Exercise as a Therapeutic Intervention in Gestational Diabetes Mellitus

Abstract

Gestational Diabetes Mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Regular exercise is important for a healthy pregnancy and can lower the risk of developing GDM. For women with GDM, exercise is safe and can affect the pregnancy outcomes beneficially. A single exercise bout increases skeletal muscle glucose uptake, minimizing hyperglycemia. Regular exercise training promotes mitochondrial biogenesis, improves oxidative capacity, enhances insulin sensitivity and vascular function, and reduces systemic inflammation. Exercise may also aid in lowering the insulin dose in insulin-treated pregnant women. Despite these benefits, women with GDM are usually inactive or have poor participation in exercise training. Attractive individualized exercise programs that will increase adherence and result in optimal maternal and offspring benefits are needed. However, as women with GDM have a unique physiology, more attention is required during exercise prescription. This review (i) summarizes the cardiovascular and metabolic adaptations due to pregnancy and outlines the mechanisms through which exercise can improve glycemic control and overall health in insulin resistance states, (ii) presents the pathophysiological alterations induced by GDM that affect exercise responses, and (iii) highlights cardinal points of an exercise program for women with GDM.

TIMER: A Clinical Study of Energy Restriction in Women with Gestational Diabetes Mellitus

“…In GDM, apart from reducing GWG, exercise is also tightly related to the glycemic control, with lower PA levels being associated with increased blood glucose concentrations [ 86 , 87 ]. In parallel, exercise can also reduce the need for insulin [ 88 ] by facilitating glucose uptake in the skeletal muscle. According to Chatzakis [ 89 ], exercise has several physiological effects, including the promotion of additional glucose uptake through improved translocation of the insulin-responsive glucose transporters (GLUT4) on the cell surface and the enhanced glucose skeletal muscle uptake in the presence of insulin [ 89 ].…”

“…These two pathways induce an improved insulin sensitivity and a reduced GWG [ 89 ]. Combined interventions with energy restriction and exercise can also mediate obesity-induced inflammation [ 88 ]. Overall, women’s awareness regarding the optimal mode, intensity and duration of PA sessions during gestation appears to be suboptimal [ 90 ].…”

Using Resistance Training in Women with Gestational Diabetes Mellitus to Improve Glucose Regulation

“…Previous studies showed that exercising during the first 20 weeks of pregnancy significantly reduces (up to 50%) a pregnant woman's risk of developing GDM [29]. Moreover, studies have shown that prenatal aerobic exercise effectively manages maternal glucose levels and may replace pharmacological therapies in pregnant women diagnosed with GDM [29][30][31]. For these reasons, several worldwide private and governmental agencies endorse pregnant women engaging in prenatal aerobic exercise for the prevention and management of GDM [24][25][26], along with a plethora of other health-related benefits.…”

Social Nervous Exercise Intervention and Its Association with Fasting Blood Glucose on Diabetes Mellitus Gestational

“…According to the 2017 IADPSG, the prevalence of GDM worldwide ranges from 6.6% to 45.3%. Recognized risk factors for developing GDM include physical inactivity, being overweight or obese, excessive weight gain during pregnancy, family history of type 2 diabetes mellitus, high parity, and advanced maternal age [2]. GDM and hyperglycemia in pregnancy is caused by several increased hormones produced by the placenta, one of which is human placental lactogen, this hormone causes insulin resistance.…”