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Background Diet and exercise during pregnancy have been used to prevent gestational diabetes mellitus (GDM) with some success. Objective To examine the effectiveness of lifestyle intervention on GDM prevention and to identify key effectiveness moderators to improve the prevention strategy. Search strategy Pubmed, Scopus, Cochrane, and cross-references were searched. Selection criteria Randomised controlled trials (RCTs) evaluating lifestyle interventions during pregnancy for GDM prevention. Data collection and analysis Two independent reviewers extracted data. A random-effects model was used to analyse the relative risk (RR) and 95% confidence interval (95% CI). Meta-regressions and subgroup analyses were used to investigate important moderators of effectiveness. Main results Forty-seven RCTs involving 15 745 participants showed that diet and exercise during pregnancy were preventive of GDM (RR 0.77, 95% CI 0.69-0.87). Four key aspects were identified to improve the preventive effect: targeting the high-risk population; an early initiation of the intervention; the correct intensity and frequency of exercise; and gestational weight gain management. Although 24 RCTs targeted women who were overweight or obese, body mass index (BMI) failed to predict the effectiveness of an intervention. Instead, interventions are most effective in high-incidence populations rather than simply in women who are overweight or obese. Furthermore, exercise of moderate intensity for 50-60 minutes twice a week could lead to an approximately 24% reduction in GDM. Conclusion The best strategy to prevent GDM is to target the high-risk population predicted by risk evaluation models and to control the gestational weight gain of women through intensified diet and exercise modifications early in their pregnancy. Tweetable abstract Four key effectiveness moderators of lifestyle interventions for GDM prevention.

OBJECTIVE To assess the feasibility and effects of identifying tuberculosis (TB) cases by integrating TB screening into routine health examinations for the elderly in rural China. METHODS Three counties in Shandong Province were randomly selected for TB screening among three groups of elderly individuals (aged ⩾60 years) at high risk for TB: 1) those with symptoms of TB, 2) patients with type 2 diabetes mellitus (DM), and 3) close contacts of TB cases. Individuals with X-rays suggestive of TB were referred to the county TB dispensary for further investigation. RESULTS Among the 93 094 elderly residents who underwent health examinations, 9044 (9.7%) were identified as high risk for TB. TB detection rates were 0.87 per 1000 among those who showed TB symptoms only and 3.36/1000 among those with DM only; however, the rate was significantly higher (115/1000) among those who had both DM and TB symptoms. No TB cases were identified from the close contacts group. CONCLUSION Integrating TB screening into annual health examinations for the elderly in rural areas was effective in identifying new cases, especially among elderly DM patients with TB symptoms.