Leisure Time Physical Activity and Gestational Diabetes Mellitus in the Omega Study

Assisted reproductive technology and physical activity among Chinese pregnant women at high risk for gestational diabetes mellitus in early pregnancy: A cross-sectional study

Currently, the number of pregnant women at high risk for gestational diabetes mellitus (GDM) and using assisted reproductive technology (ART) is increasing. The present study aims to explore the relationship between ART and physical activity in Chinese pregnant women at high risk for GDM in early pregnancy. A cross-sectional study was conducted in a regional teaching hospital in Guangzhou, China, between July 2022 and March 2023. Three hundred fifty-five pregnant women at high risk for GDM in early pregnancy completed the Chinese version of the Pregnant Physical Activity Questionnaire (PPAQ), the Pregnancy Physical Activity Knowledge Scale, the Pregnancy Physical Activity Self-Efficacy Scale, the Pregnancy Physical Activity Social Support Scale, and a sociodemographic and obstetric characteristics data sheet. Compared to women who conceived naturally, women who used ART were more likely to be 35 years or older, unemployed, primigravidae, and to have intentionally planned their pregnancies. Women who used ART had significantly lower levels of physical activity and self-efficacy compared to their counterparts who conceived naturally. Over half (55.6%) of women who used ART reported being physically inactive, and those with lower self-efficacy, as well as the unemployed, were significantly more likely to be inactive. Physical inactivity is a critical clinical issue among women who use ART, especially in the context of GDM risk. Future research should develop and test physical activity programs, including enhancing physical activity self-efficacy for women who use ART. Patient or public contribution: In this study, survey questionnaires were completed by participants among Chinese pregnant women at high risk for GDM in early pregnancy.

Physical activity during pregnancy and the risk of gestational diabetes mellitus: a systematic review and dose-response meta-analysis

BACKGROUND

Previous research has indicated the inverse association between physical activity (PA) and gestational diabetes mellitus (GDM). However, the dose-response relationship currently remains undetermined. This study aims to explore the dose-response relationship between PA during the first and second trimesters of pregnancy and GDM risk.

METHODS

Studies on the relationship between PA during pregnancy and GDM risk published before April 25, 2023, were searched for in six databases. According to the inclusion and exclusion criteria, all literature was screened for eligibility. The Newcastle-Ottawa Scale (NOS) was used to assess risk of bias. Publication bias was examined using funnel plots, Begg's and Egger's tests, as well as trim-and-fill analysis. We harmonized exposure estimates of PA during pregnancy to the common unit of the metabolic equivalent of task (MET)-h/week. Restricted cubic splines were used to model the dose-response relationship. The criteria from the World Cancer Research Fund were used to assess the certainty of evidence across outcomes. All analyses were performed using Stata 15.1.

RESULTS

The results indicated that in contrast with the lowest level of PA, promoting the highest PA level lowers the risk of GDM by 36% (RR = 0.64, 95%CI: 0.53 ~ 0.78). We found a curvilinear dose-response association between PA during the first trimester and incident GDM (Pnonlinearity = 0.012). Compared to inactive pregnant women, for those who achieved the guidelines-suggested minimum level (10 MET-h/week) of PA during the first trimester, the GDM risk was decreased by 13% (RR = 0.87, 95%CI: 0.79 ~ 0.96). A linear relationship was found between PA during the second trimester and the GDM risk (Pnonlinearity = 0.276). The results with a restricted cubic spline model suggested that pregnant women who accumulate 10 MET-h/week have a 1% reduced risk of GDM compared to completely inactive individuals. Twice (20 MET-h/week) or a higher amount of PA (50 MET-h/week) contributed to further reductions in GDM risk.

CONCLUSION

There is a dose-response relationship between higher levels of PA in both the first and second trimesters and reduced risk of GDM; the relationship is stronger in the first trimester. Increasing PA during pregnancy can prevent the development of GDM.

PROSPERO REGISTRATION NUMBER

CRD42023420564.

Current Research Trends, Hotspots, and Frontiers of Physical Activity during Pregnancy: A Bibliometric Analysis

PURPOSE

Physical activity (PA) during pregnancy has been proven beneficial to pregnant women, with a significant effect on ameliorating many severe gestational complications. This work aimed to reveal current research trends, hotspots, and future frontiers in PA during pregnancy.

METHODS

Software CiteSpace was used to perform a bibliometric analysis with 1415 publications in the Web of Science Core Collection.

RESULTS

the number of published papers on PA during pregnancy has increased gradually by year. The United States has made the most significant contribution to the research on this topic, ranking first in the world in both the number and centrality of research. A total of 54 articles (3.8%) were published in 2022. A majority of publications were research articles (n = 1176, 78.9%). The authors and institutions of the research published have more inter-country collaborations. Different patterns of PA, prevention, and amelioration of pregnancy complications are major research hotspots. Improvement of sedentary behaviour, lifestyle intervention through leisure-time PA, and preterm care are major research frontiers and have received extensive attention in recent years.

CONCLUSIONS

The current scientometric study presents an overview of PA during pregnancy research conducted throughout the preceding decades. The conclusions of this work might serve as a reference for researchers who are interested in this field.

The prevention of gestational diabetes mellitus (The role of lifestyle): a meta-analysis

Gestational diabetes mellitus (GDM) is the most common complication of pregnancy. The disease is on the rise worldwide with deleterious consequences on the fetus, mother, and children. The study aimed to review the role of lifestyle in the prevention of GDM. We searched PubMed, SCOPUS, Web of Science, Cochrane Library, EBSCO, and Google Scholar from the first published article up to December 2021; articles were eligible if they were controlled trials, prospective cohorts, and case-control. Out of 5559 articles retrieved, 66 full texts were screened, and 19 studies were included in the meta-analysis. (6 studies assessed the effects of diet, and 13 were on exercise). The dietary intervention showed significant positive effect on GDM, odd ratio = 0.69, 95% CI, 0.56-84, P-value for overall effect = 0.002. The DASH diet was better than Mediterranean Diet (odd ratio, 0.71, 95% CI, 68-74, P-value < 0.001). Regarding exercise, no significant prevention was evident on GDM, odd ratio, 0.77, 95% CI, 0.55-1.06, P-value = 0.11. However, a significant prevention of gestational diabetes was found when the exercise was mild-moderate (odd ratio = 0.65, 95% CI, 0.53-80, P < 0.0001) and started in the first trimester (odd ratio, 0.57, 95% CI, 0.43-0.75, P < 0.0001. No significant effect was found when the exercise was vigorous (odd ratio = 1.09, 95% CI, 0.50-2.38, P = 0.83) and started during the second trimester of pregnancy (odd ratio, 1.08, 95% CI, 0.65-1.80, P = 0.77. Diet and early mild-moderate exercise were effective in GDM prevention. Exercise during the second trimester and moderate-vigorous were not. Further studies assessing the type, duration, and frequency of physical activity are needed.

Gestational Diabetes Mellitus: The Crosslink among Inflammation, Nitroxidative Stress, Intestinal Microbiota and Alternative Therapies

Gestational diabetes mellitus (GDM) is characterized by a set of metabolic complications arising from adaptive failures to the pregnancy period. Estimates point to a prevalence of 3 to 15% of pregnancies. Its etiology includes intrinsic and extrinsic aspects of the progenitress, which may contribute to the pathophysiogenesis of GDM. Recently, researchers have identified that inflammation, oxidative stress, and the gut microbiota participate in the development of the disease, with potentially harmful effects on the health of the maternal-fetal binomial, in the short and long terms. In this context, alternative therapies were investigated from two perspectives: the modulation of the intestinal microbiota, with probiotics and prebiotics, and the use of natural products with antioxidant and anti-inflammatory properties, which may mitigate the endogenous processes of the GDM, favoring the health of the mother and her offspring, and in a future perspective, alleviating this critical public health problem.

The Influence of Practising Physical Activity on the Prevention and Treatment of Gestational Diabetes: A Systematic Review

BACKGROUND

During pregnancy, maintaining an inadequate lifestyle (bad eating habits, stress, consumption of toxic substances, etc.) generates complications such as pre-eclampsia, overweight, lumbar pain and Gestational Diabetes.

OBJECTIVE

This review was carried out with the objective to determine the influence of practising physical activity on the prevention and treatment of Gestational Diabetes; and to evaluate the efficacy of interventions based on therapeutic exercise in the management of such diseases.

METHOD

A systematic review of the publications of the last five years in Medline, Pubmed, Web of Science and Cinahl databases was conducting with the terms Exercise and Gestational Diabetes.

RESULTS

25 articles were found, 9 were observational studies that analysed physical activity habits through questionnaires, and other 16 applied an intervention. With respect to the frequency of the sessions, most of these studies applied their interventions three times per week, with all of them obtaining positive results. Regarding intensity, all the studies that referred to it concluded that it must be at least moderate, highlighting that, at all times, the limitations of pregnant women must be taken into account.

CONCLUSION

Both for the prevention and treatment of this disease, the physical activity must be performed for a minimum of three times per week, at least in moderate intensity, and must be based on aerobic, resistance and strength exercises.

The interaction between metabolic syndrome and physical activity, and risk for gestational diabetes mellitus

AIMS

Metabolic syndrome (MetS) is a cluster of risk factors which increases risk of cardiometabolic diseases in the adult population and increases risk for pregnancy complications such as gestational diabetes mellitus (GDM). Epidemiological data indicate that moderate-to-high levels of physical activity reduces the risk for GDM. The study aims to determine whether the association between MetS and GDM is affected by physical activity.

METHODS

We performed a prospective cohort study among 1373 pregnant nulliparous women in Adelaide, South Australia. At 9-16 weeks' gestation, demographic, lifestyle and self-reported frequencies of physical activity were obtained, and a non-fasting blood sample was taken for assessment of MetS, defined using the International Diabetes Federation criteria. GDM was diagnosed at 24-28 weeks' gestation using the World Health Organization classification.

RESULTS

1158 pregnant women were included: 107 (9%) women had MetS in early pregnancy, and 184 (16%) developed GDM. Having MetS increased the risk of developing GDM (37.4% vs. 13.7%, adjusted RR 2.5; 95% CI 1.7, 3.6). The interaction effect (RR; (95% CI) between MetS and physical activity was not significant (vigorous physical activity: 2.60; 0.46, 14.71) for ≥ 4 times per week; less vigorous activity; 0.77; 0.15, 4.02 for ≥ 4 times per week; stair climbing ≥ once day (1.16; 0.54, 2.51), all compared to no physical activity).

CONCLUSIONS

Physical activity was not an effect modifier in the association between GDM and MetS. Information collected about the nature and extent of physical activity needs to be more detailed and granular to determine whether physical activity really has an effect.

Maternal Moderate-to-Vigorous Physical Activity before and during Pregnancy and Maternal Glucose Tolerance: Does Timing Matter?

PURPOSE

To assess prospective associations between moderate-to-vigorous physical activity (MVPA) from preconception through pregnancy and glucose metabolism.

METHODS

The sample consisted of 2,388 women from the NICHD Fetal Growth Studies-Singletons, which enrolled U.S. pregnant women between 8-13 weeks of gestation. Women recalled their MVPA in periconception (past 12 months, inclusive of 1st trimester), early-to-mid (13-20 weeks of gestation), and mid-to-late 2nd trimester (20-29 weeks). These data were obtained at study visits that occurred at enrollment (8-13 weeks) and at follow-up visits at 16-22 and 24-29 weeks. MVPA was recalled using the Pregnancy Physical Activity Questionnaire. Glucose challenge test and oral glucose tolerance test results and gestational diabetes diagnosis (defined by the Carpenter-Coustan criteria) were extracted from medical records. ANCOVA and Poisson regression with robust error variance were performed to estimate associations between MVPA and glucose concentrations and gestational diabetes risk, respectively, controlling for age, race/ethnicity, and pre-pregnancy body mass index.

RESULTS

Women achieving higher levels of MVPA (≥75th percentile; 760.5 MET·min·wk-1) in early-to-mid 2nd trimester had lower glucose concentrations (β = -3.9 mg/dL, 95%CI: -7.4,-0.5) compared to their least-active counterparts (≤25th percentile; ≤117.0 MET·min·wk-1). Women maintaining recommended levels of MVPA from preconception & 1st trimester through 2nd trimester (early-to-mid: β = -3.0 mg/dL, -5.9,-0.1; mid-to-late: β = -4.2 mg/dL,-8.4,-0.1) or maintaining sufficient activity throughout 2nd trimester exhibited lower glucose levels (β = -5.6 mg/dL, -9.8,-1.4) compared to their inactive counterparts. No statistically significant associations with gestational diabetes were observed.

CONCLUSIONS

These findings demonstrate that achieving MVPA of at least 760.0 MET·min·week-1 in early-to-mid 2nd trimester or maintaining at least 500 MET ·min·week-1 from preconception through 2nd trimester may be related to improved maternal glucose metabolism in the 2nd trimester.

Exercise During the First Trimester of Pregnancy and the Risks of Abnormal Screening and Gestational Diabetes Mellitus

OBJECTIVE

To estimate the effects of exercise during the first trimester on the risks of abnormal screening and gestational diabetes mellitus (GDM).

RESEARCH DESIGN AND METHODS

Data come from PETALS, a prospectively followed pregnancy cohort (n = 2,246, 79% minorities) receiving care at Kaiser Permanente Northern California. A Pregnancy Physical Activity Questionnaire was used to assess exercise. Glucose testing results for screening and diagnostic tests were obtained from electronic health records. Inverse probability of treatment weighting and targeted maximum likelihood with data-adaptive estimation (machine learning) of propensity scores and outcome regressions were used to obtain causal risk differences adjusted for potential confounders, including prepregnancy BMI, exercise before pregnancy, and gestational weight gain. Exercise was dichotomized at 1) the cohort's 75th percentile for moderate- to vigorous-intensity exercise (≥13.2 MET-h per week or ≥264 min per week of moderate exercise), 2) current recommendations (≥7.5 MET-h per week or ≥150 min per week of moderate exercise), and 3) any vigorous exercise.

RESULTS

Overall, 24.3% and 6.5% had abnormal screening and GDM, respectively. Exercise meeting or exceeding the 75th percentile decreased the risks of abnormal screening and GDM by 4.8 (95% CI 1.1, 8.5) and 2.1 (0.2, 4.1) fewer cases per 100, respectively, in adjusted analyses.

CONCLUSIONS

Exercise reduces the risks of abnormal screening and GDM, but the amount needed to achieve these risk reductions is likely higher than current recommendations. Future interventions may consider promoting ≥38 min per day of moderate-intensity exercise to prevent GDM.

Leisure Time Physical Activity, Sedentary Time in Pregnancy, and Infant Weight at Approximately 12 Months

Background: Maternal leisure time physical activity (LTPA) and sedentary time during pregnancy may influence programming of infant growth in a sex-specific manner. Materials and Methods: Participants (N = 35,212) from the Danish National Birth Cohort reported moderate/vigorous LTPA (hours/week) in early (conception to mean 16 weeks of gestation) and late pregnancy (mean 31 weeks of gestation to delivery) during interviews at 16 weeks of gestation and 6 months postpartum. Participants reported screen time at work and time spent watching television/videos (hours/day) in early pregnancy. Infant weight at 12 months of age was reported by mothers. Weight-for-length was categorized using sex-specific international standards. Results: Participants reported on average 1 hour per week of early pregnancy moderate/vigorous LTPA, 0.5 hour per week of late pregnancy LTPA, and 3 hours per day of early pregnancy sedentary time. Early pregnancy LTPA category was not associated with infant weight (p for trend = 0.62). There were suggested associations of early pregnancy sedentary time above the first quartile with greater odds of infant underweight (odds ratio = 1.15-1.27; p for trend = 0.27). Associations were similar in male and female infants. Conclusions: There is no clear relationship between early or late pregnancy LTPA and infant weight at 12 months in our study. Maternal early pregnancy sedentary time may be associated with infant underweight at 12 months.

Factors Associated with the Leisure-Time Physical Activity (LTPA) during the First Trimester of the Pregnancy: The Cross-Sectional Study among Pregnant Women in Serbia

Background: The benefits of physical activity during pregnancy include lower maternal weight gain, a lower likelihood of gestational diabetes, low back pain, preeclampsia, preterm delivery, caesarian delivery, and macrosomia. This study aimed to examine the factors associated with insufficient leisure-time physical activity (LTPA) during the first trimester. Methods: A cross-sectional study was conducted at the Clinic for Obstetrics and Gynecology of Clinical Center of Serbia, Belgrade, between January and June of 2018. The final analyses included 162/175 pregnant women. The questionnaire was used to obtain social characteristics, pregnancy, and lifestyle characteristics (Pregnancy Risk Assessment Monitoring System-PRAMS), pre-pregnancy LTPA (International Physical Activity Questionnaire-IPAQ), and LTPA during the first trimester (Pregnancy Physical Activity Questionnaire-PPAQ). Women were classified into two groups of sufficient and insufficient LTPA during the first trimester based on the recommendations of the World Health Organization. Multivariate logistic regression analysis was applied. Results: A total of 27.2% of the women had insufficient LTPA during pregnancy. Insufficient LTPA during pregnancy was associated with <12 years of education (OR: 2.3, 95% CI: 1.05-5.04), self-rated financial status as poor (OR: 0.34, 95% CI: 0.14-0.79), and hours spent walking before pregnancy (OR: 0.87, 95% CI: 0.77-0.99). Conclusions: Our results can help direct health care professionals advice for women who are planning pregnancy towards walking as it seems to be sustained during pregnancy.

Physical activity level in women with gestational diabetes mellitus: Lifestyle INtervention for Diabetes prevention After pregnancy (LINDA-Brasil) study

BACKGROUND

The aim of this study was to investigate physical activity and associated factors in women with gestational diabetes mellitus (GDM).

METHODS

This cross-sectional study was performed on 2706 women as part of the Lifestyle INtervention for Diabetes prevention After pregnancy (LINDA-Brasil) study, recruited between 2012 and 2016 in Brazil. A structured questionnaire was used to assess physical activity. Descriptive and Poisson regression analyses were used to investigate physical activity and associated factors.

RESULTS

Counseling regarding physical activity practices was reported by 47.4% and 34.3% of women before and after a diagnosis of GDM, respectively. During pregnancy, 26% of women were classified as inactive, 39.7% were classified as insufficiently active, and 34.3% were classified as active. Compared with prepregnancy, 63.1% of women reported a decrease in physical activity levels during pregnancy. The prevalence of being inactive during pregnancy was higher among women who did not live with a partner (P = 0.003), had a lower household income (P = 0.01), were employed (P < 0.001), and who had four or more children (P < 0.001).

CONCLUSION

Among Brazilian women with GDM, physical activity levels and practices were low, with most women reporting decreased physical activity during pregnancy. A low socioeconomic status was associated with lower physical activity. These findings indicate the need to reinforce the importance of physical activity in the management of GDM in Brazil.

Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis

Objective

Gestational diabetes mellitus (GDM), gestational hypertension (GH) and pre-eclampsia (PE) are associated with short and long-term health issues for mother and child; prevention of these complications is critically important. This study aimed to perform a systematic review and meta-analysis of the relationships between prenatal exercise and GDM, GH and PE.

Design

Systematic review with random effects meta-analysis and meta-regression.

Data sources

Online databases were searched up to 6 January 2017.

Study eligibility criteria

Studies of all designs were included (except case studies) if published in English, Spanish or French, and contained information on the Population (pregnant women without contraindication to exercise), Intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone [“exercise-only”] or in combination with other intervention components [e.g., dietary; “exercise + co-intervention”]), Comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and Outcomes (GDM, GH, PE).

Results

A total of 106 studies (n=273 182) were included. ‘Moderate’ to ‘high’-quality evidence from randomised controlled trials revealed that exercise-only interventions, but not exercise+cointerventions, reduced odds of GDM (n=6934; OR 0.62, 95% CI 0.52 to 0.75), GH (n=5316; OR 0.61, 95% CI 0.43 to 0.85) and PE (n=3322; OR 0.59, 95% CI 0.37 to 0.9) compared with no exercise. To achieve at least a 25% reduction in the odds of developing GDM, PE and GH, pregnant women need to accumulate at least 600 MET-min/week of moderate-intensity exercise (eg, 140 min of brisk walking, water aerobics, stationary cycling or resistance training).

Summary/conclusions

In conclusion, exercise-only interventions were effective at lowering the odds of developing GDM, GH and PE.

Prepregnancy Fitness and Risk of Gestational Diabetes: A Longitudinal Analysis

PURPOSE

This study aimed to assess the associations of prepregnancy cardiorespiratory fitness, moderate- to vigorous-intensity physical activity (MVPA), and time spent watching television with subsequent development of gestational diabetes mellitus (GDM).

METHODS

Participants were 1333 women enrolled in the Coronary Artery Risk Development in Young Adults study who did not have diabetes either at baseline (1985-86) or before births occurring after baseline. Baseline fitness was estimated using a graded symptom-limited maximal exercise treadmill test and expressed in MET units. Baseline MVPA (exercise units per day) was measured using the Coronary Artery Risk Development in Young Adults physical activity history questionnaire, and television viewing (h·d) was assessed by self-report in 1990-1991. Logistic regression analysis was used to derive odds ratios and 95% confidence intervals, adjusting for time from baseline to delivery and baseline study center, age, race, education, parity, family history of diabetes, smoking, alcohol, saturated fat intake, waist circumference, homeostasis model assessment of insulin resistance, and HDL cholesterol.

RESULTS

Over 25 yr of follow-up, 164 women developed GDM. The odds of developing GDM were 21% lower for each 1 SD increment in baseline level of fitness (2.3 METs, odds ratio = 0.79, 95% confidence interval = 0.65-0.96). Prepregnancy MVPA and television viewing were not statistically associated with the development of GDM.

CONCLUSION

Study findings indicate that objectively assessed prepregnancy fitness, but not self-reported MVPA or television time, is associated with GDM. Clinicians should counsel women on the benefits of improving fitness in the preconception period, particularly among women at greater risk for GDM.

Associations of Diet and Physical Activity with Risk for Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis

Rising rates of gestational diabetes mellitus (GDM) and related complications have prompted calls to identify potentially modifiable risk factors that are associated with gestational diabetes mellitus (GDM). We systematically reviewed the scientific literature for observational studies examining specific dietary and/or physical activity (PA) factors and risk of GDM. Our search included PubMed, Medline, CINAHL/EBSCO, Science Direct and EMBASE, and identified 1167 articles, of which 40 met our inclusion criteria (e.g., singleton pregnancy, reported diet or PA data during pre-pregnancy/early pregnancy and GDM as an outcome measure). Studies were assessed for quality using a modified Quality Criteria Checklist from American Dietetic Association. Of the final 40 studies, 72% obtained a positive quality rating and 28% were rated neutral. The final analysis incorporated data on 30,871 pregnant women. Dietary studies were categorised into either caffeine, carbohydrate, fat, protein, calcium, fast food and recognized dietary patterns. Diets such as Mediterranean Diet (MedDiet), Dietary Approaches to Stop Hypertension (DASH) diet and Alternate Healthy Eating Index diet (AHEI) were associated with 15–38% reduced relative risk of GDM. In contrast, frequent consumption of potato, meat/processed meats, and protein (% energy) derived from animal sources was associated with an increased risk of GDM. Compared to no PA, any pre-pregnancy or early pregnancy PA was associated with 30% and 21% reduced odds of GDM, respectively. Engaging in >90 min/week of leisure time PA before pregnancy was associated with 46% decreased odds of GDM. We conclude that diets resembling MedDiet/DASH diet as well as higher PA levels before or in early pregnancy were associated with lower risks or odds of GDM respectively. The systematic review was registered at PROSPERO (www.crd.york.ac.uk/PROSPERO) as CRD42016027795.