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

BMC Pregnancy and Childbirth

Huixia Yang¹  Rina Su¹  Hui Feng¹  Yumei Wei¹  Weiwei Zhu²  Chen Wang¹ 

[1] Department of Obstetrics and Gynecology of Peking University First Hospital, Xianmen Street No. 1, Xicheng District, Beijing 100034, China;National Institute of Hospital Administration, Beijing, China

关键词: Caesarean delivery;    Low birth weight;    Macrosomia;    Preterm birth;    Gestational weight gain;    Dietary intervention;    Exercise intervention;    Gestational diabetes mellitus;    Pregnancy;   

Others  :  1228372
DOI  :  10.1186/s12884-015-0682-1

 received in 2015-05-19, accepted in 2015-10-04,  发布年份 2015

【 摘 要 】

Background

The study aimed to evaluate whether exercise intervention can be applied to pregnant women with gestational diabetes mellitus (GDM) for controlling gestational weight gain (GWG) and combating GDM-related outcomes.

Methods

Retrospective six months analysis of 14,168 single pregnant women without diabetes from 15 hospitals in Beijing in 2013. Each participant’s demographic data, interventions condition and medical information were collected individually by questionnaires and relying on medical records. The level of statistical significance was set equal to 0.05.

Results

2750 (19.4 %) pregnant women were diagnosed with GDM, 74.9 % of them received exercise intervention during pregnancy, and the starting time was 25.8 ± 3.7 gestational weeks. Women with GDM with exercise intervention (GDM-E) had the lowest BMI increase during late and mid-pregnancy than women with GDM without exercise intervention (GDM-nE) (2.05 ± 1.32 kg/m ²vs. 2.40 ± 1.30 kg/m ² , p < 0.01) and non-GDM women (2.05 ± 1.32 kg/m ²vs. 2.77 ± 1.21 kg/m ² , p < 0.01). Moreover, GDM-E group experienced a significantly lower risk of preterm birth (5.58 % vs. 7.98 %, p < 0.001), low birth weight (1.03 % vs. 2.06 %, p < 0.001) and macrosomia (9.51 % vs. 11.18 %, p > 0.05) than GDM-nE group. After including dietary factors in the analysis, women with GDM without either dietary or exercise intervention (GDM-nDnE) had the highest risk of preterm birth(OR = 1.64, 95 % CI, 1.14–2.36), while women with GDM with dietary intervention only (GDM-DnE) had the highest risk of low birth weight (OR = 3.10, 95 % CI, 1.23–7.81). However, women with GDM with both dietary and exercise intervention had the lowest rate of macrosomia.

Conclusion

Exercise intervention is a suitable non-invasive therapeutic option that can be readily applied to manage weight gain and improve pregnancy outcomes in women with GDM.

【 授权许可】

   
2015 Wang et al.

【 参考文献 】

• [1]Colagiuri S, Falavigna M, Agarwal MM, Boulvain M, Coetzee E, Hod M et al.. Strategies for implementing the WHO diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Diabetes Res Clin Pract. 2014; 103(3):364-72.
• [2]Popova PV, Grineva EN, Gerasimov AS, Kravchuk EN, Ryazantseva EM, Shelepova ES. The new combination of risk factors determining a high risk of gestational diabetes mellitus. Minerva Endocrinol, 2014. [Epub ahead of print]
• [3]Li N, Liu E, Guo J, Pan L, Li B, Wang P et al.. Maternal prepregnancy body mass index and gestational weight gain on pregnancy outcomes. PLoS One. 2013; 8(12):e82310.
• [4]Morisset AS, Tchernof A, Dubé MC, Veillette J, Weisnagel SJ, Robitaille J. Weight gain measures in women with gestational diabetes mellitus. J Womens Health (Larchmt). 2011; 20(3):375-80.
• [5]Kaar JL, Crume T, Brinton JT, Bischoff KJ, McDuffie R, Dabelea D. Maternal obesity, gestational weight gain, and offspring adiposity: the exploring perinatal outcomes among children study. J Pediatr. 2014; 165(3):509-15.
• [6]Lawlor DA, Lichtenstein P, Långström N, Lichtenstein P, Langstrom N. Association of maternal diabetes mellitus in pregnancy with offspring adiposity into early adulthood: sibling study in a prospective cohort of 280,866 men from 248,293 families. Circulation. 2011; 123(3):258-65.
• [7]Bautista-Castaño I, Henriquez-Sanchez P, Alemán-Perez N, Garcia-Salvador JJ, Gonzalez-Quesada A, García-Hernández JA et al.. Maternal obesity in early pregnancy and risk of adverse outcomes. PLoS One. 2013; 8(11):e80410.
• [8]Rodrigues PL, de Oliveira LC, Brito Ados S, Kac G. Determinant factors of insufficient and excessive gestational weight gain and maternal-child adverse outcomes. Nutrition. 2010; 26(6):617-23.
• [9]Wendland EM, Torloni MR, Falavigna M, Trujillo J, Dode MA, Campos MA et al.. Gestational diabetes and pregnancy outcomes--a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria. BMC Pregnancy Childbirth. 2012; 12:23. BioMed Central Full Text
• [10]Bowers K, Laughon SK, Kiely M, Brite J, Chen Z, Zhang C. Gestational diabetes, pre-pregnancy obesity and pregnancy weight gain in relation to excess fetal growth: variations by race/ethnicity. Diabetologia. 2013; 56(6):1263-71.
• [11]Kim SY, Sharma AJ, Sappenfield W, Wilson HG, Salihu HM. Association of maternal body mass index, excessive weight gain, and gestational diabetes mellitus with large-for-gestational-age births. Obstet Gynecol. 2014; 123(4):737-44.
• [12]Berggren EK, Stuebe AM, Boggess KA. Excess maternal weight gain and large for gestational Age risk among women with gestational diabetes. Am J Perinatol. 2015; 32(3):251-6.
• [13]Harper LM, Tita A, Biggio JR. The institute of medicine guidelines for gestational weight gain after a diagnosis of gestational diabetes and pregnancy outcomes. Am J Perinatol. 2015; 32(3):239-46.
• [14]Lee IM, Djoussé L, Sesso HD, Wang L, Buring JE. Physical activity and weight gain prevention. JAMA. 2010; 303(12):1173-9.
• [15]Tobias DK, Zhang C, van Dam RM. Physical activity before and during pregnancy and risk of gestational diabetes mellitus: a meta-analysis. Diabetes Care. 2011; 34(1):223-9.
• [16]de Barros MC, Lopes MA, Francisco RP, Sapienza AD, Zugaib M. Resistance exercise and glycemic control in women with gestational diabetes mellitus. Am J Obstet Gynecol. 2010; 203(6):556.e1-6.
• [17]Halse RE, Wallman KE, Newnham JP, Guelfi KJ. Home-based exercise training ImprovesCapillary glucose profile in GDM women. Med Sci Sports Exerc. 2014; 46(9):1702-9.
• [18]Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a world health organization guideline. Diabetes Res Clin Prac. 2014;103(3):341–63.
• [19]Zhou B. Predictive values of body mass index and waist circumference to risk factors of related diseases in Chinese adult population. Zhonghua Liu Xing Bing Xue Za Zhi. 2002; 23(1):5-10.
• [20]Rasmussen KM, Catalano PM, Yaktine AL. New guidelines for weight gain during pregnancy: what obstetrician/gynecologists should know. Curr Opin Obstet Gynecol. 2009; 21:521-6.
• [21]Harris ST, Liu J, Wilcox S, Moran R, Gallagher A. Exercise during pregnancy and its association with gestational weight gain. Matern Child Health J. 2015; 19(3):528-37.
• [22]Ruchat SM, Davenport MH, Giroux I, Hillier M, Batada A, Sopper MM et al.. Nutrition and exercise reduce excessive weight gain in normal-weight pregnant women. Med Sci Sports Exerc. 2012; 44(8):1419-26.
• [23]Jiang H, Qian X, Li M, Lynn H, Fan Y, Jiang H, McKeating A, Maguire PJ, Turner MJ. Can physical activity reduce excessive gestational weight gain? Findings from a Chinese urban pregnant women cohort study. Int J Behav Nutr Phys Act. 2012; 9:12. BioMed Central Full Text
• [24]Barakat R, Pelaez M, Lopez C, Lucia A, Ruiz JR. Exercise during pregnancy and gestational diabetes-related adverse effects: a randomized controlled trial. Br J Sports Med. 2013; 47(10):630-6.
• [25]Tomić V, Sporiš G, Tomić J, Milanović Z, Zigmundovac-Klaić D, Pantelić S. The effect of maternal exercise during pregnancy on abnormal fetal growth. Croat Med J. 2013; 54(4):362-8.
• [26]Golbidi S, Laher I. Potential mechanisms of exercise in gestational diabetes. J Nutr Metab. 2013; 2013:285948.
• [27]Xi B, Liang Y, He T, Reilly KH, Hu Y, Wang Q et al.. Secular trends in the prevalence of general and abdominal obesity among Chinese adults, 1993–2009. Obes Rev. 2012; 13(3):287-96.
• [28]Farren M, Daly N, O’Higgins AC, McKeating A, Maguire PJ, Turner MJ. The interplay between maternal obesity and gestational diabetes mellitus. J Perinat Med. 2015; 43(3):311-7.
• [29]Beyerlein A, Schiessl B, Lack N, von Kries R. Optimal gestational weight gain ranges for the avoidance of adverse birth weight outcomes: a novel approach. Am J Clin Nutr. 2009; 90:1552-1558.
• [30]Hinkle SN, Sharma AJ, Dietz PM. Gestational weight gain in obese mothers and associations with fetal growth. Am J Clin Nutr. 2010; 92:644-651.
• [31]Bodnar LM, Siega-Riz AM, Simhan HN, Himes KP, Abrams B. Severe obesity, gestational weight gain, and adverse birth outcomes. Am J Clin Nutr. 2010; 91:1642-1648.
• [32]Hedderson MM, Gunderson EP, Ferrara A. Gestational weight gain and risk of gestational diabetes mellitus. Obstet Gynecol. 2010; 115(3):597-604.
• [33]Gibson KS, Waters TP, Catalano PM. Maternal weight gain in women who develop gestational diabetes mellitus. Obstet Gynecol. 2012; 119(3):560-5.
• [34]Liu Z, Ao D, Yang H, Wang Y. Gestational weight gain and risk of gestational diabetes mellitus among Chinese women. Chin Med J (Engl). 2014; 127(7):1255-60.
• [35]Evenson KR, Wen F. National trends in self-reported physical activity and sedentary behaviors among pregnant women: NHANES 1999–2006. Prev Med. 2010; 50(3):123-8.
• [36]Lee DT, Ngai IS, Ng MM, Lok IH, Yip AS, Chung TK. Antenatal taboos among Chinese women in Hong Kong. Midwifery. 2009; 25(2):104-13.
• [37]Ribeiro CP, Milanez H. Knowledge, attitude and practice of women in Campinas, Sao Paulo. Brazil with respect to physical exercise in pregnancy: a descriptive study. Reprod Health. 2011; 8:31. BioMed Central Full Text