, 88.6 % registered digitally with a median (IQR) of 10.0 (3.0-20.0) contacts. At one-year after delivery, the high-fidelity group (n = 73; 39.7 %) had higher odds of perceiving moderate/high diabetes risk (OR 2.42; 95 % CI 1.06-5.51) and higher health literacy (adjusted difference 0.20; 95 % CI 0.04-0.35), whereas no difference was found for social support, motivation and self-efficacy compared with usual care. No difference was observed between the low fidelity and the usual care group in behaviour change mechanisms. The Face-it intervention achieved acceptable fidelity. High fidelity appears essential for improving risk perception, health literacy and supporting behaviour change mechanisms among women with recent GDM.