Physical Exercise is Associated with Glycemic Control among Women with Gestational Diabetes Mellitus: Findings from a Prospective Cohort in Shanghai, China

Abstract

Objective Physical exercise during pregnancy is beneficial to women with gestational diabetes mellitus (GDM), but evidence on the association between physical exercise and glycemic control among women with GDM is limited in China. We conducted this study to understand the total exercise times, the percentage of abnormal plasma glucose (PG), and to explore if longer physical exercise is positively associated with a lower percentage of abnormal PG among GDM women. Methods During 2019 and 2020, we established a prospective cohort with 1,050 GDM women recruited. GDM was confirmed by a diagnostic 75g OGTT, and plasma glucose in over 10 hours overnight fasting and 2-hour after breakfast was implemented during a routine antenatal checkup. Information for demographic features and physical exercises among GDM women were collected by questionnaire interviews, and abnormal PG percentage was calculated as abnormal PG times divided by total PG test times. Results Among 1,050 GDM women, the percentage of exercise times <150 minutes/week, <30 minutes/day and <60 minutes/day was 17.33%, 26.57%, and 54.10%, respectively. The median percentage of abnormal PG was 40% (IQR=20–70%). GDM women with less exercise had a higher abnormal PG percentage (y=0.0049x 2 -1.20x+88.96), ORs for women with exercise <150 minutes/week were 3.78 (95% CI=1.33–8.25), 6.97 (3.45–14.07), and 6.39 (3.61–11.33) compared with ≥ 150 minutes/week, and ORs for women with exercise <60 minutes/day were 4.62 (2.71–8.14), 3.58 (2.60–4.93), and 7.28 (4.31–12.30) compared with ≥60 minutes/day in groups divided by quartiles of P 25 , P 50 and P 75 , respectively. Conclusion This study indicated high physical exercise times and abnormal PG percentage among women with GDM in Shanghai, China. GDM women with more exercise times had a lower percentage of abnormal PG, especially when exercise times were ≥60 minutes/day, and supplementary treatments should be provided for women with over 70% abnormal plasma glucose.

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

“…Nevertheless, it appears that a GDM diagnosis alone does not motivate women to increase their PA levels [ 84 , 85 ]. 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.…”

Number of parous events affects the association between physical exercise and glycemic control among women with gestational diabetes mellitus: A prospective cohort study

“…Detailed information regarding sample size estimation and the recruitment process for women with GDM is available in previously published work. 11 The primary purpose of this research with the cohort of GDM women was to evaluate the impact of physical activity on preterm birth, adverse perinatal outcomes, and type 2 diabetes after delivery. Women with GDM verified by a diagnostic 75 g oral glucose tolerance test (OGTT) at gestational Weeks 24–28 were recruited from the Songjiang Maternal and Children's Health-care Hospital, District of Songjiang, Shanghai, China, from August 2019 to August 2020.…”

“…In addition, research has shown that physical exercise is effective in glucose control. 8 , 11 If multiparous women with GDM do have poor glucose control, as hypothesized, they may require longer physical exercise time than primiparous women to achieve the same level of glycemic control. To date, however, there is a lack of longitudinal studies investigating the relationship between physical exercise time and glucose control in both multiparous and primiparous women.…”

“… 10 In a previous study, physical exercise times of more than 60 min per day were found to be associated with a lower percentage of abnormal plasma glucose (PG) among women with GDM. 11 Presently, evidence on the optimal amount of physical exercise needed to curb elevated glucose levels among women with GDM remains limited.…”

“…12 Wagan et al 13 has reported that women with higher maternal age, multiparity, and previous GDM history have increased risk of GDM, and GDM women with advanced age had higher percentage of abnormal PG tests. 11 In general, multiparity in pregnant woman predicts a higher maternal age and a potential previous GDM history, so multiparous women with GDM are prone to a higher risk of poor glucose control than primiparous women. However, no study has been conducted to test this hypothesis.…”