Open-label or unblinded (moderate): Open-label design

Gestational diabetes occurred in 10.0% of the intervention group compared to 24.4% of controls at 28 weeks gestation (p=0.02). After adjusting for confounders including age, baseline BMI, education, employment, and family history of diabetes, telephone-based education was associated with a significant 63% reduction in gestational diabetes risk (adjusted OR=0.37, 95% CI 0.15-0.88, p=0.025). This represents a strong preventive effect with clinical significance.

BMI increase from baseline to 28 weeks was significantly lower in the intervention group (0.6±1.1 kg/m²) compared to controls (1.3±1.4 kg/m², p=0.012). While statistically significant, the absolute difference is modest. Better weight management likely contributed to the reduced gestational diabetes risk through improved insulin sensitivity.

Self-reported adherence to recommended self-care behaviors was significantly higher in the intervention group across multiple domains: healthy diet adherence (75% vs 50%, p<0.001), regular physical activity (68% vs 45%, p<0.001), and blood glucose monitoring (63% vs 44%, p=0.02). The frequent telephone contact and personalized feedback likely enhanced motivation and sustained behavior change. However, reliance on self-report may overestimate actual adherence due to social desirability bias.

Structured telephone-based lifestyle education program delivered via seven 10-15 minute counseling sessions approximately every 10 days from enrollment (before 12 weeks gestation) through 28 weeks. Sessions conducted by trained midwives and nurses covered healthy nutrition emphasizing low-glycemic index foods and culturally adapted Iranian dietary patterns, safe physical activity including daily 30-minute walks and prenatal yoga, weight management strategies, and recognition of gestational diabetes warning signs. Content personalized to individual fitness levels and cultural preferences.

Positive: 3; Negative: 0; No effect: 0; Mixed: 0

Extracted 3 outcome signals across the study

The intervention showed consistent positive effects across all measured outcomes: 60% reduction in gestational diabetes incidence (primary outcome), improved weight management, and better adherence to all self-care behaviors. No negative effects or safety concerns were reported.

↓ Gestational diabetes incidence (10.0% vs 24.4%, 60% relative risk reduction)

↓ BMI increase during pregnancy (0.6 vs 1.3 kg/m²)

Telephone-based lifestyle education reduced gestational diabetes risk by 60% in high-risk pregnant women

The intervention was associated with better weight management during pregnancy

Women receiving telephone counseling had significantly better adherence to self-care behaviors including healthy eating (75% vs 50%), regular physical activity (68% vs 45%), and blood glucose monitoring (63% vs 44%)

Gorjian Z, Nabhani N, Zahedi A. Telephone-based lifestyle education to prevent gestational diabetes in high-risk Iranian women: a randomized trial. BMC Pregnancy Childbirth. 2026;26:340. doi:10.1186/s12884-026-08830-x

Participants and care providers were not blinded to treatment assignment, which could introduce bias

Adherence to self-care behaviors was self-reported, raising potential for reporting bias and overestimation of compliance

The intervention was culturally tailored to Iranian dietary patterns and may not generalize directly to other populations

Long-term maternal and neonatal outcomes beyond 28 weeks were not assessed

A 12-week telephone-based lifestyle education program reduced gestational diabetes risk by 60% in high-risk Iranian women compared to routine prenatal care, with additional benefits for weight management and self-care behaviors.

↑ Adherence to healthy diet, physical activity, and glucose monitoring

The ADA clinical practice guidelines recommend structured lifestyle interventions including medical nutrition therapy and physical activity counseling for pregnant women at high risk for gestational diabetes to prevent or delay onset.

American Diabetes Association Standards of Care in Diabetes—2025: Management of Diabetes in Pregnancy

The World Health Organization recognizes gestational diabetes as a major public health concern affecting maternal and child health worldwide, with prevalence particularly high in Middle Eastern populations. WHO emphasizes the importance of early screening and prevention strategies in high-risk women.

Gestational Diabetes Mellitus - WHO Fact Sheet

The American College of Obstetricians and Gynecologists recognizes telemedicine including telephone-based interventions as effective tools for prenatal care delivery, particularly valuable for reaching underserved populations and providing continuous support for behavior change.

Telemedicine in Maternal Health - ACOG Committee Opinion

Since its inception, AACE has advocated for the finest in endocrine education and state-of-the-art health-care delivery without regard to race, ethnicity, gender, age, country of origin, economic status, lifestyle, sexual orientation, or domestic living arrangements. AACE actively opposes the continued existence of endocrine healthcare disparities in the USA, and will devote its resources to diminish these disparities. AACE members, staff, partners, and others with whom AACE interacts will continually advocate for understanding, prevention, and elimination of endocrine health care disparities.

2012 Position Statement on Healthcare Disparities | American Association of Clinical Endocrinology

Arnett DK, Blumenthal RS, Albert MA et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. Circulation 2019:Cir0000000000000678

2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease | American Association of Clinical Endocrinology

This updated guideline provides recommendations for the care and management of people with or at risk for diabetes mellitus at every stage, including prevention, diagnosis, and treatment.

2022 Clinical Practice Guideline for Development of a Diabetes Mellitus Comprehensive Care Plan | American Association of Clinical Endocrinology

With the novel COVID-19 virus continuing to spread, it is crucial to adhere to the advice from experts and the Centers for Disease Control and Prevention (CDC) to help reduce risk of infection for individuals and the population at large. This is particularly important for people with adrenal insufficiency and people with uncontrolled Cushing’s Syndrome.

AACE Position Statement: Coronavirus (COVID-19) and People with Adrenal Insufficiency and Cushing’s Syndrome | American Association of Clinical Endocrinology

Dr. Hirsch is Professor of Medicine at the University of Washington School of Medicine.

Alan J Garber, MD, PhD, MACE, Lectureship for the Prevention and Management of the Complications of Diabetes | American Association of Clinical Endocrinology

Prophylactic administration of metformin reduces gestational diabetes mellitus incidence in the high-risk populations: a meta-analysis : Metformin for gestational diabetes prevention.

Effectiveness of a Multipronged Intervention to Reduce Gestational Diabetes Mellitus Incidence in High-Risk Pregnant Women in Puducherry: A Mixed Method Cluster Randomised Controlled Trial Protocol Behavioural Regulation, Individual Guidance, and Healthy Transformation for MOM.

Effects of mobile health management model on the prevention of gestational diabetes mellitus in pregnant women at risk of gestational diabetes: A randomized controlled trial.

The association of serum total bile acid levels with gestational diabetes mellitus: a systematic review and meta-analysis.

Efficacy of inositol supplementation in the prevention and treatment of gestational diabetes mellitus: A meta-analysis.

Includes self-reported outcomes (moderate): Self-reported outcomes used

Limited population scope (moderate): Narrow population scope

No post-intervention follow-up (moderate): 0 weeks of follow-up after treatment ended

Open-label or unblinded study (moderate): Open-label design

Telephone-based lifestyle education reduces gestational diabetes risk by 60% in high-risk Iranian women

This randomized trial tested structured telephone counseling on healthy eating, physical activity, and weight management in 170 high-risk pregnant women in Iran. Women receiving seven telephone education sessions over 12 weeks were 60% less likely to develop gestational diabetes compared to those receiving only routine prenatal care, and they also gained less weight during pregnancy.

This study was conducted in Iran where dietary patterns, healthcare access, and cultural factors differ from Western populations. The intervention was delivered in Persian and incorporated traditional Iranian foods into healthy eating recommendations. Results may not directly translate to other settings. The study relied on self-reported measures of adherence to diet and physical activity, which participants may have overestimated. Because participants knew their group assignment, placebo effects and reporting bias may have influenced results. The study did not follow participants after delivery to assess long-term outcomes for mothers or babies.

Telephone-based lifestyle education to prevent gestational diabetes in high-risk Iranian women

This intervention was tested in high-risk pregnant women in Iran with at least two major risk factors for gestational diabetes including high BMI (≥30 kg/m²), family history of diabetes, previous gestational diabetes, or previous delivery of a large baby. Participants were ages 18-35 and less than 12 weeks pregnant at enrollment.

Telephone-based lifestyle education reduces gestational diabetes risk by 60% in high-risk Iranian women

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