Exercise and its role in gestational diabetes mellitus

Glucose metabolism in gestational diabetes and their relationship with fat mass / muscle mass index

Introduction

During pregnancy, women experience metabolic changes that may induce insulin resistance, which can be traced to the blood glucose levels A number of factors may intervene in the metabolism of glucose in pregnant women; one of them is body composition. This factor is useful for studying metabolic diseases, for which the identification of the fat mass/muscle mass index (FMMMI) considered an especially relevant factor. Owing to their nature, techniques such as bioimpedance have been sparsely used for analysis during pregnancy.

Aim

This study aimed to identify the relationship between fat mass / muscle mass index and glucose metabolism in pregnant women.

Methods

This descriptive cross-sectional study included 231 women between the ages of 18 and 35 years and 24-28 weeks of gestation, who attended a state hospital for regular check-ups and exhibited risk factors for the development of gestational diabetes (GD) according to the Current Practice Guidelines in Primary Care. The participants underwent a physical examination, anthropometric measurements bio impedance were obtained, and oral glucose tolerance curves were constructed. FMMMI was calculated.

Results

The prevalence of gestational diabetes was observed to be 13.4%. Women with a GD diagnosis had a significantly higher FMMMI than in those with no GD (0.746 ± 0.168 vs 0.567 ± 0.167;p < 0.005). The assessment of the FMMMI tertiles revealed that GD prevalence was higher in tertile 3 than in tertiles 1 and 2 (tertile 1: 2.6%; tertile 2: 9.1%; tertile 3: 24%).

Conclusion

FMMMI is associated with glucose tolerance test response in pregnant women and a higher prevalence of GD.

Comparison of home exercise under supervision and self home exercise in pregnant women with gestational diabetes: randomized controlled trial

OBJECTIVE

Exercise programs at home are successful in treating gestational diabetes by controlling blood glucose. The aim is to compare the efficacy of the self-directed home exercise program, the standard care alone and the supervised home exercise program in pregnant women with gestational diabetes on blood glucose, quality of life and pregnancy outcomes.

METHODS

This randomized, parallel, single-blind study included 45 pregnant women who were 24-28 weeks of gestation. Participants were randomly divided into the supervised home exercise group (SHEG), home exercise group (HEG) and control group (CG). While the home exercises program was taught and controlled by a physiotherapist in SHEG, the home exercise brochure was given without any training by the gynecologist in HEG. Control group maintained their usual daily care. The home exercise intervention included low to moderate structured exercise performed three days per week for 8 weeks. Their glucose responses, quality of life and pregnancy outcomes were assessed pre- and post intervention.

RESULTS

Fasting glucose and 2 h postprandial glucose levels were improved statistically in SHEG and HEG groups after intervention (p < 0.05). Differences in SHEG were statistically higher than HEG (p < 0.017). When the HEG and CG were compared, there was no superiority between the two groups in all outcome measures except the physical health. Additionally, there were no statistically significant differences in values of cesarean birth and preterm birth between groups (p > 0.05).

CONCLUSIONS

This study revealed that pregnant women should be under the supervision of physiotherapists while doing home exercises. Clinical Trial Registration The trial was approved by the registration of ClinicalTrials.gov and registration number: NCT05195333.

Effects of Exercise Intervention Based on Self-efficacy Theory on Pregnant Women with Gestational Diabetes Mellitus

BACKGROUND

During pregnancy, gestational diabetes mellitus (GDM)is a common complication. Although some exercise programs have been recommended clinically, many pregnant women have low exercise compliance, making it difficult to effectively control blood sugar. Therefore, this study constructed an exercise intervention plan based on self-efficacy theory and explored the effect of the program on blood glucose and pregnancy outcomes in patients with gestational diabetes mellitus.

METHODS

A randomized controlled trial was conducted. A usual exercise program was implemented for the participants in the control group, and the participants in the intervention group received an exercise program on the basis of the control group and combined with the self-efficacy theory. Participants were assessed based on exercise self-efficacy, blood glucose, weight gain, exercise compliance, and pregnancy outcomes at week 4, week 8 and week 12.

RESULTS

One hundred three gestational diabetes mellitus patients were recruited at baseline, 53 in the intervention group and 50 in the control group. After the intervention, the exercise self-efficacy score and exercise compliance of the intervention group were higher than those of the control group (P<0.05). Fasting blood glucose, 2-h post-prandial plasma glucose, weight gain during the intervention period, incidence of neonatal hypoglycemia, and incidence of gestational hypertension were lower than those in the control group (P<0.05).

CONCLUSION

Implementing an exercise intervention based on self-efficacy theory for gestational diabetes mellitus patients can improve exercise self-efficacy and exercise compliance, effectively control blood glucose and weight gain, improve pregnancy outcomes, and promote maternal and infant safety.

Resistance Training as a Countermeasure in Women with Gestational Diabetes Mellitus: A Review of Current Literature and Future Directions

Gestational diabetes mellitus (GDM) poses a significant health concern for both mother and offspring. Exercise has emerged as a cornerstone of glycemic management in GDM. However, most research regarding this topic examines aerobic training (AT), despite substantial evidence for the effectiveness of resistance training (RT) in improving dysregulated glucose in other groups of people with diabetes, such as in type 2 diabetes mellitus (T2DM). Thus, the purpose of this paper is to review research that examined the impact of RT on markers of glucose management in GDM, and to discuss future research directions to determine the benefits of RT in GDM. Based on the current evidence, RT is effective in reducing insulin requirement, especially in overweight women, reducing fasting glucose concentrations, and improving short-term postprandial glycemic control. However, the number of studies and findings limit conclusions about the impact of RT on risk of GDM, fasting insulin concentrations, insulin resistance, β-cell function, and intra-exercise glucose management. Overall, current evidence is accumulating to suggest that RT is a promising non-pharmacological tool to regulate circulating glucose concentrations in women with GDM, and a potential alternative or supplement to AT.

Community-based non-pharmacological interventions for pregnant women with gestational diabetes mellitus: a systematic review

BACKGROUND

Non-pharmacological interventions are the first line of Gestational diabetes mellitus (GDM) management. Community-based interventions are cheaper, more accessible, with higher patient satisfaction.

OBJECTIVES

To systematically review community-based non-pharmacological interventions and evaluate their effectiveness for GDM.

SEARCH STRATEGY

Twelve bibliographic databases and reference list of related studies from inception until January 2022.

SELECTION CRITERIA

All primary studies of community-based non-pharmacological interventions for GDM reported in English which investigated any behavioural or clinical outcome(s).

DATA COLLECTION AND ANALYSIS

Data were extracted using modified Cochrane's data extraction template. Studies were evaluated using Cochrane Collaboration's risk of bias tool. Narrative synthesis was used to summarise findings. This study is registered with PROSPERO (CRD42021257634).

MAIN RESULTS

Twenty-seven studies involving 6,242 pregnant women with GDM investigated self-management programmes, medical nutrition/diet therapy, exercise/physical activity, combined diet and exercise, calcium plus vitamin D supplementation, and continuous glucose monitoring. Self-management programmes were more effective than routine care in improving self-efficacy, two-hour postprandial blood glucose, and lifestyle behaviours but were as effective as routine care in improving infant birth weight. Self-management programmes were superior to or as effective as usual care in improving fasting blood glucose, blood glucose control, glycated haemoglobin, macrosomia, and preterm delivery. Medical nutrition/diet therapy was more effective than usual care in improving postprandial blood glucose levels. Postprandial blood glucose levels were better improved by regular supervised exercise plus daily brisk walks or a daily walking intervention than routine obstetric care or no treatment. The effects of exercise/physical activity programmes were mostly inconsistent for other outcomes. Diet and exercise were superior to diet alone in reducing maternal weight gain although there were similar outcomes for other pregnancy and foetal outcomes. Limited or conflicting evidence was found for other outcomes and interventions including calcium and vitamin D supplementation and continuous glucose monitoring intervention.

CONCLUSIONS

Community-based non-pharmacological interventions are more effective than placebo; and are more or as effective as usual care. Self-management programmes and medical nutrition/diet therapy had the most promising GDM outcomes.

FUNDING

There was no funding for this study. The study design, data collection, data analysis and interpretation, and writing of this manuscript were not influenced externally by any funder.

The Effect of Online Supervised Exercise throughout Pregnancy on the Prevention of Gestational Diabetes in Healthy Pregnant Women during COVID-19 Pandemic: A Randomized Clinical Trial

(1) Background: to examine the effect of an online supervised exercise program during pregnancy on the prevention of GDM, and on maternal and childbirth outcomes. (2) Methods: we conducted a randomized clinical trial (NCT04563065) in 260 pregnant women without obstetric contraindications who were randomized into two study groups: intervention group (IG, N = 130) or control group (CG, N = 130). An online supervised exercise program was conducted from 8-10 to 38-39 weeks of pregnancy. (3) Results: no significant differences were found at baseline in maternal characteristics; nevertheless, certain outcomes showed a favorable trend towards the IG. A lower number and percentage of GDM cases were found in the IG compared to the CG (N = 5/4.9% vs. N = 17/16.8%, p = 0.006). Similarly, fewer cases of excessive maternal weight gain (N = 12/11.8% vs. N = 31/30.7%, p = 0.001) were found in the IG, and a lower percentage of instrumental deliveries (N = 8/11.3% vs. N = 13/15.1%) and c-sections (N = 7/9.9% vs. N = 20/23.3%, p = 0.046). (4) Conclusions: an online supervised exercise program can be a preventative tool for GDM in healthy pregnant women.

Inositol Nutritional Supplementation for the Prevention of Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

This study was aimed at assessing the efficacy and safety of inositol nutritional supplementation during pregnancy for the prevention of GDM. PubMed, Embase, MEDLINE, and Cochrane library were systematically searched for randomized controlled trails (RCTs) in this field until May 2022. Primary outcomes were the incidence for GDM and plasma glucose levels by oral glucose tolerance test (OGTT). Pooled results were expressed as relative risk (RR) or mean difference (MD) with a 95% confidence interval (95% CI). Seven RCTs with 1321 participants were included in this study. Compared with the control group, 4 g myo-inositol (MI) supplementation per day significantly decreased the incidence of GDM (RR = 0.30, 95% CI (0.18, 0.49), p < 0.00001). It significantly decreased the plasma glucose levels of OGTT regarding fasting-glucose OGTT (MD = −4.20, 95% CI (−5.87, −2.54), p < 0.00001), 1-h OGTT (MD = −8.75, 95% CI (−12.42, −5.08), p < 0.00001), and 2-h OGTT (MD = −8.59, 95% CI (−11.81, −5.83), p < 0.00001). It also decreased the need of insulin treatment, and reduced the incidence of preterm delivery and neonatal hypoglycemia. However, no difference was observed between 1.1 g MI per day plus 27.6 mg D-chiro-inositol (DCI) per day and the control group regarding all evaluated results. In conclusion, 4 g MI nutritional supplementation per day during early pregnancy may reduce GDM incidence and severity, therefore may be a practical and safe approach for the prevention of GDM.

Effects of resistance exercise on blood glucose level and pregnancy outcome in patients with gestational diabetes mellitus: a randomized controlled trial

INTRODUCTION

To date, the effects of resistance exercise on diabetes-related parameters (blood glucose level and insulin use) and pregnancy outcome in participants with gestational diabetes mellitus (GDM) have not been compared with those of aerobic exercise. To investigate the effect of resistance exercise versus aerobic exercise on blood glucose level, insulin utilization rate, and pregnancy outcome in patients with GDM.

RESEARCH DESIGN AND METHODS

From December 2019 to December 2020, 100 pregnant women with GDM were selected and divided into a resistance exercise group (49 patients) and an aerobic exercise group (51 patients) randomly. The aerobic exercise group received an aerobic exercise intervention, while the resistance exercise group received a resistance exercise intervention. Both groups received exercise intervention for 50-60 min, 3 times per week, lasting for 6 weeks. In addition, patients in both groups received the same routine care, including personalized dietary intervention, online education, and school courses for pregnant women.

RESULTS

The blood glucose level in the resistance exercise group and the aerobic exercise group was lower after the intervention than before the intervention (p<0.05). After the intervention, no significant differences were observed in the fasting blood glucose level, insulin utilization rate, and incidence of adverse pregnancy outcomes between the two groups (p>0.05); however, significant differences were noted in 2-hour postprandial blood glucose level and exercise compliance between the two groups (p<0.05), with the resistance exercise group showing better outcomes than the aerobic exercise group.

CONCLUSIONS

Resistance exercise is more compliant for pregnant women with GDM than aerobic exercise; hence, it is necessary to popularize resistance exercise in this specific population group. Long-term effects of resistance exercise should be evaluated in future studies.

TRIAL REGISTRATION NUMBER

ChiCTR 1900027929.

Social Nervous Exercise Intervention and Its Association with Fasting Blood Glucose on Diabetes Mellitus Gestational

BACKGROUND: Gestational diabetes mellitus (GDM) has been identified as a major complication of pregnancies and has remained a major cause of perinatal morbidity and mortality, in both mother and child. Exercise can be used as a strategy to reduce hyperglycemia experienced during GDM. Regular exercise is important for a healthy pregnancy and can lower the risk of developing GDM. For women with GDM. Exercise is safe and can affect the pregnancy outcomes beneficially. The role of exercise about increases skeletal muscle glucose uptake and minimizing hyperglycemia. Social nervous (SaSo) exercise is a moderate-intensity exercise intervention that plays a role in controlling blood glucose through autonomic nervous stimulation so that it has an effect on glucose homeostasis. Social nervous exercise can stimulate the parasympathetic or myelinated vagus nerves. The social nerve or the social nervous system is the vagus nerve nc-X which is supported by cranial nerves, namely, nerves V, VII, IX, and XI centered in the nucleus ambiguous. AIM: The aim of the study is to determine the impact of a social nervous (SaSo) exercise training program consisting of warm-up, core (prayer movements), and cooling exercises on glucose homeostasis parameters in pregnant women diagnosed with GDM. METHODS: Thirty-seven pregnant women diagnosed with GDM at 24–28 weeks of gestation were allocated into two groups, thats the experimental group (n=19) with the SaSo program being regularly monitored and the control group (n=18) receiving only standard antenatal care for GDM. The Saso program started from the time diabetes was diagnosed until 6 weeks of intervention. Interventions were performed twice per week and sessions lasted 40–45 min. RESULTS: The baseline results for the experimental and control groups were homogeneous, without differences in the baseline variables (p > 0.05). Social nervous exercise the experimental group significantly reduced fasting blood glucose levels (p < 0.001) compared to the control group. CONCLUSIONS: A social nervous exercise program has a beneficial effect on fasting blood glucose levels in late pregnancy.

Immunobiological Properties and Clinical Applications of Interleukin-38 for Immune-Mediated Disorders: A Systematic Review Study

Exponential growth in the usage of "cytokines" (as seroimmunobiomarkers) has facilitated more accurate prognosis, early diagnosis, novel, and efficient immunotherapeutics. Numerous studies have reported immunopathophysiological and immunopathological processes of interleukin-38 (IL-38). Therefore, in this systematic review article, the authors aimed to present an updated comprehensive overview on the immunobiological mechanisms, diagnostic, and immune gene-based therapeutic potentials of IL-38. According to our inclusion and exclusion criteria, a total of 216 articles were collected from several search engines and databases from the January 2012 to July 2021 time interval by using six main keywords. Physiologic or pathologic microenvironments, optimal dosage, and involved receptors affect the functionalities of IL-38. Alterations in serum levels of IL-38 play a major role in the immunopathogenesis of a wide array of immune-mediated disorders. IL-38 shows anti-inflammatory activities by reduction or inhibition of pro-inflammatory cytokines, supporting the therapeutic aspects of IL-38 in inflammatory autoimmune diseases. According to the importance of pre-clinical studies, it seems that manipulation of the immune system by immunomodulatory properties of IL-38 can increase the accuracy of diagnosis, and decipher optimal clinical outcomes. To promote our knowledge, more collaboration is highly recommended among laboratory scientists, internal/infectious diseases specialists, oncologists, immunologists, diseases-specific biomarkers scientists, and basic medical researchers.

Effects of Moderate-Intensity Aerobic Exercise on Blood Glucose Levels and Pregnancy Outcomes in Patients With Gestational Diabetes Mellitus: A Randomized Controlled Trial

INTRODUCTION

To investigate the effects of structured moderate-intensity aerobic exercise on blood glucose, insulin, and pregnancy outcomes in patients with gestational diabetes mellitus (GDM).

METHODS

One hundred one patients with GDM were randomly divided into a control group (50 cases) and an experimental group (51 cases) in a class 3 first-level general hospital. GDM patients in the control group received a personalized diabetes diet intervention, online education, and routine prenatal care. The experimental group added 6 weeks of moderate-intensity aerobic exercise in addition to the identical conditions given to the control group. The differences of fasting and 2-h postprandial blood glucose, insulin use, and adverse pregnancy outcomes were evaluated between the experimental and control group after intervention.

RESULTS

Outcomes were available from 89 participants. Compared with before intervention, there were statistically significant differences in fasting blood glucose and 2-h blood glucose after three meals in both groups (P < 0.05). There were statistically significant differences in the average fasting blood glucose, the average 2-h postprandial blood glucose, the insulin dosage, and the utilization rate between the experimental and control group after the intervention (P < 0.05). Parameters in the experimental group were all lower than in the control group. Compared with the control group, the incidence of adverse pregnancy outcomes in the experimental group after intervention was not statistically significant (P > 0.05).

CONCLUSION

Moderate-intensity aerobic exercise can help improve blood glucose control and insulin use in patients with GDM. In the future, long-term follow-up can be conducted for maternal and neonatal infants to evaluate the impact of exercise intervention on the risk of type 2 diabetes.

CLINICAL TRIAL REGISTRATION

The trial was approved by the registration of the Chinese Clinical Trial Registry. Registration number: ChiCTR1900027929.

Comparison of health-promoting lifestyle and irrational health beliefs in healthy pregnant women and gestational diabetes mellitus

BACKGROUND

Gestational diabetes mellitus (GDM) is a common complication of pregnancy. The goal of this study was to compare health-promoting lifestyles and irrational health beliefs in pregnant women with GDM and healthy pregnant women.

MATERIALS AND METHODS

The present study was a descriptive causal-comparative study in which 100 eligible GDM women and 100 eligible healthy women were selected through available sampling in three referral hospitals in Tehran In 2020. In this study, the Health Promoting Lifestyle Profile (HPLP) and the Irrational Health Beliefs Scale (IHBS) were used. Data were analyzed using independent t-test and logistic regression by SPSS 16 software.

RESULTS

Findings showed that there is a significant relationship between the variables of IHBS and HPLP. For every one unit increase in an IHBS score, the chance of having diabetes increases by 2.8%. In the case of HPLP, women who exercised well were 7.5% less likely to develop diabetes, and those who took good responsibility were 7.8% less likely to develop diabetes. Furthermore, in independent t-test, the HPLP variable showed a significant difference between the two groups with diabetes and healthy individuals (P < 0.001). Furthermore, in comparing the subscales of this variable, physical activity (P < 0.0001), self-fulfillment (P < 0.004), responsibility (P < 0.003), and stress control (P < 0.001), a significant difference was observed. The results of IHBS research showed a significant difference between the two groups of gestational diabetes and healthy individuals (P < 0.004).

CONCLUSION

The results of the present study show the need to identify and focus on irrational health beliefs and health-promoting lifestyles. Modification of these psychological structures can be useful in the prevention and management of this chronic disease.

Exercise and the Prevention of Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) is associated with pregnancy complications and fetal complications, as well as long-term health consequences for women and their offspring. Pregnancy is a pseudodiabetogenic state of increasing insulin resistance and decreasing insulin sensitivity, which places a woman at increased risk for GDM. Exercise facilitates the uptake of blood glucose into cells to be used for energy, making exercise a potential strategy in preventing GDM. Extensive evidence has found an association between consistent moderate to vigorous exercise in pregnancy and the prevention of GDM. With close attention to risk factors, maternity care nurses and other health care providers can play an important role in educating pregnant women on exercise recommendations to help them achieve optimal health and wellness.

Impact of dietary counseling on the perception of diet in patients with gestational diabetes mellitus

AIMS/INTRODUCTION

Medical nutrition therapy is the cornerstone of gestational diabetes mellitus (GDM) treatment. Patients with GDM should receive dietary counseling regarding diet and exercise.

MATERIALS AND METHODS

To study patients' perception level of diet and their level of understanding after dietary counseling, we analyzed 225 reports of dietary counseling of patients with GDM prepared by dieticians. We also assessed the patients' level of understanding after dietary counseling by asking questions regarding the counseling content. The answers to the questions were aggregated, and substantially similar answers were grouped and categorized.

RESULTS

The dieticians' suggestions were well understood by the patients. Moreover, the patients also identified their previous incorrect eating habits, such as excessive carbohydrate restriction or inappropriate fruit intake. Although distributed frequent meals were recommended by the dieticians, few patients actually practiced this for various reasons. Some patients were apparently influenced by dietary information from the mass media.

CONCLUSION

Dietary counseling was regarded as helpful and acceptable to most patients with GDM in our hospital, and many suggestions were recognized as informative for modification of previous dietary habits. By providing the results of the questionnaire survey to the dieticians, they can improve the quality of their counseling, which is expected to result in better individual care of the patients.

Application of diversified and quantitative management model of exercise intervention in patients with gestational diabetes mellitus

Objective: The study aims to explore the application of diversified and quantitative management model of exercise intervention in patients with gestational diabetes mellitus (GDM). Methods: From January 2018 to July 2018, 150 pregnant women with GDM were recruited from HangZhou Maternity Hospital, and were randomly divided into control group (n = 75) and experimental group (n = 75). All patients were registered pregnancy exercise self-efficacy scale (P-ESES), fasting blood glucose (FBG), and 2-hour postpranational blood glucose (2hPG). Patients in control group received conventional sports, while patients in experimental group added multiple quantitative exercise intervention management mode until delivery (accumulated at least 30 min per day, the time of not less than 150 min per week). After 4 weeks of intervention, patients in both groups were measured P-ESES, FBG, and 2hPG levels. Results: A total of 12 patients dropped out of the study, was lost to follow-up or was admitted to another hospital; therefore, 138 cases (68 vs. 70) were included in analysis. There was no significant difference of P-ESES, FBG, and 2hPG of patients in baseline. After four weeks intervention, compared with the control group, the P-ESES score was significantly increased (p<.05), the overcoming movement disorder, overcoming emotional disorder, and overcoming support disorder scores were significantly improved (p<.05), and the levels of FBG and 2hPG were significantly decreased (p<.05) in experimental group. Finally, the coincidence rate of weight gain during pregnancy was increased, the rate of macrosomia delivery and cesarean section were decreased in experimental group (p<.05). Conclusion: Quantitative management model of multiform exercise therapy improved patients with GDM.

Qualitative study on public health nurses' experience and assessment of nutritional and physical activity counseling of women with gestational diabetes

INTRODUCTION

The number of pregnant women with gestational diabetes mellitus (GDM) has increased worldwide. GDM is a known risk factor for pregnant mothers and their fetuses that may increase various complications and health concerns. Nutrition and physical activity (PA) counseling during pregnancy can be crucial in supporting pregnant women to adopt healthier lifestyle practices and reducing these risks. This study describes public health nurses’ (PHNs) experiences of nutrition and PA counseling and their assessments on how to develop the counseling for pregnant women with GDM.

METHODS

This is a descriptive qualitative study containing theme-interviews of 11 PHNs working in an antenatal maternity care setting. The data were analyzed using inductive content analysis.

RESULTS

Five main themes were identified related to PHNs’ experiences and assessment of nutrition and PA counseling for pregnant women with GDM: competency of nutrition and PA counseling, challenges of counseling, positive experiences of counseling, printed material, and counseling practices. PHNs considered nutrition and PA counseling both challenging and rewarding. There was lack of knowledge and skills to provide proper counseling and adequate material to support versatile counseling.

CONCLUSIONS

Material related to nutrition and PA counseling should be updated and standardized. PHNs need further training to improve knowledge in the area of diet and exercise.

Less sedentary time is associated with a more favourable glucose-insulin axis in obese pregnant women-a secondary analysis of the DALI study

Background/objectives

Obese pregnant women are at high risk of developing gestational diabetes mellitus (GDM), which might be reduced by sufficient physical activity (PA) and reduced sedentary time (ST). We assessed whether PA and ST are longitudinally associated with the glucose-insulin axis in obese pregnant women.

Subjects/methods

In this secondary analysis of the DALI (vitamin D And Lifestyle Intervention for gestational diabetes mellitus prevention) study, pregnant women, <20 weeks gestation, with a pre-pregnancy body mass index (BMI) ≥ 29 kg/m², without GDM on entry were included. Time spent in moderate-to-vigorous PA (MVPA) and ST were measured objectively with accelerometers at <20 weeks, 24–28 weeks and 35–37 weeks of gestation. Fasting glucose (mmol/l) and insulin (mU/l), insulin resistance (HOMA-IR) and first-phase and second-phase insulin release (Stumvoll first and second phase) were assessed at the same time. Linear mixed regression models were used to calculate between-participant differences and within-participant changes over time. Analyses were adjusted for gestational age, randomisation, pre-pregnancy BMI, education and age. MVPA, Insulin, HOMA-IR and Stumvoll first and second phase were log-transformed for analyses due to skewness.

Results

232 women were included in the analysis. Concerning differences between participants, more ST was associated with higher fasting glucose (Estimate: 0.008; 95% CI: 0.002, 0.014), fasting insulin (0.011; 0.002, 0.019), HOMA-IR (0.012; 0.004, 0.021) and Stumvoll first and second phase (0.008; 0.001, 0.014 and 0.007; 0.001, 0.014). Participants with more MVPA had lower Stumvoll first and second phase (−0.137; −0.210, −0.064 and −0.133; −0.202, −0.063). Concerning changes over time, an increase in ST during gestation was associated with elevated Stumvoll first and second phase (0.006; 0.000, 0.011).

Conclusions

As the glucose-insulin axis is more strongly associated with ST than MVPA in our obese population, pregnant women could be advised to reduce ST in addition to increasing MVPA. Moreover, our findings suggest that behaviour change interventions aiming at GDM risk reduction should start in early or pre-pregnancy.

Predictors of physical activity following gestational diabetes: Application of health action process approach

Aim

Regular physical activity can reduce the chance of developing type 2 diabetes in women with a history of gestational diabetes. The present study investigated the relationship between the constructs of the health action process approach and regular physical activity in women with a history of gestational diabetes.

Design

This was a cross-sectional study.

Methods

A total of 150 women who had given birth 6-24 months prior to the study and had experienced gestational diabetes in their recent pregnancy were selected using multistage cluster sampling. Data were collected from December 2018 to May 2019 using a researcher-made questionnaire including constructs of health action process approach.

Results

The common fit indices revealed that health action process approach had an acceptable fit to the observations (root mean square error of approximation = 0.054, Tucker-Lewis index = 0.95, comparative fit index = 0.955). The model's constructs predicted 48% of intention variance and 35% of physical activity variance. Action self-efficacy and coping planning were the most important predictors of intention and behaviour, respectively.

Advanced glycation end products and adipocytokines and oxidative stress in placental tissues of pregnant women with gestational diabetes mellitus

Correlation between expression levels of advanced glycation end products (AGEs) and adipocytokines and oxidative stress index malondialdehyde (MDA) in placental tissues of pregnant women with gestational diabetes mellitus (GDM) was investigated. Seventy-two cases of GDM pregnant women who received routine prenatal examination and gave birth in the Department of Obstetrics, Binzhou City Center Hospital from March 2016 to May 2017 were collected as the observation group. Another 80 cases of normal pregnant women who gave birth at the same time were selected as the control group. Enzyme linked immunosorbent assay (ELISA) was used to detect the expression levels of AGEs, visfatin, APN and IL-6 in the lysate of placental tissues. MDA levels were measured by thiobarbituric acid method. Correlation of expression levels of AGEs, visfatin, APN, IL-6 and MDA were analyzed. The expression level of MDA in placental tissues of the observation group was significantly higher than that of the control group (t=16.44, P<0.001). The correlation of expression levels between AGEs, adipocytokines and MDA in placental tissues of the two groups was analyzed, and it was found that the expression levels of AGEs, visfatin and IL-6 in the two groups were positively correlated with MDA. There was a significantly negative correlation between APN and MDA in the two groups. The incidence of cesarean section, neonatal hypoglycemia, fetal distress and macrosomia in the observation group was significantly higher than that in the control group (P<0.05). There was no significant difference in the incidence of membrane rupture and premature birth between the two groups (P>0.05). In conclusion, the expression levels of AGEs, visfatin and IL-6 in placental tissues of GDM pregnant women are positively correlated with MDA. There is a significant negative correlation between APN and MDA, and they play an important role in the pathogenesis of GDM.

How diet, physical activity and psychosocial well-being interact in women with gestational diabetes mellitus: an integrative review

Background

Gestational Diabetes Mellitus (GDM) is associated with future cardio-metabolic risks for the mother and her child. In addition, one-third of women with recent GDM develop postpartum depression. Given these adverse impacts of GDM on the health of the mother and her offspring, it is important to intervene on modifiable factors, such as diet, physical activity, and psychosocial well-being. This integrative review therefore explored evidence on how these modifiable factors interact in women with GDM and their offspring, and how effective combined interventions are on reducing adverse impacts of GDM.

Methods

A comprehensive search strategy included carefully selected terms that corresponded to the domains of interest (diet, physical activity and psychosocial well-being). The databases searched for articles published between 1980 and February 2018 were: CINAHL, PsycINFO, Embase, Pubmed and Cochrane. Studies that were included in this review were either observational or intervention studies that included at least two domains of interest. Articles had to at least report data on maternal outcomes of women with GDM.

Results

The search strategies identified 14′419 citations after excluding duplicates. After screening titles and then abstracts, 114 articles were selected for detailed evaluation of their full text, and 16 were included in this review: two observational and 14 intervention studies. Results from observational studies showed that psychosocial well-being (social support and self-efficacy) were positively associated with physical activity and dietary choice. Intervention studies always included diet and physical activity interventions, although none integrated psychosocial well-being in the intervention. These lifestyle interventions mostly led to increased physical activity, improved diet and lower stress perception. Many of these lifestyle interventions also reduced BMI and postpartum diabetes status, improved metabolic outcomes and reduced the risk of preterm deliveries and low birth weight.

Conclusion

This integrative review showed that psychosocial well-being interacted with diet as well as with physical activity in women with GDM. We recommend that future studies consider integrating psychosocial well-being in their intervention, as observational studies demonstrated that social support and self-efficacy helped with adopting a healthy lifestyle following GDM diagnosis.

Electronic supplementary material

The online version of this article (10.1186/s12884-019-2185-y) contains supplementary material, which is available to authorized users.

Effect of Physical Activity during Pregnancy on Gestational Diabetes Mellitus

AIMS

The present study evaluates association between physical activity and Gestational Diabetes Mellitus (GDM), for it can be an effective intervention for its management. Though physical activity helps maintain glucose homeostasis, evidences of GDM risk are less extensive. Therefore, this study also identifies its correlation with maternal blood glucose levels.

MATERIALS AND METHODS

A prospective case-control study was carried out among pregnant women attending regular antenatal clinic at two private hospitals. The study comprised of 100 cases and 273 matched controls. Data was collected by personal interviews using a standard questionnaire. Physical activity was assessed using long form of International Physical Activity Questionnaire (IPAQ) reported as Metabolic Equivalent-Minutes per week (MET-Minutes/Week). Statistical Package for Social Sciences (SPSS) was used for analysis.

RESULTS

Results shows high exposure rates for low-to-moderate physical activity among cases, across all domains and sub-activities. The odds of GDM engaged in domestic and gardening activities for <2999 MET-minutes per week are 10 times higher than involved for ≥3000 MET-minutes per week (P < 0.001). The study also shows poor or no correlation between physical activity during pregnancy and maternal blood glucose levels.

CONCLUSION

Despite existence of poor or no relationship with maternal blood glucose levels, prolonged sedentary behavior and decreased physical activities, especially domestic, are potential risk factors for GDM, a major finding of the study.

Maternal physical activity prior to and during pregnancy does not moderate the relationship between maternal body mass index and infant macrosomia

OBJECTIVES

Maternal body mass index (BMI) is a significant determinant of infant macrosomia. Given the strong metabolic effects of physical activity (PA), independent of body mass, it is unclear as to whether maternal PA may affect the risk of delivering a macrosomic infant. Thus, the purpose of this study was to determine if maternal PA moderates the relationship between maternal BMI and infant macrosomia.

DESIGN

Cross-sectional study using data from the National Maternal and Infant Health Survey (1988).

METHODS

Women with singleton pregnancies, delivering term (37-44 weeks), live-birth infants (n=6390) were included in the analyses. Multiple logistic regression models were performed to determine the moderating effects of maternal self-reported PA in the preconception and prenatal periods on the risk of infant macrosomia after adjusting for maternal age, race/ethnicity, gestational age and weight gain, smoking and alcohol use, and infant sex.

RESULTS

Mothers were on average 25 years of age and nearly 25% were overweight or obese. Prevalence of macrosomia was 9%. Overweight or obese women had increased odds of delivering a macrosomic infant (OR=1.69, p<0.0001; OR=1.67, p=0.0032, respectively). Nearly 50% and 42% of mothers reported participating in at least 30min of moderate PA, three times per week in the preconception and prenatal periods, respectively. Neither maternal PA in the preconception (OR=0.98, p=0.34) nor prenatal (OR=1.00, p=0.13) periods moderated the association between maternal BMI and infant macrosomia.

CONCLUSIONS

Maternal BMI was a significant predictor of infant macrosomia. However, mothers participating in at least 90min of PA per week in the preconception or prenatal periods did not moderate this association. More rigorous study designs and precise measurements of maternal PA and neonatal size are warranted.

Exercise as a therapeutic intervention to optimize fetal weight

The Developmental Origins of Health and Disease suggest the in utero environment programs offspring obesity and cardiovascular disease. Therefore, there is a need to implement safe therapeutic interventions that do not involve the intake of medications or biological products during pregnancy that can improve maternal and fetal health. Prenatal exercise is established to promote maternal and fetal health. It is generally recommended that women accumulate at least 150 min per week of moderate-intensity exercise. It has been demonstrated that prenatal exercise maintains healthy weight gain and improves maternal glucose control, maternal cardiac autonomic control, placental efficiency (increases angiogenesis, downregulates genes involved in fatty acid transport and insulin transport across the placenta, and upregulates genes involved in amino acid transport across the placenta), and oxidative stress. These adaptations following exercise improve maternal metabolism and provide adequate uteroplacental perfusion. In this review, we will focus on exercise as a therapeutic intervention to optimize fetal weight. It has been established that prenatal exercise does not increase the risk of having a small for gestational age baby. To the contrary, prenatal exercise has been associated with the prevention of excessive fat accumulation in the newborn and the maintenance of fetal muscle mass.

Enablers and barriers for women with gestational diabetes mellitus to achieve optimal glycaemic control - a qualitative study using the theoretical domains framework

Background

Glycaemic target recommendations vary widely between international professional organisations for women with gestational diabetes mellitus (GDM). Some studies have reported women’s experiences of having GDM, but little is known how this relates to their glycaemic targets. The aim of this study was to identify enablers and barriers for women with GDM to achieve optimal glycaemic control.

Methods

Women with GDM were recruited from two large, geographically different, hospitals in New Zealand to participate in a semi-structured interview to explore their views and experiences focusing on enablers and barriers to achieving optimal glycaemic control. Final thematic analysis was performed using the Theoretical Domains Framework.

Results

Sixty women participated in the study. Women reported a shift from their initial negative response to accepting their diagnosis but disliked the constant focus on numbers. Enablers and barriers were categorised into ten domains across the three study questions. Enablers included: the ability to attend group teaching sessions with family and hear from women who have had GDM; easy access to a diabetes dietitian with diet recommendations tailored to a woman’s context including ethnic food and financial considerations; free capillary blood glucose (CBG) monitoring equipment, health shuttles to take women to appointments; child care when attending clinic appointments; and being taught CBG testing by a community pharmacist. Barriers included: lack of health information, teaching sessions, consultations, and food diaries in a woman’s first language; long waiting times at clinic appointments; seeing a different health professional every clinic visit; inconsistent advice; no tailored physical activities assessments; not knowing where to access appropriate information on the internet; unsupportive partners, families, and workplaces; and unavailability of social media or support groups for women with GDM. Perceived judgement by others led some women only to share their GDM diagnosis with their partners. This created social isolation.

Conclusion

Women with GDM report multiple enablers and barriers to achieving optimal glycaemic control. The findings of this study may assist health professionals and diabetes in pregnancy services to improve their care for women with GDM and support them to achieve optimal glycaemic control.