Prepregnancy Fitness and Risk of Gestational Diabetes: A Longitudinal Analysis

Whitaker, Kara M.; Ingram, Katherine H.; Appiah, Duke; Nicholson, Wanda K; Bennett, Wendy L.; Lewis, Cora E.; Reis, Jared P.; Schreiner, Pamela J.; Gunderson, Erica P.

doi:10.1249/mss.0000000000001600

Cited by 17 publications

(30 citation statements)

References 40 publications

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“…We also lacked cardiometabolic measures between each birth, and therefore the childbearing years were condensed into one period, restricting our ability to study other relevant reproductive factors such as lactation. Cardiorespiratory fitness was not available for each of the necessary years and therefore could not be studied as a serial covariate, although we recently showed that it is a stronger predictor of future GDM than physical activity (23). Our models also only examined a linear trend in risk factors, although for weight gain and WC, this is a reasonable assumption.…”

Section: Discussionmentioning

confidence: 99%

Changes in Cardiometabolic Risk Factors Before and After Gestational Diabetes: A Prospective Life‐Course Analysis in CARDIA Women

Catov

Sun

Bertolet

et al. 2020

Obesity

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This study hypothesized that both preconception and postchildbearing patterns of cardiometabolic risk factors may be different for women with gestational diabetes mellitus (GDM) compared with women without GDM. Methods: Among 1,302 (51% black) women in the Coronary Artery Risk Development in Young Adults (CARDIA) study with births and followed for 30 years, this study evaluated changes in cardiometabolic factors (BMI, waist circumference [WC], lipids, blood pressure) during prechildbearing (prior to the first postbaseline birth) and postchildbearing periods (after the last birth) by GDM status using piecewise linear mixed models adjusted for sociodemographics, parity, and time-varying covariates. Results: Compared with women who did not develop GDM, weight and WC increases in women who developed GDM (n = 152, 12%) were faster (BMI difference: +0.12 kg/m 2 /y, P = 0.04; WC difference: +0.28 cm/y, P = 0.04) during the prechildbearing period, accounting for covariates. This translated to an average of 1.3 kg of excess weight gain across 4 years among women with subsequent GDM versus non-GDM births. In contrast, slopes after childbearing did not differ by GDM status, nor were there other cardiometabolic differences. Conclusions: Women with GDM exhibited an increasing prepregnancy pattern of weight gain and central adiposity. Absolute postchildbearing weight was also higher in GDM-affected women, but the slope of gain after GDM was not.

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Section: Discussionmentioning

confidence: 99%

Changes in Cardiometabolic Risk Factors Before and After Gestational Diabetes: A Prospective Life‐Course Analysis in CARDIA Women

Catov

Sun

Bertolet

et al. 2020

Obesity

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“…The 18 included studies were conducted in 26 countries, 19 were developed, and seven were developing countries. [15][16][17][18][26][27][28][29][30][31][32][33][34][35][36][37][38][39] The total sample size was 60 804. The follow-up duration varied from 6 months to 25 years and the studies were published between 2006 and 2021.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…In addition, eight studies assessed SB based on participants' self-reports. [16][17][18][27][28][29]31,39 Characteristics of the 18 included studies are displayed in Table 1.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Six studies determined the prevalence of SB among women who had or who developed GDM during the study (Table 3). [15][16][17][18]29,34 Most of these studies used self-reporting to assess SB, and all used their own cutoffs to classify SB. Two mentioned the term "sedentary behavior," one defined this as a physical activity level (PAL) of 1.40-1.69 15 and the other asked participants to self-report their total time spent sitting per day.…”

Section: Prevalence Of Sb Among Pregnant Women Who Had or Who Developed Gdmmentioning

confidence: 99%

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Sedentary behaviors and gestational diabetes mellitus: A systematic review

Zhu

Wang

et al. 2021

J of Obstet and Gynaecol

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Aim: Sedentary behaviors are activities that expend less energy than 1.5 metabolic equivalents, such as watching TV, sitting. We aim to systematically review the evidence to determine the association of sedentary behavior (SB) with the risk of gestational diabetes mellitus, and the associations of SB with health outcomes in pregnant women with gestational diabetes mellitus (GDM) and women at high risk of gestational diabetes mellitus. Methods: Two researchers independently performed a literature search using PubMed, Medline, EMBASE, CINAHL, the Cochrane Library, the Rehabilitation and Sports Medicine Source, and the Sedentary Behavior Research Database for studies published up to January 27, 2021. Randomized controlled trials, quasiexperimental studies, and observational studies were screened and selected if SB was assessed in the context of gestational diabetes mellitus. Two reviewers extracted the relevant information and independently assessed the included studies for quality and bias. Results: Eighteen studies were included, involving 60 804 patients, and the timeline of the original study included was from 2006 to 2021. Our review showed that SB before pregnancy was not associated with the risk of gestational diabetes mellitus, while SB during pregnancy was uncertain about the risk of gestational diabetes mellitus. In addition, there were significant associations between SB time and metabolic outcomes. In addition, SB may cause some adverse maternal and fetal outcomes. Conclusion: SB is likely to be the intermediary variable between occurrence of GDM and adverse maternal and infant outcome, rather than a direct influencing factor. Limited by the quantity and quality of included studies, the above conclusions need to be verified by more high-quality studies.

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“…Although the use of cardiorespiratory fitness testing in non-pregnant populations is established, its utility during pregnancy is only beginning to emerge. Over the last decade, cohort studies examining the relationship between cardiorespiratory fitness with maternal and fetal health outcomes have linked low VO 2max during pregnancy with elevated maternal blood pressure (Bisson, Rheaume, Bujold, Tremblay, & Marc, 2014), long duration labor (Kardel, Johansen, Voldner, Iversen, & Henriksen, 2009), an increased risk of gestational diabetes mellitus (Whitaker et al, 2018), preterm birth (Lane-Cordova et al, 2018), and a small-for-gestational age baby (Lane-Cordova et al, 2018). Exercise testing in a clinical setting during pregnancy also provides insight into cardiopulmonary changes elicited during exercise which can help identify women at an increased risk of adverse pregnancy outcomes, and can aid in the development of personalized exercise programs.…”

Section: Introductionmentioning

confidence: 99%

Cardiopulmonary exercise testing during pregnancy

Wowdzia

Davenport

2020

Birth Defects Research

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The goal of this review is to examine practical considerations when conducting cardiopulmonary exercise testing during pregnancy. In a clinical and research setting, cardiopulmonary exercise testing during pregnancy is valuable in identifying underlying cardiopulmonary conditions, stratifying the risk of adverse pregnancy outcomes, as well as establishing exercise tolerance/limitations. This review encompasses information regarding the unique physiological adaptations that occur throughout gestation (e.g., changes in resting heart rate, blood pressure, glucose, etc.) and how these adaptations impact the interpretation of physiological measurements. There are also key concerns that are unique to pregnant populations that should be considered when participating in exercise (i.e., fetus, ventilation, thermoregulation, urinary incontinence, low back pain, and pelvic girdle pain). This step‐by‐step review of cardiopulmonary exercise testing outlines pregnancy related adjustments to standardized methods (i.e., screening/documentation, pre‐ and post‐test measurements, protocol specifics, modality selection, and fetal monitoring) which should be considered for the safety of both the participant and fetus. Currently, pregnancy specific exercise testing guidelines are lacking. Therefore, we will be discussing the limitations of current recommendations such as a safe cut off for resting heart rate and pregnancy specific test termination criteria.

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Prepregnancy Fitness and Risk of Gestational Diabetes: A Longitudinal Analysis

Abstract: 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.

Cited by 17 publications

References 40 publications

Changes in Cardiometabolic Risk Factors Before and After Gestational Diabetes: A Prospective Life‐Course Analysis in CARDIA Women

Changes in Cardiometabolic Risk Factors Before and After Gestational Diabetes: A Prospective Life‐Course Analysis in CARDIA Women

Sedentary behaviors and gestational diabetes mellitus: A systematic review

Cardiopulmonary exercise testing during pregnancy

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