Exercise intervention during pregnancy can be used to manage weight gain and improve pregnancy outcomes in women with gestational diabetes mellitus

The association of physical activity during pregnancy with birthweight extremes: A scoping review

OBJECTIVES

Birthweight (BW) indicates newborn health and is a risk factor for development of chronic diseases later in life. The aim was to investigate whether or not prenatal physical activity (PA) influences BW extremes and how PA influences BW extremes in those diagnosed with pregnancy-related diseases.

DESIGN

We performed a scoping review.

METHODS

Searches were completed on five databases and studies identified were uploaded to Covidence.

RESULTS

Across the five databases 3114 studies were identified and after screening, 69 of these studies were used for the final review. Of the 61 studies that considered low BW (LBW)/small for gestational age (SGA) infants, the majority of results (69 %) indicated that PA during pregnancy had no significant impact on LBW or SGA infants. In addition, 11 % of studies reported a significant decrease in the prevalence of LBW infants, however two studies (3 %) reported a significant increase in LBW or SGA infants, likely relating to individuals with high body mass index and poor adherence to PA. Of the 41 studies that did report LGA/macrosomia, 34 % reported that PA significantly reduced the prevalence of higher BW infants. One study reported the association between meeting exercise recommendations and reducing the odds of LGA infants in those with pregnancy-related diseases.

CONCLUSIONS

We provide evidence on the association of prenatal PA with BW extremes. It is suggested that prenatal PA does not increase the risk of delivering LBW/SGA infants and may reduce the prevalence of large BW infants. Further research is needed to confirm these relationships and explain their underlying mechanisms.

Role of dietary food intake patterns, anthropometric measures, and multiple biochemical markers in the development of pregnancy-specific urinary incontinence in gestational diabetes mellitus

OBJECTIVES

The aim of this study was to assess maternal dietary food intake patterns, anthropometric measures, and multiple biochemical markers in women with gestational diabetes mellitus and pregnancy-specific urinary incontinence and to explore whether antedating gestational diabetes mellitus environment affects the pregnancy-specific urinary incontinence development in a cohort of pregnant women with gestational diabetes mellitus and pregnancy-specific urinary incontinence.

METHODS

Maternal dietary information and anthropometric measurements were collected. At 24 wk of gestation, with a fasting venipuncture sample, current blood samples for biochemical markers of hormones, vitamins, and minerals were analyzed. The groups were compared in terms of numerical variables using analysis of variance for independent samples followed by multiple comparisons.

RESULTS

Of the 900 pregnant women with complete data, pregnant women in the gestational diabetes mellitus pregnancy-specific urinary incontinence group had higher body mass index during pregnancy, arm circumference, and triceps skinfold than the non-gestational diabetes mellitus continent and non-gestational diabetes mellitus pregnancy-specific urinary incontinence groups, characterizing an obesogenic maternal environment. Regarding dietary food intake, significant increases in aromatic amino acids, branched-chain amino acids, dietary fiber, magnesium, zinc, and water were observed in pregnancy-specific urinary incontinence group compared with the non-gestational diabetes mellitus continent group. Serum vitamin C was reduced in the gestational diabetes mellitus pregnancy-specific urinary incontinence group compared with the non-gestational diabetes mellitus pregnancy-specific urinary incontinence group.

CONCLUSIONS

This study emphasizes the necessity for a comprehensive strategy for gestational diabetes mellitus women with pregnancy-specific urinary incontinence in terms of deviation in maternal adaptation trending toward obesity and maternal micronutrients deficiencies.

Effects of women with gestational diabetes mellitus related weight gain on pregnancy outcomes and its experiences in weight management programs: a mixed-methods systematic review

Introduction

Proper controlling gestational diabetes mellitus (GDM)-related gestational weight gain (GWG) during pregnancy can optimize pregnancy outcomes and improve postpartum glucose homeostasis. This study aimed to explore the existing intervention programs, the effects on pregnancy outcomes, and the experiences of weight management for GDM-related GWG in women with GDM.

Methods

This mixed-methods systematic review was retrieved from nine databases. The retrieval time was from the database construction to September 20, 2023, and all studies were published in English and Chinese. The included records used quantitative, qualitative, or mixed methods and reported original studies of weight-related intervention regimens, effects on pregnancy outcomes, and women's experiences and perceptions. This review used a convergent segregated approach to synthesize and integrate research findings from Joanna Briggs Institute (JBI) mixed-methods systematic reviews.

Results

There were 16 articles that met the inclusion criteria, and the articles came from seven different countries and included 23,997 women with GDM. The meta-analysis pooled outcomes for the incidence of weight gain exceeding the Institute of Medicine (IOM) recommendations after GDM diagnosis to delivery was 0.31% (95% CI 0.21-0.42). The effectiveness of GDM-related weight interventions in reducing weight gain after GDM diagnosis was supported by quantitative evidence. The GDM-related GWG below the IOM recommendations is a protective factor (OR=0.68, 95%CI 0.48-0.97) for large for gestational Age (LGA), and above the IOM recommendations is a risk factor (OR=1.62, 95%CI 1.15-2.27) for LGA. In addition, no significant statistical significance was found in the pooled outcomes of small for gestational age (SGA). Avoiding excessive weight gain helps to optimize neonatal birth weight, pregnancy outcomes, and maternal blood glucose levels. According to qualitative survey results, some women with GDM experienced weight stigma, and a positive relationship between healthcare providers and GDM women helped in weight management.

Conclusion

Following a diagnosis of GDM, weight management interventions positively affected GWG and pregnancy outcomes. In order to improve compliance and safety of weight management in women with GDM, criteria and interventions for weight gain associated with GDM need to be further explored and improved.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=404492, identifier CRD42023404492.

Physical Activity as a Modern Intervention in the Fight against Obesity-Related Inflammation in Type 2 Diabetes Mellitus and Gestational Diabetes

Diabetes is one of the greatest healthcare problems; it requires an appropriate approach to the patient, especially when it concerns pregnant women. Gestational diabetes mellitus (GDM) is a common metabolic condition in pregnancy that shares many features with type 2 diabetes mellitus (T2DM). T2DM and GDM induce oxidative stress, which activates cellular stress signalling. In addition, the risk of diabetes during pregnancy can lead to various complications for the mother and foetus. It has been shown that physical activity is an important tool to not only treat the negative effects of diabetes but also to prevent its progression or even reverse the changes already made by limiting the inflammatory process. Physical activity has a huge impact on the immune status of an individual. Various studies have shown that regular training sessions cause changes in circulating immune cell levels, cytokine activation, production and secretion and changes in microRNA, all of which have a positive effect on the well-being of the diabetic patient, mother and foetus.

The association of insufficient gestational weight gain in women with gestational diabetes mellitus with adverse infant outcomes: A case-control study

Background

To investigate the association between insufficient maternal gestational weight gain (GWG) during dietary treatment, and neonatal complications of small-for-gestational-age (SGA) infants born to mothers with Gestational diabetes mellitus (GDM).

Methods

A retrospective case-control study was conducted, involving 1,651 infants born to mothers with GDM. The prevalence of a perinatal outcome and maternal GWG were compared among SGA, adequate- (AGA), and large-for-gestational-age (LGA); association with birth weight and GWG was identified using Pearson's correlation analysis; binary logistic regression was performed to determine the odds ratio (OR) associated with SGA.

Results

In total, 343 SGA, 1025 AGA, and 283 LGA infants met inclusion criteria. The frequency of SGA infants who were siblings (41.7 vs. 4.3 vs. 1.9%) and composite of complications (19.2 vs. 12.0 vs. 11.7%) were higher in SGA infants than in those in AGA or LGA infants group (both P < 0.01). GWG and pre-partum BMI were lower among the SGA mothers with GDM group (11.7 ± 4.5 kg, 25.2 ± 3.1 kg/m2) than AGA (12.3 ± 4.6 kg, 26.3 ± 3.4 kg/m2) or LGA (14.0 ± 5.1 kg, 28.7 ± 3.9 kg/m2) mothers with GDM group. Binary logistic regression showed that siblings who were SGA (AOR 18.06, 95% CI [10.83-30.13]) and preeclampsia (AOR 3.12, 95% CI [1.34-7.30]) were associated with SGA, but not GWG below guidelines (P > 0.05). The risk of SGA (25.7 vs. 19.1 vs. 14.2%) and FGR (15.3 vs. 10.9 vs. 7.8%) was higher in GWG below guidelines group than those in GWG above and within guidelines group, the risk of low Apgar score (6.4 vs. 3.0 vs. 2.8%) was higher in GWG above guidelines group than that in GWG below and within guidelines group (P < 0.05).

Conclusion

Our findings demonstrated that GWG above and below guidelines, compared with GWG within guidelines, had a higher risk of adverse infant outcomes. Our findings also suggested that GWG below guidelines did not increase the risk for SGA, though SGA infants had more adverse outcomes among neonates born to mothers with GDM.

Nutritional and Exercise-Focused Lifestyle Interventions and Glycemic Control in Women with Diabetes in Pregnancy: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Diabetes disrupts one in six pregnancies, bestowing immediate and long-term health risks to mother and child. Diet and exercise are commonly prescribed to control dysglycemia, but their effectiveness across sub-populations and types of diabetes (type-1; type-2; or gestational diabetes mellitus, GDM) is uncertain. Therefore, a systematic review and meta-analysis on the effect of diet and/or exercise on glycemia in pregnant women with diabetes was conducted. Random effects models were used to evaluate effect sizes across studies and anticipated confounders (e.g., age, ethnicity, BMI). Of the 4845 records retrieved, 26 studies (8 nutritional supplements, 12 dietary, and 6 exercise interventions) were included. All studies were conducted in patients with GDM. Overall, supplement- and exercise-based interventions reduced fasting glucose (−0.30 mmol/L; 95% CI = −0.55, −0.06; p = 0.02; and 0.10 mmol/L; 95% CI = −0.20, −0.01; p = 0.04); and supplement- and diet-based interventions reduced HOMA-IR (−0.40; 95% CI = −0.58, −0.22; p < 0.001; and −1.15; 95% CI = −2.12, −0.17; p = 0.02). Subgroup analysis by confounders only confirmed marginal changed effect sizes. Our results suggest a favorable role of certain nutritional supplements, diet, and exercise practices on glycemia in women with GDM and underline a lack of evidence in ~20% of other diabetes-related pregnancies (i.e., women with pre-existing diabetes).

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.

Aerobic or Resistance Exercise for Improved Glycaemic Control and Pregnancy Outcomes in Women with Gestational Diabetes Mellitus: A Systematic Review

Exercise is often recommended in addition to diet and medication in the management of gestational diabetes mellitus (GDM). Our aim was to determine if strength training compared with aerobic exercise had an impact on glycaemic control, maternal and neonatal outcomes. The Cochrane library, Embase, PubMed, CINAHL, Medline, Google Scholar, and OpenGrey were searched. Over 758 pregnant women (mother-baby pairs) from 14 studies are included in this systematic review. Interventions ranged from cycling, aerobic exercises, walking, yoga, or combined aerobic and resistance exercises. Of the studies identified, none directly compared aerobic exercise with strength training. Half of the studies showed benefit in glycaemic control with additional exercise compared with usual physical activity. There was largely no impact on obstetric or neonatal outcomes. Studies on exercise in GDM have reiterated the safety of exercise in pregnancy and shown mixed effects on maternal glycaemic control, with no apparent impact on pregnancy outcomes. The heterogenicity of reported studies make it difficult to make specific recommendations on the optimum exercise modality for the management of GDM. The use of a core outcome set for GDM may improve reporting of studies on the role of exercise in its management.

Association of Genetic Predisposition and Physical Activity With Risk of Gestational Diabetes in Nulliparous Women

IMPORTANCE

Polygenic risk scores (PRS) for type 2 diabetes (T2D) can improve risk prediction for gestational diabetes (GD), yet the strength of the association between genetic and lifestyle risk factors has not been quantified.

OBJECTIVE

To assess the association of PRS and physical activity in existing GD risk models and identify patient subgroups who may receive the most benefits from a PRS or physical activity intervention.

DESIGN, SETTINGS, AND PARTICIPANTS

The Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort was established to study individuals without previous pregnancy lasting at least 20 weeks (nulliparous) and to elucidate factors associated with adverse pregnancy outcomes. A subcohort of 3533 participants with European ancestry was used for risk assessment and performance evaluation. Participants were enrolled from October 5, 2010, to December 3, 2013, and underwent genotyping between February 19, 2019, and February 28, 2020. Data were analyzed from September 15, 2020, to November 10, 2021.

EXPOSURES

Self-reported total physical activity in early pregnancy was quantified as metabolic equivalents of task (METs). Polygenic risk scores were calculated for T2D using contributions of 84 single nucleotide variants, weighted by their association in the Diabetes Genetics Replication and Meta-analysis Consortium data.

MAIN OUTCOMES AND MEASURES

Estimation of the development of GD from clinical, genetic, and environmental variables collected in early pregnancy, assessed using measures of model discrimination. Odds ratios and positive likelihood ratios were used to evaluate the association of PRS and physical activity with GD risk.

RESULTS

A total of 3533 women were included in this analysis (mean [SD] age, 28.6 [4.9] years). In high-risk population subgroups (body mass index ≥25 or aged ≥35 years), individuals with high PRS (top 25th percentile) or low activity levels (METs <450) had increased odds of a GD diagnosis of 25% to 75%. Compared with the general population, participants with both high PRS and low activity levels had higher odds of a GD diagnosis (odds ratio, 3.4 [95% CI, 2.3-5.3]), whereas participants with low PRS and high METs had significantly reduced risk of a GD diagnosis (odds ratio, 0.5 [95% CI, 0.3-0.9]; P = .01).

CONCLUSIONS AND RELEVANCE

In this cohort study, the addition of PRS was associated with the stratified risk of GD diagnosis among high-risk patient subgroups, suggesting the benefits of targeted PRS ascertainment to encourage early intervention.

Is limited access to obstetric services associated with adverse birth outcomes? A cross-sectional study of Korean national birth data

OBJECTIVES

The geographical disparity in the access to essential obstetric services is a public health issue in many countries. We explored the association between timely access to obstetric services and the individual risk of adverse birth outcomes.

DESIGN

Repeated cross-sectional design.

SETTING

South Korean national birth data linked with a medical service provision database.

PARTICIPANTS

1 842 718 singleton livebirths from 2014 to 2018.

PRIMARY OUTCOME MEASURES

Preterm birth (PTB), post-term birth, low birth weight (LBW) and macrosomia.

RESULTS

In the study population, 9.3% of mothers lived in districts where the Time Relevance Index (TRI) was as low as the first quartile (40.6%). Overall PTB and post-term birth rates were 5.0% and 0.1%, respectively. Among term livebirths, LBW and macrosomia occurred in 1.0% and 3.3%, respectively. When the TRI is lower, representing less access to obstetric care, the risk of macrosomia was higher (adjusted OR=1.15, 95% CI 1.11 to 1.20 for Q1 compared with Q4). Similarly, PTB is more likely to occur when TRI is lower (1.05, 95% CI 1.00 to 1.10 for Q1; 1.03, 95% CI 1.01 to 1.05 for Q2). There were some inverse associations between TRI and post-term birth (0.80, 95% CI 0.71 to 0.91, for Q2; 0.84, 95% CI 0.76 to 0.93, for Q3).

CONCLUSIONS

We observed less accessibility to obstetric service is associated with higher risks of macrosomia and PTB. This finding supports the role of obstetric service accessibility in the individual risk of adverse birth outcomes.

Possible roles of exercise and apelin against pregnancy complications

The prevalence of maternal obesity during pregnancy is associated with the risk of gestational diabetes, preeclampsia, and cardiomyopathy. Environmental factors such as active lifestyles and apelin may lead to beneficial changes. In rats, apelin and exercise (45 to 65% VO_2max for 6 to 9 weeks) during pregnancy increase brown adipose tissue (BAT) proteins such as Cidea, Elovl3, UCP1, PRDM16, and PGC-1α in males and females fetuses, while white adipose tissue (WAT) is reduced. In humans and animals, apelin and exercise stimulate the expression of the glucose transporters (GLUT1/2/4) in the muscle and adipose tissue through the PI3K/Akt and AMPK pathways. Hence, exercise and apelin may are known as regulators of energy metabolism and be anti-obesity and anti-diabetic properties. In mice, exercise also creates a short-term hypoxic environment in the pregnant mother, activating HIF-1, VEGF, and VEGFR, and increasing angiogenesis. Exercise and apelin also increase vasodilation, angiogenesis, and suppression of inflammation through the L-arginine/eNOS/NO pathway in humans. Exercise can stimulate the ACE2-Ang-(1-7)-Mas axis in parallel with inhibiting the ACE-Ang II-AT1 pathway. Exercise and apelin seem to prevent preeclampsia through these processes. In rats, moderate-intensity exercise (60 to 70% VO_2max for 8 weeks) and apelin/APJ also may prevent pathological hypertrophy in pregnancy by activating the PI3K/Akt/mTOR/p70S6K pathway, PI3k-Akt-ERK1/2-p70S6K pathway, and the anti-inflammatory cytokine IL-10. Since pre-clinical studies have been more on animal models, future research with scientific guidelines should pay more attention to human specimens. In future research, time factors such as the first, second, and third trimesters of pregnancy and the intensity and duration of exercise are important variables that should be considered to determine the optimal intensity and duration of exercise.

Interventions to reduce preterm birth and stillbirth, and improve outcomes for babies born preterm in low- and middle-income countries: A systematic review

BACKGROUND

Reducing preterm birth and stillbirth and improving outcomes for babies born too soon is essential to reduce under-5 mortality globally. In the context of a rapidly evolving evidence base and problems with extrapolating efficacy data from high- to low-income settings, an assessment of the evidence for maternal and newborn interventions specific to low- and middle-income countries (LMICs) is required.

METHODS

A systematic review of the literature was done. We included all studies performed in LMICs since the Every Newborn Action Plan, between 2013 - 2018, which reported on interventions where the outcome assessed was reduction in preterm birth or stillbirth incidence and/or a reduction in preterm infant neonatal mortality. Evidence was categorised according to maternal or neonatal intervention groups and a narrative synthesis conducted.

RESULTS

179 studies (147 primary evidence studies and 32 systematic reviews) were identified in 82 LMICs. 81 studies reported on maternal interventions and 98 reported on neonatal interventions. Interventions in pregnant mothers which resulted in significant reductions in preterm birth and stillbirth were (i) multiple micronutrient supplementation and (ii) enhanced quality of antenatal care. Routine antenatal ultrasound in LMICs increased identification of fetal antenatal conditions but did not reduce stillbirth or preterm birth due to the absence of services to manage these diagnoses. Interventions in pre-term neonates which improved their survival included (i) feeding support including probiotics and (ii) thermal regulation. Improved provision of neonatal resuscitation did not improve pre-term mortality rates, highlighting the importance of post-resuscitation care. Community mobilisation, for example through community education packages, was found to be an effective way of delivering interventions.

CONCLUSIONS

Evidence supports the implementation of several low-cost interventions with the potential to deliver reductions in preterm birth and stillbirth and improve outcomes for preterm babies in LMICs. These, however, must be complemented by overall health systems strengthening to be effective. Quality improvement methodology and learning health systems approaches can provide important means of understanding and tackling implementation challenges within local contexts. Further pragmatic efficacy trials of interventions in LMICs are essential, particularly for interventions not previously tested in these contexts.

Macrosomia and large for gestational age in Asia: One size does not fit all

Macrosomia, usually defined as infant birth weight of ≥4000 g, does not consider gestational age, sex, or country/region-specific differences in mean birth weight and maternal body weight. This issue is particularly relevant for Asia, where 60% of the world's population lives, due to variations in maternal size and birth weights across populations. Large for gestational age (LGA), defined as birth weight > 90th centile, is a more sensitive measure as it considers gestational age and sex, though it is dependent on the choice of growth charts. We aimed to review reporting of macrosomia and LGA in Asia. We reviewed the literature on prevalence and risk of macrosomia and LGA in Asia over the last 29 years. Prevalence of macrosomia ranged from 0.5% (India) to 13.9% (China) while prevalence of LGA ranged from 4.3% (Korea) to 22.1% (China), indicating substantial variation in prevalence within and between Asian countries. High pre-pregnancy body mass index, excessive gestational weight gain, and impaired glucose tolerance conferred risk of macrosomia/LGA. Incidence of macrosomia and LGA varies substantially within and between Asian countries, as do the growth charts and definitions. The latter makes it impossible to make comparisons but suggests differences in intrauterine growth between populations. Reporting LGA, using standardized country/regional growth charts, would better capture the incidence of high birth weight and allow for comparison and identification of contributing factors. Better understanding of local drivers of excessive intrauterine growth could enable development of improved strategies for prevention and management of LGA.

Effects of Maternal Exercise During Pregnancy on Perinatal Growth and Childhood Obesity Outcomes: A Meta-analysis and Meta-regression

BACKGROUND

Perinatal growth abnormalities program susceptibility to childhood obesity, which is further exaggerated by maternal overweight and obesity (MO) during pregnancy. Exercise is highly accessible, but reports about the benefits of maternal exercise on fetal growth and childhood obesity outcomes are inconsistent, reducing the incentives for pregnant women to participate in exercise to improve children's perinatal growth.

OBJECTIVE

This systematic review and meta-analysis aims to establish evidence-based efficacy of exercise in mothers with normal weight (MNW) and MO during pregnancy in reducing the risks of perinatal growth abnormalities and childhood obesity. In addition, the impacts of exercise volume are also assessed.

METHODS

The PubMed, ScienceDirect, Web of Science, and Cochrane Library databases were searched from inception to February 15, 2020. We included randomized controlled trials with exercise-only intervention or exercise with other confounders in pregnant MNW (body mass index, BMI 18.5-24.9 kg/m²) and MO (BMI ≥ 25 kg/m²), which were further subgrouped in the meta-analysis. Primary outcomes included birth weight, preterm birth, small for gestational age (SGA), large for gestational age (LGA), infant and childhood weight, and childhood obesity. A linear meta-regression analysis was also used to explore the effects of exercise volume on outcomes.

RESULTS

99 studies were included in the meta-analysis (n = 596,876), and individual study quality ranged from fair to good according to the Newcastle-Ottawa scale assessment. Exercise only interventions in MNW reduced preterm birth by 15% (26 studies, n = 76,132; odds ratio [OR] 0.85; 95% CI 0.72, 1.01; I² = 83.3%), SGA by 17% (33 studies, n = 92,351; OR 0.83; 95% CI 0.71, 0.98; I² = 74.5%) and LGA by 17% (29 studies, n = 84,310; OR 0.83; 95% CI 0.74, 0.95; I² = 60.4%). Exercise only interventions in MO reduced preterm birth by 33% (2 studies, n = 3,050; OR 0.67; 95% CI 0.70, 0.96; I² = 0%), SGA by 27% (8 studies, n = 3,909; OR 0.73; 95% CI 0.50, 1.05; I² = 40.4%) and LGA by 55% (9 studies, n = 81,581; OR 0.45; 95% CI 0.18, 1.11; I² = 98.3%). Exercise only interventions in MNW reduced childhood obesity by 53% (3 studies, n = 6,920; OR 0.47; 95% CI 0.36, 0.63; I² = 77.0%). However, no significant effect was observed in outcomes from exercise confounders in either MNW or MO. In the meta-regression, the volume of exercise-only intervention in MNW was negatively associated with birth weight, greatly driven by volumes more than 810 metabolic equivalents (MET)-min per week. Other outcomes were not associated with exercise volume.

CONCLUSIONS

This systematic review and meta-analysis suggests that exercise during pregnancy in both MNW and MO safely and effectively reduce the risks of preterm birth, SGA, and LGA. Furthermore, MNW exercise also reduces the risk of childhood obesity. Overall, regardless of prepregnancy BMI, maternal exercise during pregnancy provides an excellent opportunity to mitigate the high prevalence of adverse birth outcomes and childhood obesity.

A case-control study to predict the risk of gestational diabetes mellitus by initial fasting blood sugar or past gestational history

BACKGROUND

Gestational diabetes mellitus (GDM) deserves proper prevention, diagnosis, and management due to healthcare implications from both maternal and fetal concerns.

OBJECTIVE

To evaluate the rate and investigate the risk factors for developing GDM.

MATERIALS AND METHODS

In this case-control, universal screening for GDM between 24 and 28 wk of gestation was performed in 613 pregnant women attending a prenatal clinic in Tehran who were followed-up until delivery between March 2017 to March 2018. Of the 613 women, 143 had GDM and 470 had normal glucose tolerance test as the primary diagnosis. Some GDM risk factors were compared in two groups.

RESULTS

Impaired glucose tolerance test was detected in 143 (23.3%) patients. Prevalence of GDM was higher in the first-trimester fasting blood sugar (FBS) > 90 qmg/dl group (p < 0.001). Comparison of the GDM and the normal glucose tolerance test groups demonstrated significant differences in maternal age, first-trimester FBS, third-trimester vitamin D level, maternal platelet count, maternal body mass index (BMI) (before 12 wk of gestation), weight gain during pregnancy, and the history of gestational complications in previous pregnancy (p < 0.01). In logistic regression, GDM was independently associated with older maternal age, higher first-trimester FBS, the history of gestational complications in previous pregnancy, lower third-trimester vitamin D level, and higher maternal platelet count (p < 0.01).

CONCLUSION

Both patients with higher initial FBS and the history of gestational complications in previous pregnancy should be considered high risk for GDM and screened earlier.

Effectiveness of a Virtual Exercise Program During COVID-19 Confinement on Blood Pressure Control in Healthy Pregnant Women

BACKGROUND

The situation caused by COVID-19 has led to movement restrictions for the majority of the population due to the confinement established by the health authorities. This new situation has changed people's habits and significantly affected the pregnant population. Decreased exercise and increased psychophysical stress are associated with excessive weight gain, diabetes, and gestational cardiovascular complications that affect the mother, fetus, and newborn. Recent research shows that the dynamics of maternal blood pressure is one of the most important control factors during pregnancy. Thus, prevention of these type of pathologies through interventions without maternal-fetal risks is important.

OBJECTIVES

To examine the influence of a virtual exercise program on maternal blood pressure during pregnancy.

MATERIALS AND METHODS

A randomized clinical trial design was used (NCT04563065). Data from 72 pregnant women without obstetric contraindications under confinement conditions in the Madrid area were collected. Women were randomly assigned to the intervention (IG) or control group (CG). They previously signed informed consent forms. A moderate exercise program was performed as an intervention from 8-10 to 38-39 weeks of pregnancy. Systolic (SBP) and diastolic (DBP) maternal blood pressure were measured during the first, second and third trimesters of pregnancy, as well as before and immediately after delivery in both study groups.

RESULTS

No differences in systolic and diastolic blood pressure during the first, second and third trimesters were found between groups. Significant differences in SBP were found immediately before delivery (IG = 119.83 ± 10.16 vs. CG = 125.6 ± 10.91; p = 0.047) and immediately after delivery (IG = 115.00 ± 11.18 vs. CG = 122.24 ± 15.71; p = 0.045).

CONCLUSIONS

Results show lower SBP values for the IG during delivery than CG. A virtual exercise program throughout pregnancy during COVID-19 confinement can help to control systolic blood pressure before and immediately after delivery in healthy pregnant women.

WeChat-assisted dietary and exercise intervention for prevention of gestational diabetes mellitus in overweight/obese pregnant women: a two-arm randomized clinical trial

PURPOSE

This study aimed to examine the influence of a WeChat-based dietary and exercise intervention on gestational diabetes mellitus (GDM) prevention in overweight/obese pregnant women in Beijing.

METHODS

Overweight/obese pregnant women were recruited in the early stages of pregnancy. After screening by include and exclude standards, eligible women were randomly divided into two groups, intervention and control groups. The control group received a general advice session about pregnancy nutrition and weight management. The intervention group received three face-to-face sessions about personalized dietary and exercise intervention, with the help of WeChat as a monitoring tool to promote treatment plan adherence. At 24-28 weeks of pregnancy, GDM was diagnosed according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Gestational weight gain (GWG), maternal and neonatal outcomes were also collected.

RESULTS

This study analyzed 215 participants. At the mid-trimester, 42 (37.8%) women in the control group were diagnosed with GDM (n = 111) versus 25 (24.5%) in the intervention group (n = 104; p < 0.05). The intervention group gained 11.2 ± 4.9 kg during the whole gestation period, with 4.9 ± 3.1 kg-weight increment in the first 25 weeks of pregnancy, versus 13.4 ± 5.0 kg and 6.9 ± 3.2 kg in the first 25 weeks in the control group (between groups: p < 0.001/p = 0.002). Incidence of macrosomia was not significantly lower in the intervention group than in the control group (8/7.9% vs 11/9.9%) (p > 0.05). No significant difference was found in the rate of natural labor and occurrence of perinatal complications (e.g., preterm birth, gestational hypertension, and preeclampsia) between the groups (p > 0.05).

CONCLUSIONS

The WeChat-assisted dietary and exercise intervention was effective in reducing the occurrence of GDM and excessive weight gain in overweight/obese pregnant women. Disseminating knowledge of pregnancy and childbirth through social media platforms like WeChat could be an important part of antenatal care.

Movement Behavior during Pregnancy and Adverse Maternal-Fetal Outcomes in Women with Gestational Diabetes: A Pilot Case-Control Study

Gestational diabetes mellitus (GDM) is a major complication in pregnancy. GDM is associated with a higher risk for adverse maternal–fetal outcomes. Associations between movement behavior, including physical activity (PA) and sedentary behavior (SB), and maternal–fetal outcomes are still unclear. The objective of this study was to investigate associations between movement behavior and adverse maternal–fetal outcomes in women with GDM. A total of 68 women with GDM (20–35 weeks, 32.1 ± 5.8 years) were included in this pilot case-control study. The cases were defined by the presence of an adverse composite maternal–fetal outcome (preterm birth, newborn large for gestational age, and neonatal hypoglycemia). Controls were defined as no adverse maternal–fetal outcome. PA intensities and domains, steps/day (pedometer), and SB were analyzed. A total of 35.3% of participants showed adverse maternal–fetal outcomes (n = 24). The controls showed a higher moderate-intensity PA level than the cases (7.5, 95%CI 3.6–22.9 vs. 3.1, 95%CI 0.4–10.3 MET-h/week; p = 0.04). The moderate-intensity PA level was associated with a lower risk for adverse maternal–fetal outcomes (OR 0.21, 95%CI 0.05–0.91). No significant associations were observed for other PA and SB measures (p > 0.05). In conclusion, moderate-intensity PA during pregnancy seems to have a protective role against adverse maternal–fetal outcomes in women with GDM.

The Role of Lifestyle Intervention in the Prevention and Treatment of Gestational Diabetes

Obesity during pregnancy is associated with the development of adverse outcomes, including gestational diabetes mellitus (GDM). GDM is highly associated with obesity and independently increases the risk of both complications during pregnancy and future impaired glycemic control and risk factors for cardiovascular disease for both the mother and child. Despite extensive research evaluating the effectiveness of lifestyle interventions incorporating diet and/or exercise, there remains a lack of definitive consensus on their overall efficacy alone or in combination for both the prevention and treatment of GDM. Combination of diet and physical activity/exercise interventions for GDM prevention demonstrates limited success, whereas exercise-only interventions report of risk reductions ranging from 3 to 49%. Similarly, combination therapy of diet and exercise is the first-line treatment of GDM, with positive effects on maternal weight gain and the prevalence of infants born large-for-gestational age. Yet, there is inconclusive evidence on the effects of diet or exercise as standalone therapies for GDM treatment. In clinical care, women with GDM should be treated with a multidisciplinary approach, starting with lifestyle modification and escalating to pharmacotherapy if needed. Several key knowledge gaps remain, including how lifestyle interventions can be optimized during pregnancy, and whether intervention during preconception is effective for preventing the rising prevalence of GDM.

Abnormal expression of TRIAP1 and its role in gestational diabetes mellitus-related pancreatic β cells

Gestational diabetes mellitus (GDM) is a disease that is typically characterized by insulin resistance and pancreatic β cell dysfunction. Currently, the role of TP53-regulated inhibitor of apoptosis 1 (TRIAP1) in the process of GDM remains to be elucidated. Therefore, the present study investigated the effects of TRIAP1 on GDM-related pancreatic β cells. Reverse transcription-quantitative PCR and western blot assays were conducted to analyze the expression levels of TRIAP1 in the peripheral blood of patients with GDM and subjects with healthy pregnancies. Subsequently, TRIAP1 small interfering RNA (siRNA), control siRNA, TRIAP1 plasmid and control plasmid were transfected into INS-1 cells to assess the effects of TRIAP1 on pancreatic β cells. ELISA was used to assess the total insulin content and insulin secretion of pancreatic β cells. MTT and flow cytometry assays were performed to determine the viability and apoptosis of pancreatic β cells. The results demonstrated that TRIAP1 expression was downregulated in peripheral blood samples from patients with GDM. Transfection with TRIAP1 siRNA significantly decreased the levels of total insulin content and reduced insulin secretion in pancreatic β cells. In addition, downregulation of TRIAP1 in pancreatic β cells significantly induced cell apoptosis and reduced cell viability. Accordingly, transfection of INS1 cells with TRIAP1 siRNA increased the levels of the apoptosis-associated genes apoptotic protease-activating factor 1, caspase-3, caspase-7 and caspase-9. However, transfection of the cells with TRIAP1 plasmid resulted in the opposite effects. TRIAP1 increased the growth of pancreatic β cells and their ability to secrete insulin, thus playing a protective role in GDM. The findings verified the effects and the underlying mechanism of TRIAP1 in pancreatic β cells and may provide additional clinical applications for the therapy of GDM.

Risk score for predicting primary cesarean delivery in women with gestational diabetes mellitus

Background

Women with gestational diabetes mellitus (GDM) have a higher risk of cesarean delivery (CD) than glucose-tolerant women. The aim of this study was to develop and validate a risk score for predicting primary CD in women with GDM.

Methods

A risk score for predicting primary CD was developed using significant clinical features of 385 women who had a diagnosis of GDM and delivered at our institution between January 2011 and December 2014. The score was then tested for validity in another cohort of 448 individuals with GDM who delivered between January 2015 and December 2018.

Results

The risk score was developed using the features nulliparity, excess gestational weight gain, and insulin use. The scores that classified the pregnant women as low risk (0 points), intermediate risk (1–3 points), and high risk (≥ 4 points) were directly associated with the primary CD rates of the women in the development cohort: 14.7, 38.2 and 62.3%, respectively (P <  0.001). The model showed good calibration and acceptable discriminative power with a C statistic of 0.724 (95% confidence interval, 0.670–0.777). Similar results were observed in the validation cohort.

Conclusion

A risk score using the features nulliparity, excess gestational weight gain, and insulin use can estimate the risk for primary CD in women with GDM.

Developmental origins of ovarian disorder: impact of maternal lean gestational diabetes on the offspring ovarian proteome in mice†

Gestational diabetes mellitus (GDM) is an obstetric disorder affecting approximately 10% of pregnancies. The four high-fat, high-sucrose (HFHS) mouse model emulates GDM in lean women. Dams are fed a HFHS diet 1 week prior to mating and throughout gestation resulting in inadequate insulin response to glucose in mid-late pregnancy. The offspring of HFHS dams have increased adiposity, thus, we hypothesized that maternal metabolic alterations during lean GDM would compromise ovarian function in offspring both basally and in response to a control or HFHS diet in adulthood. Briefly, DLPL were lean dams and control diet pups; DLPH were lean dams and HFHS pups; DHPL were HFHS dams and control diet pups; and DHPH were HFHS dams and HFHS pups. A HFHS challenge in the absence of maternal GDM (DLPL vs. DLPH) increased 3 and decreased 30 ovarian proteins. Maternal GDM in the absence of a dietary stress (DLPL vs. DHPL) increased abundance of 4 proteins and decreased abundance of 85 proteins in the offspring ovary. Finally, 87 proteins increased, and 4 proteins decreased in offspring ovaries due to dietary challenge and exposure to maternal GDM in utero (DLPL vs. DHPH). Canopy FGF signaling regulator 2, deleted in azoospermia-associated protein 1, septin 7, and serine/arginine-rich splicing factor 2 were altered across multiple offspring groups. Together, these findings suggest a possible impact on fertility and oocyte quality in relation to GDM exposure in utero as well as in response to a western diet in later life.

The combination of symphysis-fundal height and abdominal circumference as a novel predictor of macrosomia in GDM and normal pregnancy

Background

Macrosomia is a major adverse pregnancy outcome of gestational diabetes mellitus (GDM). Although BMI, symphysis-fundal height (SFH) and abdominal circumference (AC) are associated with foetal weight, there are some limitations to their use, especially for the prediction of macrosomia. This study aimed to identify a novel predictive methodology to improve the prediction of high-risk macrosomia.

Methods

Clinical information was collected from 3730 patients. The association between the ISFHAC (index of the SFH algorithm multiplied by the square of AC) and foetal weight was determined and validated. A new index, the ISFHAC, was evaluated by area under the curve (AUC) analysis.

Results

A total of 1087 GDM and 657 normal singleton pregnancies were analysed. The ISFHAC was positively correlated with foetal weight in GDM pregnancies and normal pregnancies (NPs). The AUCs of the ISFHAC were 0.815 in the GDM group and 0.804 in the NP group, which were higher than those of BMI, SFH, AC and GA. The ISFHAC cut-off points were 41.7 and 37 in the GDM and NP groups, respectively. The sensitivity values for the prediction of macrosomia with high ISFHAC values were 75.9 and 81.3% in the GDM and NP groups, respectively, which were higher than those with BMI. Regarding the validation data, the sensitivity values for prediction with high ISFHAC values were 78.9% (559 GDM pregnancies) and 78.3% (1427 NPs).

Conclusions

The ISFHAC can be regarded as a new predictor of and risk factor for macrosomia in GDM pregnancy and NP.

Effects of High-Fat Diet and Exercise Intervention on the Metabolism Regulation of Infant Mice

Maternal exercise is crucial for promoting the health of the offspring. Previous studies showed that long-term maternal exercise improves energy metabolism during pregnancy. Whether swimming exercise can reverse the metabolic disorders caused by high-fat exposure in the early life of the offspring is yet to be elucidated. Three-week-old C57BL/6 female mice were randomly assigned to the standard chow diet group (SC), standard chow diet and exercise group (SC-Ex), high-fat diet group (HFD), and high-fat diet and exercise group (HFD-Ex). After swimming intervention for 13 weeks, male and female mice were caged, and the exercise intervention lasted until delivery. Then, the mothers were fed standard chow diet. A total of 8 offsprings/group were randomly selected after 4 weeks of lactation for GTT and ITT. After body composition analysis, the mice were sacrificed to obtain specimens. The levels of metabolism factors and IL-6 were measured by suspension microarray. Subsequently, 15 min after starting the GTT and ITT, the curve detected significant difference between the HFD and other groups. The body fat percentage of the HFD-Ex offspring was significantly lower than that of HFD offspring (p < 0.05) irrespective of the gender. The levels of IL-6 and TG in the male offspring in the HFD-Ex group were improved significantly (p < 0.05). Compared to the HFD offspring, serum glucose and GIP in the female offspring in the HFD-Ex group was significantly reduced (p < 0.05). Long-term exercise of the mother effectively improved the metabolic disorder caused by high-fat exposure in the infant offspring. Thus, the metabolic inheritance of the offspring is gender-dependent; the maternal metabolism can make male offspring genetically susceptible.

Technology-supported lifestyle interventions to improve maternal-fetal outcomes in women with gestational diabetes mellitus: A meta-analysis

BACKGROUND

The increasing incidence of gestational diabetes mellitus (GDM) is a global health problem. Lifestyle interventions have been recognized as effective measures to enhance maternal and child health. Traditional education approaches, personalized consultation and home visits to promote change in patients' lifestyle are limited by cost, lack of resources and inability to provide broad coverage. The increased use of technological approaches can cross these barriers.

OBJECTIVES

The meta-analysis aimed to evaluate the effectiveness of technology-supported lifestyle interventions for women with gestational diabetes mellitus.

METHODS

Databases that were reviewed included the Cochrane Library, PubMed, Web of Science, EBSCO, Embase, Medline, CINAHL and ClinicalTrials.gov. from inception to September 2019. Randomized controlled trials (RCTs) of technology-supported lifestyle interventions used for women with gestational diabetes mellitus (GDM) were identified. Two reviewers independently assessed each study using Cochrane Collaboration's tool. Maternal-fetal outcomes as well as weight gain in pregnancy and maternal blood glucose were presented as relative risks (RR) or a mean difference (MD).

RESULTS

Of the 3993 articles reviewed, ten RCTs involving 979 women were included. Technology-supported lifestyle interventions reduced pregnancy weight gain (MD = -1.55, 95% CI = [-1.81 to -1.29], P < 0.001) and mean (1-h and 2-h) postprandial blood glucose (MD = -0.31, 95% CI = [-0.58 to -0.03], P = 0.03), with low heterogeneity of 36% and 18%, respectively. No evidence of significant effect existed on other maternal-fetal outcomes, such as weeks of gestation at delivery, caesarean birth, pre-eclampsia/gestational hypertension, instrumental vaginal birth, premature delivery, newborn weight, neonatal hypoglycemia, large-for-gestational age, fetal macrosomia, NICU admission and respiratory morbidity (I² ranging from 0% to 51%). No significant improvement was noted in glycosylated hemoglobin (HbA1c) and fasting blood glucose (FBG), with strong heterogeneity of 95% and 84%, respectively.

CONCLUSIONS

Technology-supported lifestyle interventions are associated with reducing pregnancy weight gain and mean (1-h and 2-h) postprandial blood glucose in women with GDM. Well-designed research studies are needed to identify the full potential of technology-supported lifestyle interventions, especially interventions guided by theoretical models.

Different exercises for pregnant women with gestational diabetes: a meta-analysis of randomized controlled trials

INTRODUCTION

There is evidence that maternal and child outcomes in patients with gestational diabetes mellitus (GDM) are associated with different exercise patterns. However, the evidence on which forms of exercise are beneficial for pregnant women with GDM is unclear.

EVIDENCE ACQUISITION

PubMed, EMBASE, the Cochrane Library and the Web of Science were systematically searched for eligible studies until Feb.24, 2019. A randomized controlled trial (RCT) was used as the study method. The literature quality was evaluated and the data extracted by two researchers, and statistical analysis was carried out using Review Manage 5.2 software.

EVIDENCE SYNTHESIS

A total of nine RCTs were included. The research results show that compared with the conventional treatment group, aerobic exercise reduced the fasting blood glucose (WMD=-0.35, 95% CI: -0.62 to -0.08, I2=87%), postprandial blood glucose (WMD=-0.62, 95% CI:-0.95 to -0.29, I2=84%) and glycosylated hemoglobin levels (WMD=-0.35, 95% CI:-0.49 to -0.20, I2=71%) in patients with GDM. Compared with the conventional treatment group, the dosage of insulin (WMD=0.97, 95% CI: 0.42-2.26, I2=0%) in patients with GDM in the resistance exercise group was reduced, and the effect of combined treatment was statistically significant. Compared with the conventional treatment group, the combination of aerobic exercise plus resistance exercise training reduced postprandial blood glucose in patients with GDM (WMD=-0.64, 95% CI:-0.94 to -0.34), and the combined treatment effect was statistically significant.

CONCLUSIONS

Different types of exercise have different intervention effects on the outcome of patients with gestational diabetes. However, we do not have enough data to determine whether infants benefit from this exercise, and it is still necessary to conduct large-scale, high-quality and long-term intervention studies for verification.

Reliability and validity of Turkish version of pregnancy physical activity questionnaire (PPAQ) in patients with gestational diabetes mellitus. J OBSTET GYNAECOL 2019;40:176-181. [PMID: 31466492 DOI: 10.1080/01443615.2019.1606178]

Gestational diabetes mellitus (GDM) is a common complication during pregnancy. Evaluation of the quantitative physical activity in diabetic pregnant women is critical. The aim of this study was to test the reliability and validity of the Pregnancy Physical Activity Questionnaire (PPAQ) in Turkish patients with GDM. A total of 120 pregnant women between the ages of 18 and 44 years with GDM were included. The reliability of the questionnaire was measured by internal consistency and analysis of 2-week test-retest reliability. Of the patients, 74 completed the test-retest procedure. Concurrent validity was examined by comparing the PPAQ with the Short Form of the International Physical Activity Questionnaire (IPAQ) in 36 patients. Test-retest intraclass correlation coefficient scores varied between 0.72 and 0.95. The Spearman rank correlation analysis showed that the PPAQ total activity values were statistically significantly correlated with the total values of IPAQ-Short Form (r = 0.410 and p = .030). In conclusion, the Turkish version of the PPAQ is a valid and reliable tool for the measurement of the physical activity level of pregnant women with GDM.Impact statementWhat is already known on this subject? The pregnancy physical activity questionnaire (PPAQ) developed in 2004 by Chasan-Taber et al.; is a simple and short questionnaire measuring the frequency, duration, and intensity of physical activity in pregnant women. To date, this questionnaire has been translated into many languages and has been used in a number of studies.What do the results of this study add? The aim of this study was to test the reliability and validity of the PPAQ in Turkish pregnant women with GDM. On the basis of our study results, we suggest that the Turkish version of the PPAQ is a valid and reliable tool for the measurement of the physical activity level of pregnant women with GDM.What are the implications of these findings for clinical practice and/or further research? Evaluation of the quantitative physical activity in diabetic pregnant women may contribute to gain a better understanding of the role of physical activity during treatment and may be useful to compare the results of different studies carried out in different places more effectively.

Dietary and exercise interventions and glycemic control and maternal and newborn outcomes in women diagnosed with gestational diabetes: Systematic review

Gestational diabetes mellitus (GDM) is one of the most common complication of pregnancy and can lead to significant perinatal mortalities as well as long term risk of comorbidities for both mother and her offspring. This systematic review aimed to explore whether combined diet and exercise interventions are associated with improved glycemic control and/or improved maternal and newborn outcomes in women with GDM when compared to dietary interventions. A search on combined diet and exercise interventions during pregnancy in women with GDM was performed in 3 electronic databases: PubMed (NCBI), ScienceDierct, and the Cochrane Library. Evaluated outcomes were fasting blood glucose levels, postprandial blood glucose levels, glycated hemoglobin percentages, total weight gain during pregnancy, proportion of caesarean delivery, proportion of patients needing insulin, neonatal birth weight, proportion of macrosomia, neonatal hypoglycemia, and preterm birth. This systematic review identified eight randomized, controlled trials involving 592 pregnant women and 350 infants. The risk of bias of the included trials ranged from high to low. The combined diet and exercise interventions reduced fasting and postprandial blood glucose levels when compared to dietary interventions. No significant differences were reported in the selected trials regarding total weight gain during pregnancy, cesarean section, neonatal birth weight, macrosomia, neonatal hypoglycemia, and preterm birth between diet plus exercise and diet groups. The combination of diet and exercise interventions help to control postprandial blood glucose concentration in women diagnosed with GDM, but did not change either maternal or newborn outcomes. REGISTRATION: PROSPERO CRD42018109896.

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.

Pregnancy and Lactation: A Window of Opportunity to Improve Individual Health

Human and animal studies indicate that obesity during pregnancy adversely impacts both maternal health and offspring phenotype predisposing them to chronic diseases later in life including obesity, dyslipidemia, type 2 diabetes mellitus, and hypertension. Effective interventions during human pregnancy and/or lactation are needed to improve both maternal and offspring health. This review addresses the relationship between adverse perinatal insults and its negative impact on offspring development and presents some maternal intervention studies such as diet modification, probiotic consumption, or maternal exercise, to prevent or alleviate the negative outcomes in both the mother and her child.

Gestational diabetes mellitus: Multi-disciplinary treatment approaches

Gestational diabetes mellitus (GDM) is the most common metabolic disease of pregnancy, associated with several perinatal complications. Adequate glycemic control has been proved to decrease risk of GDM-related complications. Several studies have shown the beneficial effect of exercise and medical nutrition treatment on glycemic and weight control in GDM-affected women. Moreover, pharmacological agents, such as insulin and specific oral anti-diabetic agents can be prescribed safely during pregnancy, decreasing maternal blood glucose and, thus, perinatal adverse outcomes. Multi-disciplinary treatment approaches that include both lifestyle modifications (medical nutritional therapy and daily physical exercise) and pharmacological treatment, in cases of failure of the former, constitute the most effective approach. Insulin is the gold standard pharmacological agent for GDM treatment. Metformin and glyburide are two oral anti-diabetic agents that could serve as alternative, although not equal in terms of effectiveness and safety, treatment for GDM. As studies on short-term safety of metformin are reassuring, in some countries it is considered as first-line treatment for GDM management. More studies are needed to investigate the long-term effects on offspring. As safety issues have been raised on the use of glyburide during pregnancy, it must be used only when benefits surpass possible risks.

Demographic influence on maternal weight gain during pregnancy: where will we end up?

PURPOSE

Maternal obesity is one of the most commonly occurring risk factors in obstetrics. Complications, such as gestational diabetes, venous thromboembolism, preeclampsia and many more, exist far more often in obese women than in pregnant women of normal weight.

METHODS

Changes in maternal weight gain during pregnancy were analysed in Schleswig-Holstein between 1995 and 1997 and between 2004 and 2009. Between 1995 and 1997 data were drawn from 74,000 singleton pregnancies and between 2004 and 2009 from 118,000 pregnancies. The data centre of the University of Rostock performed the statistical analysis.

RESULTS

Maternal weight at the time of first consultation with proof of pregnancy was 67.6 kg in 1995 and increased to 70.7 kg in 2009. This means an absolute difference of 3.1 kg. Maternal weight at the time of delivery changed from 80.8 to 84.9 kg in the same period. This is an absolute difference of 4.1 kg. Body weight is higher in 2009 than in 1995 across nearly all age groups. Even in younger women (aged 17 years and over) differences in weight can be registered. The obesity rate (BMI ≥ 30) in relation to maternal age was also analysed. In general, the rate of obesity is higher in 2009 than in 1995 across all age groups.

CONCLUSIONS

These results show an increase in maternal weight gain during pregnancy over the last decades. However, the change in maternal weight is not dependent upon maternal age. The weight differences are consistent across nearly all age groups. Thus, age is not a risk factor for overweight and obesity.

Prevalence of Gestational Diabetes Mellitus in Eastern and Southeastern Asia: A Systematic Review and Meta-Analysis

AIM

To review the prevalence of gestational diabetes mellitus (GDM) in Eastern and Southeastern Asia.

METHODS

We systematically searched for observational studies on GDM prevalence from January 2000 to December 2016. Inclusion criteria were original English papers, with full texts published in peer-reviewed journals. The quality of included studies was evaluated using the guidelines of the National Health and Medical Research Council, Australia. Fixed effects and random effects models were used to estimate the summary prevalence of GDM and the corresponding 95% confidence intervals (CI).

RESULTS

A total of 4415 papers were screened, and 48 studies with 63 GDM prevalence observations were included in the final review. The pooled prevalence of GDM was 10.1% (95% CI: 6.5%-15.7%), despite substantial variations across nations. The prevalence of GDM in lower- or upper-middle income countries was about 64% higher than in their high-income counterparts. Moreover, the one-step screening method was twice more likely to be used in diagnosing GDM when compared to the two-step screening procedure.

CONCLUSIONS

The prevalence of GDM in Eastern and Southeastern Asia was high and varied among and within countries. There is a need for international uniformity in screening strategies and diagnostic criteria for GDM.

A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women

BACKGROUND

Obesity and being overweight are becoming epidemic, and indeed, the proportion of such women of reproductive age has increased in recent times. Being overweight or obese prior to pregnancy is a risk factor for gestational diabetes mellitus, and increases the risk of adverse pregnancy outcome for both mothers and their offspring. Furthermore, the combination of gestational diabetes mellitus with obesity/overweight status may increase the risk of adverse pregnancy outcome attributable to either factor alone. Regular exercise has the potential to reduce the risk of developing gestational diabetes mellitus and can be used during pregnancy; however, its efficacy remain controversial. At present, most exercise training interventions are implemented on Caucasian women and in the second trimester, and there is a paucity of studies focusing on overweight/obese pregnant women.

OBJECTIVE

We sought to test the efficacy of regular exercise in early pregnancy to prevent gestational diabetes mellitus in Chinese overweight/obese pregnant women.

STUDY DESIGN

This was a prospective randomized clinical trial in which nonsmoking women age >18 years with a singleton pregnancy who met the criteria for overweight/obese status (body mass index 24≤28 kg/m²) and had an uncomplicated pregnancy at <12⁺⁶ weeks of gestation were randomly allocated to either exercise or a control group. Patients did not have contraindications to physical activity. Patients allocated to the exercise group were assigned to exercise 3 times per week (at least 30 min/session with a rating of perceived exertion between 12-14) via a cycling program begun within 3 days of randomization until 37 weeks of gestation. Those in the control group continued their usual daily activities. Both groups received standard prenatal care, albeit without special dietary recommendations. The primary outcome was incidence of gestational diabetes mellitus.

RESULTS

From December 2014 through July 2016, 300 singleton women at 10 weeks' gestational age and with a mean prepregnancy body mass index of 26.78 ± 2.75 kg/m² were recruited. They were randomized into an exercise group (n = 150) or a control group (n = 150). In all, 39 (26.0%) and 38 (25.3%) participants were obese in each group, respectively. Women randomized to the exercise group had a significantly lower incidence of gestational diabetes mellitus (22.0% vs 40.6%; P < .001). These women also had significantly less gestational weight gain by 25 gestational weeks (4.08 ± 3.02 vs 5.92 ± 2.58 kg; P < .001) and at the end of pregnancy (8.38 ± 3.65 vs 10.47 ± 3.33 kg; P < .001), and reduced insulin resistance levels (2.92 ± 1.27 vs 3.38 ± 2.00; P = .033) at 25 gestational weeks. Other secondary outcomes, including gestational weight gain between 25-36 gestational weeks (4.55 ± 2.06 vs 4.59 ± 2.31 kg; P = .9), insulin resistance levels at 36 gestational weeks (3.56 ± 1.89 vs 4.07 ± 2.33; P = .1), hypertensive disorders of pregnancy (17.0% vs 19.3%; odds ratio, 0.854; 95% confidence interval, 0.434-2.683; P = .6), cesarean delivery (except for scar uterus) (29.5% vs 32.5%; odds ratio, 0.869; 95% confidence interval, 0.494-1.529; P = .6), mean gestational age at birth (39.02 ± 1.29 vs 38.89 ± 1.37 weeks' gestation; P = .5); preterm birth (2.7% vs 4.4%, odds ratio, 0.600; 95% confidence interval, 0.140-2.573; P = .5), macrosomia (defined as birthweight >4000 g) (6.3% vs 9.6%; odds ratio, 0.624; 95% confidence interval, 0.233-1.673; P = .3), and large-for-gestational-age infants (14.3% vs 22.8%; odds ratio, 0.564; 95% confidence interval, 0.284-1.121; P = .1) were also lower in the exercise group compared to the control group, but without significant difference. However, infants born to women following the exercise intervention had a significantly lower birthweight compared with those born to women allocated to the control group (3345.27 ± 397.07 vs 3457.46 ± 446.00 g; P = .049).

CONCLUSION

Cycling exercise initiated early in pregnancy and performed at least 30 minutes, 3 times per week, is associated with a significant reduction in the frequency of gestational diabetes mellitus in overweight/obese pregnant women. And this effect is very relevant to that exercise at the beginning of pregnancy decreases the gestational weight gain before the mid-second trimester. Furthermore, there was no evidence that the exercise prescribed in this study increased the risk of preterm birth or reduced the mean gestational age at birth.

Physical activity patterns and gestational diabetes outcomes - The wings project

OBJECTIVE

To compare physical activity (PA) patterns in pregnant woman with and without gestational diabetes (GDM) and to assess the effects of an exercise intervention on change in PA patterns, blood glucose levels and pregnancy outcomes in GDM women.

METHODS

For the first objective, PA patterns were studied in 795 pregnant women with and without GDM. For the second objective, the Women in India with Gestational Diabetes Strategy-Model of Care (WINGS-MOC) intervention were evaluated in 151 women out of 189 with GDM. PA was assessed using a validated questionnaire and a pedometer. Changes in PA patterns, glycemic parameters and neonatal outcomes were evaluated.

RESULTS

Overall, only 10% of pregnant women performed recommended levels of PA. Women with GDM were significantly more sedentary compared to those without GDM (86.2 vs. 61.2%, p<0.001). After the MOC was implemented in women with GDM, there was a significant improvement in PA and a decrease in sedentary behaviour amongst women (before MOC, moderate activity: 15.2%, sedentary: 84.8% vs. after MOC-moderate: 26.5%, sedentary: 73.5%; p<0.001), and an increase in their daily step count from 2206/day to 2476/day (p<0.001). Fasting 1 and 2-h postprandial glucose values significantly decreased (p<0.001 for all). Sedentary behaviour was associated with a fourfold higher risk (p=0.02), and recreational walking with 70% decreased risk, of adverse neonatal outcomes (p=0.04) after adjusting for potential confounders.

CONCLUSIONS

PA levels are inadequate amongst this group of pregnant women studied i.e. those with and without GDM. However, a low-cost, culturally appropriate MOC can bring about significant improvements in PA in women with GDM. These changes are associated with improved glycemic control and reduction in adverse neonatal outcomes.