Exercise and the Prevention of Gestational Diabetes Mellitus

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.

Exercise Intervention Improves Blood Glucose Levels and Adverse Pregnancy Outcomes in GDM Patients: A Meta-Analysis

Objective

The objective of this study is to systematically evaluate the effect of exercise on gestational diabetes (GDM).

Methods

The databases of PubMed, Cochrane Library, Web of Science, Embase, CNKI, VIP, and Wanfang were searched to collect publications regarding physical exercises and GDM. The two researchers screened the literature, extracted the data, and analyzed the risk of bias of the included data using RevMan 5.3 software. The primary outcomes analyzed included the fasting blood glucose, 2-h postprandial blood glucose, glycosylated hemoglobin, premature delivery, cesarean section, neonatal macrosomia, premature rupture of membranes, and neonatal hypoglycemia.

Results

A total of 9 studies with 1289 GDM patients were included. Compared with the control group, exercise could significantly reduce the 2-h postprandial blood glucose (MD = −0.62, 95% CI (-0.91 to -0.34), Z = 4.29, P < 0.0001), improve HbA1c(RR = −0.47, 95% CI (-0.81 to -0.13), Z = 2.69, P = 0.007), reduce the cesarean section rate (RR = 0.83, 95% CI (0.71-0.98), Z = 2.25, P = 0.02), and decrease the incidence of neonatal macrosomia in GDM patients (RR = 0.57, 95% CI (0.34-0.95), Z = 2.17, P = 0.03).

Conclusion

Exercise intervention can improve the blood glucose level of GDM patients, such as 2-h postprandial blood glucose and HbA1c. Meanwhile, exercise can also reduce adverse pregnancy outcomes, such as premature birth and macrosomia. Therefore, prescribing exercise to GDM patients can effectively manage GDM and improve adverse pregnancy outcomes.

The effect of gestational diabetes mellitus on occurrence of the pelvic girdle pain and symptom severity in pregnant women

The primary objective of this study was to examine the effect of gestational diabetes mellitus (GDM) on pelvic girdle pain (PGP) occurrence and symptom severity. Pregnant women who were with/without GDM, 20-40 years of age, and also in the second and third trimesters of pregnancy were included in the study. PGP provocation tests were administered to 187 pregnant women to determine the presence and severity of PGP. Based on the test results, the study subjects were divided into two groups; Group 1 (GDM+, PGP+; n:32) and Group 2 (GDM-, PGP+; n:35). Both groups were asked to fill in the Pelvic Girdle Questionnaire (PGQ). The relationship between the presence of GDM and the presence of PGP was found to be significant (p = .043). It was found the groups were similar in view of pain, and also in PGQ total/subscale scores (p > .05). Although GDM has no effect on symptom severity, it has been determined that it may relate to the development of PGP. Therefore, early interventions (nutrition, exercise, belt using, etc.) are recommended to prevent the development of PGP in pregnant women with a family history of diabetes, with a previous diagnosis of diabetes and/or with GDM detected in their previous pregnancies. Clinical Trial Number: 04769375Impact of StatementWhat is already known on this subject? Gestational diabetes mellitus and pelvic girdle pain are pathologies that develops secondary to pregnancy-related systemic and biomechanical changes.What do results on this study add? GDM may related the development of PGP.What are the implications of these findings for clinical practice and/or further research? Early interventions (nutrition, exercise, belt using, etc.) and strict control of pregnant women in view of PGP is recommended to prevent the development of PGP in pregnant women with a family history of diabetes, with previous diagnosis of diabetes and/or with GDM detected in their previous pregnancies. The evaluation of pregnant women for PGP before administering interventions, such as exercise and diet (both decrease the pro-inflammatory markers), following the diagnosis of GDM and the measurement of plasma anti- and pro-inflammatory marker values in the same time period will further reveal the relationship between GDM and PGP.

Sex-specific mediating effect of gestational weight gain between pre-pregnancy body mass index and gestational diabetes mellitus

Background

Inappropriate weight gain may increase the risk of gestational diabetes mellitus (GDM). However, the relationship between pre-pregnancy body mass index (BMI), weight gain, and GDM has not been precisely quantified. This study aimed to explore whether gestational weight gain played a mediating role between pre-pregnancy BMI and GDM and whether the mediating effect was sex specific.

Methods

This study established a population-based observational cohort to assess weight gain in pregnant women. Mediation analyses were performed to quantify whether weight gain mediated the association between pre-pregnancy BMI and GDM.

Results

A total of 67,777 pregnant women were included in the final analysis, among whom 6751 (10.0%) were diagnosed with GDM. We verified that both pre-pregnancy BMI and weight gain were associated with GDM, and that BMI negatively contributed to weight gain. We also found that weight gain had a significant mediating effect on the relationship between pre-pregnancy BMI and GDM (Z_a × Z_b confidence intervals [CIs] 0.00234–0.00618). Furthermore, the effect was sex-specific, in that it was only significant in overweight women carrying female fetuses (Z_a × Z_b CIs 0.00422–0.01977), but not male fetuses (Z_a × Z_b CIs −0.00085 to 0.01236).

Conclusions

Weight gain during pregnancy had a fetal sex-specific mediating effect between pre-pregnancy BMI and GDM.