The safety and efficacy of supervised exercise on pregnant women with overweight/obesity: A systematic review and meta-analysis of randomized controlled trials

A systematic review and meta-analysis of exercise-based intervention to prevent gestational diabetes in women with overweight or obesity

BACKGROUND

There is evidence that exercise may reduce the risk of gestational diabetes mellitus (GDM) and improve other obstetric outcomes in overweight or obese pregnant women. However, the available evidence is of low quality and inconclusive. The purpose of this study is to assess the effects of exercise, compared with usual care, in reducing GDM and other obstetric risks, in overweight and obese pregnant women.

METHODS

We searched MEDLINE, Embase, and the Cochrane Library from their inception dates up to August 2022. Randomised studies comparing physical exercise versus routine obstetric care in pregnant women with overweight or obesity (BMI ≥ 25.0). Each abstract and full-text article was independently reviewed by the same two authors. The primary outcome was the incidence of GDM, and the secondary outcomes were excessive weight gain, preterm delivery, and foetal macrosomia. Summary risk ratios (RRs) and 95% confidence intervals (CIs) were calculated.

MAIN RESULTS

Seven studies covering 1162 patients were identified. Exercise did not reduce the risk of GDM: RR, 0.82 [95% CI, (0.58-1.17)] but subgroup analysis shows a significant benefit among patients adhering to the programs: RR, 0.56 [95% CI, (0.40-0.78)] and no effect among non-adherents: RR, 1.11 [95% CI, (0.82-1.50)]. We did not find a significant effect on excessive weight gain: RR, 0.92 [95% CI, (0.76-1.11)] but there was a reduction in the risk of foetal macrosomia: RR, 0.5 [95% CI, (0.32-0.79)]. Exercise has not been associated with an increased risk of preterm birth: RR, 0.79 [95% CI, (0.44-1.39)].

CONCLUSIONS

The present study does not allow us to conclude that structured exercise programs for pregnant women with overweight or obesity leads to a reduction in the risk of gestational diabetes. When exercise program adherence is high, a significant reduction of GDM is observed. These findings will need to be confirmed with large primary trials. A reduction in the incidence of foetal macrosomia has also been observed. TRIAL REGISTRATION: This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO; identifier: CRD42023399004).

An umbrella review of systematic reviews on interventions of physical activity before pregnancy, during pregnancy, and postpartum to control and/or reduce weight gain

BACKGROUND

The increasing prevalence of overweight and obesity worldwide represents a (chronic) complex public health problem. This is also seen among women of childbearing age despite increased efforts to promote physical activity (PA) interventions. Excessive gestational weight gain (GWG) is associated with negative health outcomes for both mothers and offspring.

OBJECTIVES

To summarize current systematic reviews (SRs) on PA interventions during pregnancy and postpartum to prevent excessive GWG and identify the most effective approaches.

SEARCH STRATEGY

A literature search was conducted on major electronic databases (MEDLINE/Pubmed, Cochrane, Web of Science, Epistemonikos) from inception to March 2023.

SELECTION CRITERIA

This study included SRs and meta-analyses of studies involving women aged 18 years or older from diverse ethnic backgrounds, who were either in the preconception period, pregnant, or within 1 year postpartum and who had no contraindications for exercise. Women with chronic diseases, such as pre-existing diabetes (type 1 or type 2) were excluded.

DATA COLLECTION AND ANALYSIS

Two reviewers extracted data from selected studies assessing the impact of PA in preconception, pregnancy, and postpartum. Methodologic quality was assessed with the AMSTAR-2 tool. A narrative summary of results addresses relationships between PA and weight before, during, and after pregnancy, informing future research priorities for preventing excessive weight gain. This study is registered on PROSPERO (CRD420233946666).

MAIN RESULTS

Out of 892 identified articles, 25 studies were included after removing duplicates, unrelated titles, and screening titles and abstracts for eligibility. The results demonstrate that PA can help prevent excessive GWG and postpartum weight retention. Structured and supervised moderate-intensity exercise, at least twice a week, and each session lasting a minimum of 35 min seems to provide the greatest benefits.

CONCLUSIONS

Women who comply with the PA program and recommendations are more likely to achieve adequate GWG and return to their pre-pregnancy body mass index after delivery. Further research is warranted to explore how preconception PA influences pregnancy and postpartum outcomes given the absence of identified preconception-focused interventions.

Management of hypertensive disorders in pregnancy: a Position Statement of the European Society of Hypertension Working Group 'Hypertension in Women'

Hypertensive disorders in pregnancy (HDP), remain the leading cause of adverse maternal, fetal, and neonatal outcomes. Epidemiological factors, comorbidities, assisted reproduction techniques, placental disorders, and genetic predisposition determine the burden of the disease. The pathophysiological substrate and the clinical presentation of HDP are multifarious. The latter and the lack of well designed clinical trials in the field explain the absence of consensus on disease management among relevant international societies. Thus, the usual clinical management of HDP is largely empirical. The current position statement of the Working Group 'Hypertension in Women' of the European Society of Hypertension (ESH) aims to employ the current evidence for the management of HDP, discuss the recommendations made in the 2023 ESH guidelines for the management of hypertension, and shed light on controversial issues in the field to stimulate future research.

Gestational Metabolic Risk: A Narrative Review of Pregnancy-Related Complications and of the Effectiveness of Dietary, Exercise and Lifestyle Interventions during Pregnancy on Reducing Gestational Weight Gain and Preventing Gestational Diabetes Mellitus

Objective: This study is a Narrative Review that aims at investigating the implications of obesity, excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM). Additionally, this Review seeks to explore the effectiveness of nutrition, and/or exercise interventions during pregnancy on reducing GWG and preventing GDM. Materials and Methods: The search in literature included studies that identified obesity, GWG, GDM and associated risks during pregnancy. Also, SR and MA focusing on interventions including diet, or physical activity (PA), or combined (i.e., lifestyle interventions) and their impact on metabolic risk during pregnancy, were identified through searches in PubMed, Cochrane Database of Systematic Reviews (CDSRs), and Scopus. Results: The study findings suggest that lifestyle interventions during pregnancy may be effective in reducing excessive GWG. Regarding the prevention of GDM, results from studies evaluating lifestyle interventions vary. However, significant and less controversial results were reported from studies assessing the efficacy of exercise interventions, particularly in high-risk pregnant women. Conclusions: Lifestyle interventions during pregnancy may reduce excessive GWG. Exercise during pregnancy may prevent GDM, especially in high-risk pregnant women. Future research is warranted to tailor lifestyle interventions for optimal effectiveness during pregnancy.

Physical Activity during Pregnancy and Risk of Gestational Diabetes Mellitus: A Meta-Review

BACKGROUND

Nowadays, pregnant women require more individualized attention in their assistance process during pregnancy. One of the aspects that requires the most focus is the suitability of carrying out physical activity. The objective of this meta-review is to find out the effects of physical activity during pregnancy on the incidence of GDM compared to women who do not perform physical activity.

METHODS

A search was conducted in Cochrane, CSIC, Ebscohost, Proquest, Pubmed, Scielo, and Scopus. The search focused on systematic reviews and meta-analyses published in the last five years. The AMSTAR-2 scale was used as a quality assessment tool for the final sample.

RESULTS

A total of 18 systematic reviews and meta-analyses were included. Sixteen of them found out that physical activity during pregnancy has preventive effects for GDM compared with women who lacked physical activity. Among the studies, we found a reduction in the risk of GDM of between 24% and 38% and odds ratios ranging between 0.39 and 0.83 calculated for a 95% CI. Only two studies did not find statistically significant effects. Other variables such as type and duration of physical activity, overweight and obesity, gestational age, etc., were also considered.

CONCLUSIONS

Physical activity prevents the incidence of GDM. The main characteristics that enhance this preventive effect are starting at the initial stages of pregnancy and maintaining during the whole pregnancy as well as combining strength and aerobic exercise at a low to moderate intensity.

Systematic Reviews on the Prevention of Adverse Pregnancy Outcomes Related to Maternal Obesity to Improve Evidence-Based Counselling

Background

Health professionals and their patients should understand the importance of evidence. In the case of gestational diabetes mellitus, which is often associated with an abnormally high body mass index, the immediate and long-term outcome of women and their offspring depends in part on advice and implementation of lifestyle changes before, during and after pregnancy.

Methods

Up to September 2023, MEDLINE, CENTRAL, and WEB OF SCIENCE were used to identify systematic reviews and meta-analyses on the prevention of gestational diabetes. The ROBIS and AMSTAR criteria were analyzed for all systematic reviews.

Results

A total of 36 systematic reviews were identified. Dietary interventions, physical activity or a combined approach all reduced adverse pregnancy outcomes such as gestational diabetes, pregnancy-induced hypertension and related morbidities. Within the randomized controlled trials included in the 36 systematic reviews, the type, intensity and frequency of interventions varied widely. The primary outcomes, reporting and methodological quality of the 36 systematic reviews and meta-analyses also varied.The meta-analysis with the highest ROBIS and AMSTAR-2 scores was selected to design an icon array based on a fact box simulating 100 patients.

Conclusions

We propose a methodology for selecting the best evidence and transforming it into a format that illustrates the benefits and harms in a way that can be understood by lay patients, even if they cannot read. This model can be applied to counselling for expectant mothers in low and high-income countries, regardless of socioeconomic status, provided that women have access to appropriately trained healthcare providers.

Comparative effect of different types of physical exercise and intensity levels on low birth weight: A systematic review and network meta-analysis

BACKGROUND

Low birth weight (LBW) has been established as a major determinant of neonatal mortality and morbidity. However, there is no evidence of the effectiveness of different types of physical exercise (PE) at different intensities during pregnancy to prevent LBW.

OBJECTIVES

To compare the effectiveness of different types of PE at different levels of intensity in pregnant women to prevent LBW.

DESIGN

A systematic review and network meta-analysis was performed according to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols for Network Meta-Analysis extension statement.

DATA SOURCES AND METHODS

We searched the PubMed, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science databases from inception to November 2023. We included randomized controlled trials (RCTs). A random effects method was used to calculate the pooled mean difference (MD). The effect of each intervention was calculated using a network meta-analysis with a frequentist perspective.

RESULTS

Forty-three RCTs were included in the systematic review, and 38 RCTs were included in the network meta-analysis. In the general population, although no significant results, the MDs for light-moderate strength, moderate-vigorous strength, and moderate-vigorous Pilates exercises were favorable for preventing LBW. Furthermore, moderate-vigorous strength exercise was effective to prevent LBW, reporting significant MD compared to control groups in the healthy population (310.00, 95% confidence interval: 78.40, 541.60; I2 = 81.3%).

CONCLUSION

Strength exercises at a moderate-vigorous intensity could be a potential strategy for the prevention of LBW in the healthy population. However, our findings should be interpreted with caution because the overall risk of bias was between "some concerns" and "high," and the overall certainty of the evidence was low.

REGISTRATION

PROSPERO CRD42023401770.

Can Pre-Pregnancy Body Mass Index and Maternal Exercise Affect Birth and Neonatal Outcomes-A Cross Sectional Study

There has been a dramatic worldwide increase in the prevalence of obesity or overweight and physical inactivity in women of reproductive age. Growing evidence suggests that pre-pregnancy maternal abnormal body mass index (BMI) and lower physical activity level are associated with poor maternal health and perinatal outcomes. The aim of this study was to assess how self-perceived exercise and pre-pregnancy BMI are associated with preterm birth, low birth weight, and type of birth. We conducted a retrospective cross-sectional study of 394 Polish women in the postpartum period. We used a questionnaire with the structure of the medical interview. To analyze factors related to birth outcomes, we used the Pearson's Chi-squared test of independence and odds ratio (OR), with a corresponding 95% confidence interval (CI), followed by a multiple logistic regression. Women who reported being physically active before pregnancy (p = 0.00) and during pregnancy (p = 0.03) were more likely to give birth on time and had a lower incidence of very-premature and extremely premature births compared to inactive women. Importantly, they were more likely to have vaginal birth (p = 0.03). Pre-pregnancy BMI influenced the week of delivery, i.e., inadequate, too-high BMI contributed to an increase in the percentage of premature births [OR (95% CI) = 1.19 (1.06; 1.34)]. The findings indicate that promoting physical activity and weight management remains a priority in public health policy, and women of childbearing age should be encouraged to adopt or maintain an active and healthy lifestyle during pregnancy in order to avoid sedentary- and obesity-associated risks affecting birth and newborns' health.

Participant characteristics in the prevention of gestational diabetes as evidence for precision medicine: a systematic review and meta-analysis

BACKGROUND

Precision prevention involves using the unique characteristics of a particular group to determine their responses to preventive interventions. This study aimed to systematically evaluate the participant characteristics associated with responses to interventions in gestational diabetes mellitus (GDM) prevention.

METHODS

We searched MEDLINE, EMBASE, and Pubmed to identify lifestyle (diet, physical activity, or both), metformin, myoinositol/inositol and probiotics interventions of GDM prevention published up to May 24, 2022.

RESULTS

From 10347 studies, 116 studies (n = 40940 women) are included. Physical activity results in greater GDM reduction in participants with a normal body mass index (BMI) at baseline compared to obese BMI (risk ratio, 95% confidence interval: 0.06 [0.03, 0.14] vs 0.68 [0.26, 1.60]). Combined diet and physical activity interventions result in greater GDM reduction in participants without polycystic ovary syndrome (PCOS) than those with PCOS (0.62 [0.47, 0.82] vs 1.12 [0.78-1.61]) and in those without a history of GDM than those with unspecified GDM history (0.62 [0.47, 0.81] vs 0.85 [0.76, 0.95]). Metformin interventions are more effective in participants with PCOS than those with unspecified status (0.38 [0.19, 0.74] vs 0.59 [0.25, 1.43]), or when commenced preconception than during pregnancy (0.21 [0.11, 0.40] vs 1.15 [0.86-1.55]). Parity, history of having a large-for-gestational-age infant or family history of diabetes have no effect on intervention responses.

CONCLUSIONS

GDM prevention through metformin or lifestyle differs according to some individual characteristics. Future research should include trials commencing preconception and provide results disaggregated by a priori defined participant characteristics including social and environmental factors, clinical traits, and other novel risk factors to predict GDM prevention through interventions.

Exercise during pregnancy for preventing gestational diabetes mellitus and hypertensive disorders: An umbrella review of randomised controlled trials and an updated meta-analysis

OBJECTIVE

This study aimed to provide, through an umbrella review, an overview of the effect of single exercise interventions during pregnancy on gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP). Also, to update the current evidence through an updated meta-analysis.

DESIGN

Umbrella review.

SETTING

PubMed, EMBASE, Web of Science, Cochrane database of systematic reviews, Epistemonikos, SPORTDiscus, Clinicaltrials.gov, and PROSPERO register were searched from the database inception until August 2021.

POPULATION

Peer-reviewed systematic reviews and meta-analyses of randomised controlled trials (RCTs) and RCTs samples.

METHODS

Random-effects model was used to calculate relative risk with 95% confidence interval in the updated meta-analysis. The reference category was the groups that received usual prenatal care. AMSTAR 2 and the Cochrane Collaboration tool were used to assess the quality and GRADE approach was used to assess the overall certainly of evidence.

MAIN OUTCOME MEASURES

GDM and HDP relative risk.

RESULTS

Twenty-three systematic reviews and meta-analyses; and 63 RCTs were included. Single exercise interventions reduced the incidence of GDM and HDP in most systematic reviews and meta-analyses. Moreover, exercise interventions during pregnancy decrease the incidence of developing GDM and GH, particularly when they are supervised, have a low to moderate intensity level, and are initiated during the first trimester of pregnancy.

CONCLUSION

Based on the findings, obstetric and physical exercise professionals could recommend exercise interventions during pregnancy as an effective strategy to improve maternal outcomes.

Risk factors of lower birth weight, small-for-gestational-age infants, and preterm birth in pregnancies following bariatric surgery: a scoping review

PURPOSE

Bariatric surgery increases the risk of lower birth weight, small-for-gestational-age (SGA) infants, and preterm birth in a subsequent pregnancy. However, the factors that contribute to these adverse birth outcomes are unclear. This review aimed to collate available information about risk factors of lower birth weight, SGA, and preterm birth following bariatric surgery.

METHODS

A literature search was conducted using five databases (PubMed, PsycINFO, EMBASE, Web of Science, and Cochrane Library) to obtain relevant studies.

RESULTS

A total number of 85 studies were included. Studies generally excluded surgery-to-conception interval, pregnancy complications, cigarette use, and maternal age as influencing factors of birth weight, SGA, or preterm birth. In contrast, most studies found that malabsorptive procedures, lower gestational weight gain, lower glucose levels, abdominal pain, and insufficient prenatal care were associated with an elevated risk of adverse birth outcomes. Findings were mixed regarding the effects of surgery-to-conception weight loss, pre-pregnancy body mass index, micronutrient deficiency, and lipid levels on birth outcomes. The examination of maternal microbiome profiles, placental function, alcohol use, and exercise was limited to one study; therefore, no conclusions could be made.

CONCLUSION

This review identified factors that appear to be associated (e.g., surgery type) or not associated (e.g., surgery-to-conception interval) with birth outcomes following bariatric surgery. The mixed findings and the limited number of studies on several variables (e.g., micronutrients, exercise) highlight the need for further investigation. Additionally, future studies may benefit from exploring interactions among risk factors and expanding to assess additional exposures such as maternal mental health.

Preeclampsia and Obesity-The Preventive Role of Exercise

Obesity is now recognized as a worldwide epidemic. An inadequate diet and reduced physical activity are acknowledged as the leading causes of excess body weight. Despite growing evidence that obesity is a risk factor for unsuccessful pregnancies, almost half of all women who become pregnant today are overweight or obese. Common complications of pregnancy in this group of women are preeclampsia and gestational hypertension. These conditions are also observed more frequently in women with excessive weight gain during pregnancy. Preeclampsia is one of the most serious pregnancy complications with an unpredictable course, which in its most severe forms, threatens the life and health of the mother and her baby. The early identification of the risk factors for preeclampsia development, including obesity, allows for the implementation of prophylaxis and a reduction in maternal and fetal complications risk. Additionally, preeclampsia and obesity are the recognized risk factors for developing cardiovascular disease in later life, so prophylaxis and treating obesity are paramount for their prevention. Thus, a proper diet and physical activity might play an essential role in the prophylaxis of preeclampsia in this group of women. Limiting weight gain during pregnancy and modifying the metabolic risk factors with regular physical exercise creates favorable metabolic conditions for pregnancy development and benefits the elements of the pathogenetic sequence for preeclampsia development. In addition, it is inexpensive, readily available and, in the absence of contraindications to its performance, safe for the mother and fetus. However, for this form of prevention to be effective, it should be applied early in pregnancy and, for overweight and obese women, proposed as an essential part of planning pregnancy. This paper aims to present the mechanisms of the development of hypertension in pregnancy in obese women and the importance of exercise in its prevention.

The effect of exercise on the prevention of gestational hypertension in obese and overweight pregnant women: An updated meta-analysis

Background

Gestational hypertension (GH) is a common disease that seriously threatens the safety and health of pregnant women and their newborns. Physical exercise (PE) is widely recognized as a health maintenance method and it has numerous benefits. Studies on the association between PE and the risk of GH in obese and overweight pregnant women have generated controversial findings. This updated meta-analysis was performed to reassess the effects of PE on GH.

Methods

The articles from inception to April 2022, presenting studies investigating exercise intervention and pregnancy outcomes were explored across several online databases. Heterogeneity among the included studies was estimated and tested by Q test and I ² statistic. Risk ratios (RRs) and 95% confidence intervals (CI) were calculated through either random-effect or fixed-effect models. Subgroup analyses, sensitivity analyses, and publication bias diagnoses were also conducted.

Results

Twelve with 1,649 subjects were included. PE was associated with a reduced risk of GH in obese and overweight pregnant women (Pooled RR = 0.58, 95% CI = 0.42-0.81, P = 0.001; I ² = 24.3%). Subgroup analysis found significant trends amongst Eastern countries (RR = 0.59, 95% CI = 0.36-0.96, P = 0.033). Sensitivity analysis suggested the results were stable. No publication bias was detected based on Begg's test and Egger's test.

Conclusion

PE was associated with reduced risk of GH in obese and overweight pregnant women, especially in Eastern countries. More well-designed studies are still needed to further elaborate on these associations.

Systematic review registration

CRD42022326183.

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.

Effects of Supervised Exercise on the Development of Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis

Hypertensive disorders of pregnancy (HDP) are the most common medical complication in pregnancy, affecting approximately 10-15% of pregnancies worldwide. HDP are a major cause of maternal and perinatal morbidity and mortality, and each year, worldwide, around 70,000 mothers and 500,000 babies die because of HDP. Up-to-date high-quality systematic reviews quantifying the role of exercise and the risks of developing HDP are currently lacking. Physical exercise is considered to be safe and beneficial to pregnant women. Supervised exercise has been shown to be safe and to be more beneficial than unsupervised exercise in the general population, as well as during pregnancy in women with obesity and diabetes. Therefore, we undertook a systematic review and meta-analysis to investigate the effects of women performing supervised exercise during pregnancy compared to a control group (standard antenatal care or unsupervised exercise) on the development of HDP. We searched Medline, Embase, CINHAL, and the Cochrane Library, which were searched from inception to December 2021. We included only randomized controlled trials (RCTs) investigating the development of HDP compared to a control group (standard antenatal care or unsupervised exercise) in pregnant women performing supervised exercise. Two independent reviewers selected eligible trials for meta-analysis. Data collection and analyses were performed by two independent reviewers. The PROSPERO registration number is CRD42020176814. Of 6332 articles retrieved, 16 RCTs met the eligibility criteria, comparing a total of 5939 pregnant women (2904 pregnant women in the intervention group and 3035 controls). The risk for pregnant women to develop HDP was significantly reduced in the intervention compared to the control groups, with an estimated pooled cumulative incidence of developing HDP of 3% in the intervention groups (95% CI: 3 to 4) and of 5% in the control groups (95% CI: 5 to 6), and a pooled odds ratio (OR) comparing intervention to control of 0.54 (95% CI:0.40 to 0.72, p < 0.001). A combination of aerobic and anaerobic exercise, or yoga alone, had a greater beneficial effect compared to performing aerobic exercise only (mixed-OR = 0.50, 95% CI:0.33 to 0.75, p = 0.001; yoga-OR = 0.28, 95% CI:0.13 to 0.58, p = 0.001); aerobic exercise only-OR = 0.87, 95% CI:0.55 to 1.37, p = 0.539). Pregnancy is an opportunity for healthcare providers to promote positive health activities, thus optimizing the health of pregnant women with potential short- and long-term benefits for both mother and child. This systematic review and meta-analysis support a beneficial effect of either structured exercise (combination of aerobic, strength, and flexibility workouts) or yoga for preventing the onset of HDP. Yoga, considered a low-impact physical activity, could be more acceptable and safer for women in pregnancy in reducing the risk of developing HDP.

Analysis and Intervention of Factors Affecting Abnormal Postpartum Glucose Tolerance and Gestational Recurrence in Gestational Diabetes

ObjectiveTo investigate the influencing factors of abnormal postpartum glucose tolerance and pregnancy recurrence in gestational diabetes mellitus (GDM) and to develop reasonable interventions to prevent postpartum glucose tolerance and recurrence of pregnancy. Methods. Retrospective analysis of clinical data of 238 GDM patients during pregnancy, including age, body mass index (BMI) before and after pregnancy, regular exercise during pregnancy, insulin use, family history of diabetes, fasting blood glucose (FPG) during pregnancy, oral glucose tolerance test (OGTT) 2 h time value, blood lipid index, and whether pregnant again. At the same time, the women were followed up by telephone or home visits to understand and guide the patient's diet and exercise. The clinical characteristics of the two groups of patients were compared. According to the OGTT test, the recovery of glucose tolerance in pregnant women 6–8 weeks postpartum was divided into the normal postpartum glucose tolerance group and the abnormal group. Logistic multivariate analysis was used to find the influencing factors of postpartum glucose tolerance and recurrence of pregnancy. Results. Between 238 patients of followed-up, 150 pregnant women had abnormal postpartum glucose tolerance, accounting for 63.03%. There were 115 repregnants, of whom 37 (32.17%) had a recurrence of postpartum glucose tolerance. Pre and postpregnancy BMI, insulin use during pregnancy, family history of diabetes, FPG during pregnancy, OGTT 2 h values, and triglyceride (TG) were independent risk factors for abnormal postpartum diabetes and recurrence of pregnancy in GDM patients. Conclusions. Patients with GDM are at high risk of postpartum abnormal glucose tolerance and pregnancy recurrence, which may be influenced by the pregnant woman's prepregnancy and postpartum BMI, insulin use during pregnancy, family history of diabetes, FPG, OGGT 2 h values during pregnancy, and TG levels. Therefore, health education for pregnant women should be strengthened in the clinic, with guidance on proper diet for weight control, increased exercise, and regular blood glucose screening and monitoring for those at risk.