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Sweeting A, Hannah W, Backman H, Catalano P, Feghali M, Herman WH, Hivert MF, Immanuel J, Meek C, Oppermann ML, Nolan CJ, Ram U, Schmidt MI, Simmons D, Chivese T, Benhalima K. Epidemiology and management of gestational diabetes. Lancet 2024:S0140-6736(24)00825-0. [PMID: 38909620 DOI: 10.1016/s0140-6736(24)00825-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/07/2024] [Accepted: 04/19/2024] [Indexed: 06/25/2024]
Abstract
Gestational diabetes is defined as hyperglycaemia first detected during pregnancy at glucose concentrations that are less than those of overt diabetes. Around 14% of pregnancies globally are affected by gestational diabetes; its prevalence varies with differences in risk factors and approaches to screening and diagnosis; and it is increasing in parallel with obesity and type 2 diabetes. Gestational diabetes direct costs are US$1·6 billion in the USA alone, largely due to complications including hypertensive disorders, preterm delivery, and neonatal metabolic and respiratory consequences. Between 30% and 70% of gestational diabetes is diagnosed in early pregnancy (ie, early gestational diabetes defined by hyperglycaemia before 20 weeks of gestation). Early gestational diabetes is associated with worse pregnancy outcomes compared with women diagnosed with late gestational diabetes (hyperglycaemia from 24 weeks to 28 weeks of gestation). Randomised controlled trials show benefits of treating gestational diabetes from 24 weeks to 28 weeks of gestation. The WHO 2013 recommendations for diagnosing gestational diabetes (one-step 75 gm 2-h oral glucose tolerance test at 24-28 weeks of gestation) are largely based on the Hyperglycemia and Adverse Pregnancy Outcomes Study, which confirmed the linear association between pregnancy complications and late-pregnancy maternal glycaemia: a phenomenon that has now also been shown in early pregnancy. Recently, the Treatment of Booking Gestational Diabetes Mellitus (TOBOGM) trial showed benefit in diagnosis and treatment of early gestational diabetes for women with risk factors. Given the diabesity epidemic, evidence for gestational diabetes heterogeneity by timing and subtype, and advances in technology, a life course precision medicine approach is urgently needed, using evidence-based prevention, diagnostic, and treatment strategies.
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Affiliation(s)
- Arianne Sweeting
- Department of Endocrinology, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia
| | - Wesley Hannah
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, India
| | - Helena Backman
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Patrick Catalano
- Maternal Infant Research Institute, Obstetrics and Gynecology Research, Friedman School of Nutrition Science and Policy, Tufts University School of Medicine, Tufts University, Boston, MA, USA
| | - Maisa Feghali
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Willliam H Herman
- Schools of Medicine and Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Marie-France Hivert
- Department of Population Medicine, Division of Chronic Disease Research Across the Lifecourse, Harvard Pilgrim Health Care Institute, Harvard Medical School, Harvard University, Boston, MA, USA; Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Jincy Immanuel
- School of Medicine, Western Sydney University, Sydney, NSW, Australia; Texas Woman's University, Denton, TX, USA
| | - Claire Meek
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
| | - Maria Lucia Oppermann
- Department of Obstetrics and Gynecology, School of Medicine of Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Christopher J Nolan
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, ACT, Australia; Department of Endocrinology, Canberra Health Services, Woden, ACT, Australia
| | - Uma Ram
- Seethapathy Clinic and Hospital, Chennai, India
| | - Maria Inês Schmidt
- Postgraduate Program in Epidemiology, School of Medicine of Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - David Simmons
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Tawanda Chivese
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Katrien Benhalima
- Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
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Menek MY, Kaya AK. Comparison of home exercise under supervision and self home exercise in pregnant women with gestational diabetes: randomized controlled trial. Arch Gynecol Obstet 2024; 309:1075-1082. [PMID: 38184491 DOI: 10.1007/s00404-023-07339-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/07/2023] [Indexed: 01/08/2024]
Abstract
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.
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Affiliation(s)
- Merve Yilmaz Menek
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey.
| | - Ayse Kavasoglu Kaya
- Department of Obstetrics and Gynecology, Medipol University Camlıca Hospital, Istanbul, Turkey
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Weng MH, Chou HC, Liaw JJ. The effects of unsupervised home-based exercise training during pregnancy: A systematic review. Worldviews Evid Based Nurs 2024. [PMID: 38361353 DOI: 10.1111/wvn.12712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/29/2023] [Accepted: 12/31/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Pregnant women may experience physical and emotional distress. Exercise is recommended for healthy pregnant women and is beneficial for their mental and physical health. Unsupervised home-based exercise is cost-effective for pregnant women as an occasional solution for their discomfort. However, no synthesis of randomized trials on this topic has been conducted. AIMS The aim of this study was to evaluate the effectiveness of unsupervised home-based exercise during pregnancy. METHODS A systematic search for randomized controlled trials was performed in electronic databases. The review extracted eligibility criteria based on unsupervised home-based exercise intervention. The quality of the included studies was performed using the Cochrane Risk of Bias Tool 2.0. This review was registered a priori in PROSPERO (CRD42023452966). RESULTS In total, seven studies were selected for systematic review. Participant adherence rates for the three reported studies varied considerably, ranging from 33% to 75%. Two studies revealed that unsupervised home-based exercise improved symptom severity in relation to long-term adherence to exercise. Two studies suggested that maternal aerobic fitness increased due to exercise. One study revealed improved sleep quality. However, none of the studies supported the positive effects of exercise on fatigue, maternal insulin sensitivity, prenatal weight gain, postnatal weight loss, birth pain, and cesarean section. LINKING EVIDENCE TO ACTION Unsupervised home-based exercise improves discomfort symptoms during pregnancy but requires a long intervention period. This finding suggests that the evaluation period needs to be longer to identify the effects of exercise. In addition, a theoretical-based integrity exercise plan should be considered to promote the effectiveness of unsupervised home-based exercise.
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Affiliation(s)
- Min-Hsueh Weng
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Hung-Chieh Chou
- Department of Pediatrics, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jen-Jiuan Liaw
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
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Veisy A, Mohammad-Alizadeh-Charandabi S, Abbas-Alizadeh S, Mirghafourvand M, Ghaderi F, Haghighi M. Monitored home-based with or without face-to-face exercise for maternal mental health during the COVID-19 pandemic. J Reprod Infant Psychol 2024; 42:110-125. [PMID: 35416742 DOI: 10.1080/02646838.2022.2063267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Despite the known beneficial effects of exercise, most pregnant women do not exercise regularly. Most studies on exercise have been conducted on supervised exercise and there is limited evidence regarding the adherence and effect of other exercise programs on pregnancy outcomes. Therefore, we aimed to investigate adherence to a face-to-face plus monitored home exercise program versus a monitored home-based exercise program on its own during pregnancy. In addition, effects of these two exercise programs on women's mental health during pregnancy and postpartum (primary outcomes) and on some other maternal and neonatal outcomes (secondary outcomes) will be assessed. METHODS In this superiority trial with three parallel arms, 150 women at 12-18 weeks of gestation will be randomised equally into three groups (face-to-face plus monitored home exercise, only monitored home-based exercise, and control). The exercise programs will be performed up to the 38th week of gestation during which participants will be assessed at specific intervals during the pregnancy, and post-partum and followed up until six months after childbirth. The exercise diary will be used to assess the adherence. The Edinburgh Depression Scale and the Positive and Negative Affect Schedule will be used to assess prenatal and postnatal depression and affect, respectively. DISCUSSION This study reflects the feasibility and acceptance of two exercise programs for pregnant women and their effects on important outcomes. If these programs are followed properly and effectively, pregnant women's health can be improved using these methods at a lower cost compared to the conventional supervised exercise program.
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Affiliation(s)
- Afsaneh Veisy
- Student Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Mohammad-Alizadeh-Charandabi
- Social Determinants of Health Research Center, Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shamci Abbas-Alizadeh
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center (Sdhrc), Department of Family Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Fariba Ghaderi
- Department of Physiotherapy, Faculty of Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahmonir Haghighi
- Department of Psychiatry, Urmia University of Medical Sciences, Urmia, Iran
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Ghahfarrokhi MM, Banitalebi E, Negaresh R, Motl RW. Home-Based Exercise Training in Multiple Sclerosis: A Systematic Review with Implications for Future Research. Mult Scler Relat Disord 2021; 55:103177. [PMID: 34343867 DOI: 10.1016/j.msard.2021.103177] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/20/2021] [Accepted: 07/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Substantial evidence supports the benefits of supervised exercise training (ET) in people with multiple sclerosis (MS). However, there are limitations such as transportation problems preventing physical activity for some people with MS. One opportunity for increasing physical activity participant in people with MS is home-based exercise training (HBET), yet we are unaware of a systematic review of HBET in people with MS. We undertook a systematic review for enhancing the knowledge about HBET in people with MS. METHODS To identify eligible studies, we included the medical subject headings (MeSH) keywords including 'multiple sclerosis' OR 'MS' OR 'degenerative nerve disease' AND 'home-based exercise' OR 'home-based training' OR 'home-based balance training' OR 'home-based rehabilitation' OR 'physical telerehabilitation' OR 'home-based walking' OR 'home-based step training.' Studies were included in this review that examined the effect of HBET in people with MS, were written in English, and available in full-text. RESULTS According to inclusion and exclusion criteria, 24 studies were judged eligible to be included in this systematic review. The results indicated that a total number of 10 studies had mainly implemented combined ET interventions. Balance and aerobic ET had been included in 5 studies. Three studies had further administered resistance ET interventions and one study had applied exergaming. Moreover, 13 studies had focused on the effects of ET on physical fitness, one article had reflected on the impact of ET on fatigue, and nine cases had included fatigue, quality of life, and fitness as outcome measures. CONCLUSIONS Home-based ET, 2-7 times per week, is beneficial, feasible, and safe in people with MS. Nevertheless, there were notable limitations, including (a) adherence to interventions, which needs to be addressed in future studies, and (b) disability-related outcomes which should be considered in future HBET studies.
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Affiliation(s)
| | | | - Raoof Negaresh
- Department of Physical Education & Sport Sciences, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
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Yang S, Lin R, Si L, Li Z, Jian W, Yu Q, Jia Y. Cod-Liver Oil Improves Metabolic Indices and hs-CRP Levels in Gestational Diabetes Mellitus Patients: A Double-Blind Randomized Controlled Trial. J Diabetes Res 2019; 2019:7074042. [PMID: 31956660 PMCID: PMC6949680 DOI: 10.1155/2019/7074042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/30/2019] [Accepted: 12/02/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To investigate the effects of cod-liver oil on metabolic status and high-sensitivity C-reactive protein (hs-CRP) in patients with gestational diabetes mellitus (GDM). METHODS This study was a randomized, double-blinded, placebo-controlled trial with the allocation ratio of 1 : 1. The contents of EPA and DHA in cod-liver oil were measured using a gas chromatograph. A total of 550 GDM patients were randomly divided into the intervention group (cod-liver oil) and the control group (placebo, mineral oil), and both groups were given regular dietary care. Glycosylated hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), 2-hour plasma glucose (2hPG), lipid profiles, homeostatic model assessment insulin resistance (HOMA-IR), and hs-CRP were measured. Primary outcomes were different in HbA1c, FPG, 2hPG, and HOMA-IR between the two groups after 4-week randomization. Secondary outcomes were the blood glucose levels and perinatal complications (pregnancy-induced hypertension, polyhydramnios, premature delivery, postpartum hemorrhage, postpartum infection, premature rupture of membranes, and cesarean section) between the two groups before and after 12-16 weeks of cod-liver oil intervention from middle pregnancy to late pregnancy. RESULTS EPA and DHA were the main components of cod-liver oil with 76 mg/mL and 150 mg/mL, respectively. There was no significant difference for primary outcomes in the levels of HbA1c, FPG, 2hPG, HOMA-IR, and lipid profiles between the two groups (P > 0.05). For the secondary outcomes, the levels of HbA1c, FPG, 2hPG, triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol ratio (LDL-C), HOMA-IR, and hs-CRP in the intervention group were significantly lower than those in the control group (P < 0.05). The incidence of perinatal complications in the intervention group was lower than that in the control group too (P < 0.05). CONCLUSIONS Cod-liver oil consumption effectively reduced the levels of blood glucose, lipid levels, hs-CRP, and HOMA-IR and the incidence of perinatal complications.
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Affiliation(s)
- Shuli Yang
- Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun 130041, China
| | - Ruixin Lin
- Department of Hepatopancreatobiliary Surgery, The Second Hospital of Jilin University, Changchun 130041, China
| | - Lihui Si
- Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun 130041, China
| | - Zhuo Li
- Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun 130041, China
| | - Wenwen Jian
- Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun 130041, China
| | - Qing Yu
- Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun 130041, China
| | - Yan Jia
- Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun 130041, China
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