Regular Exercise During Pregnancy to Prevent Gestational Diabetes

Stafne, Signe Nilssen; Salvesen, Kjell Å.; Romundstad, Pål Richard; Eggebø, Torbjørn Moe; Carlsen, Sven Magnus; Mørkved, Siv

doi:10.1097/aog.0b013e3182393f86

Cited by 176 publications

(259 citation statements)

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“…In a study of healthy pregnant women, mild physical activity was found to lower the risk of developing gestational diabetes (26). In contrast, a recent randomized control trial in women of normal body weight showed that exercise during pregnancy did not decrease the prevalence of gestational diabetes compared with sedentary controls (43). Few human studies have investigated offspring effects of maternal exercise during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Perinatal exercise improves glucose homeostasis in adult offspring

Carter

Lewis

Wilkerson

et al. 2012

American Journal of Physiology-Endocrinology and Metabolism

138

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Emerging research has shown that subtle factors during pregnancy and gestation can influence long-term health in offspring. In an attempt to be proactive, we set out to explore whether a nonpharmacological intervention, perinatal exercise, might improve offspring health. Female mice were separated into sedentary or exercise cohorts, with the exercise cohort having voluntary access to a running wheel prior to mating and during pregnancy and nursing. Offspring were weaned, and analyses were performed on the mature offspring that did not have access to running wheels during any portion of their lives. Perinatal exercise caused improved glucose disposal following an oral glucose challenge in both female and male adult offspring (P Ͻ 0.05 for both). Blood glucose concentrations were reduced to lower values in response to an intraperitoneal insulin tolerance test for both female and male adult offspring of parents with access to running wheels (P Ͻ 0.05 and P Ͻ 0.01, respectively). Male offspring from exercised dams showed increased percent lean mass and decreased fat mass percent compared with male offspring from sedentary dams (P Ͻ 0.01 for both), but these parameters were unchanged in female offspring. These data suggest that short-term maternal voluntary exercise prior to and during healthy pregnancy and nursing can enhance long-term glucose homeostasis in offspring.running; pregnancy; programming; mice IN 2007, 23.5 MILLION PEOPLE in the US were estimated to have diabetes, and this number is increasing (4). Interestingly, and what is often underappreciated, is that the metabolic status of an individual is decided not only by their inherited genes, nutritional intake, and physical exercise but also by maternal nutrition and obesity during pregnancy. In 1992, Hales and Barker (18) put forth the thrifty phenotype hypothesis that suggested that malnourished pregnant mothers produce smaller offspring that have a higher incidence of obesity, diabetes, and heart disease in adulthood. This hypothesis has since been modified to the developmental origins of health and disease (DOHaD) (15,17,18).The DOHaD suggests that the maternal environment and fetal programming lead to a higher incidence of several diseases later in life (14, 16). A growing number of studies have been designed to provide evidence for the negative impact of DOHaD, using mice, rats, and sheep as animal models (11,12,31,38). Many of these studies are directed at malnutrition through protein restriction or physical stressors that produce similar effects (8,11,34,44,45), but more recent studies are elucidating the metabolic effects of high-fat diet consumption during pregnancy on offspring (22,38,44,48).It has been known since Hippocrates and Galen that physical activity is an important component of a healthy lifestyle (33). However, knowledge about the contributions of maternal exercise during pregnancy and the long-term consequences on offspring is minimal. In both rats and mice, maternal exercise during pregnancy can improve brain physiology and cognition...

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Section: Discussionmentioning

confidence: 99%

Perinatal exercise improves glucose homeostasis in adult offspring

Carter

Lewis

Wilkerson

et al. 2012

American Journal of Physiology-Endocrinology and Metabolism

138

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“…Seven randomized controlled trials, published between 2009 and 2012, are summarized in Table 1 [32][33][34][35][36][37][38]. In contrast to observational data, a recent summary of five of these studies concluded that they could find no clear effect on preventing GDM [39].…”

Section: Can Exercise Prevent Gdm?mentioning

confidence: 99%

“…Therefore, it is likely that a lack of statistical power and the failure to control for significant confounding factors, such as diet and gestational weight gain, may have contributed to nonsignificant findings in both individual trials and the published meta-analysis. Power calculations to determine adequate sample size were reported in only one of the five included studies [34]. In this study, the authors estimated that 381 patients were required in each group.…”

Section: Can Exercise Prevent Gdm?mentioning

confidence: 99%

“…First, there have only been a limited number of trials conducted in a small number of women. With the exception of two recently published trials [34,38], all of the other trials have included less than 100 patients. Therefore, it is likely that a lack of statistical power and the failure to control for significant confounding factors, such as diet and gestational weight gain, may have contributed to nonsignificant findings in both individual trials and the published meta-analysis.…”

Section: Can Exercise Prevent Gdm?mentioning

confidence: 99%

“…Studies in high-risk populations may not require as many participants, particularly if the incidence of GDM in the control group is higher and the effect of exercise training may be more protective. Reduced 2-h blood glucose (116.8 vs 123.9 mg/dl; p = 0.012) [38] High-risk population (overweight or obese women and/or other risk factors for insulin resistance) 2 ) to a standard exercise program or routine care control for a 12 week duration, beginning at 18-22 weeks gestation [34]. The intervention program included a weekly supervised 60-min exercise session, containing a combination of aerobic, strength and balance exercises.…”

Section: Can Exercise Prevent Gdm?mentioning

confidence: 99%

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The Role of Exercise in Reducing the Risks of Gestational Diabetes Mellitus

Hopkins

Artal

2013

Womens Health (Lond Engl)

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Women's Health (2013) 9(6), [569][570][571][572][573][574][575][576][577][578][579][580][581] support the demands of fetal growth. A progressive and marked insulin resistance develops in maternal skeletal muscle, beginning around mid-pregnancy and progressing during the third trimester to levels that approximate the insulin resistance seen in T2DM [9]. Hormones and adipo kines secreted from the placenta, including TNF-a, placental lactogen, placental growth hormone, cortisol and progesterone, are probable triggers of insulin resistance in pregnancy, owing to rapid reversal at delivery [10].Normal pregnancy is characterized by increased insulin secretion from pancreatic b cells to compensate for peripheral insulin resistance. This can be displayed as a hyperbolic relationship between insulin sensitivity (the inverse of insulin resistance) and insulin secretion from pancreatic b cells (Figure 2). The development of GDM occurs when a mother does not secrete enough insulin in order to be able to meet the metabolic stress of peripheral insulin resistance. The reciprocal relation ship is preserved in most GDM women, but occurs at much lower level of insulin secretion. That is, women with GDM secrete 40-70% less insulin for any degree of insulin resistance [11,12]. Therefore, pregnancy-induced insulin resistance may unmask the b-cell dysfunction characteristic of GDM [13].Serial assessments of insulin sensitivity starting before pregnancy have also demonstrated slightly greater insulin resistance persisting into the third trimester in women with GDM compared with normal pregnant women [11]. This resistance applies to both the action of insulin Gestational diabetes mellitus & maternal obesityGestational diabetes mellitus (GDM) is the most common medical complication of pregnancy and is defined as glucose intolerance or high blood glucose concentrations (hyperglycemia), with onset or first recognition during pregnancy. The prevalence of GDM varies from 1 to 20% and is rising worldwide in line with increasing trends of maternal obesity and Type 2 diabetes mellitus (T2DM) [1,2]. The incidence of GDM rises disproportionately with increasing obesity. A recent meta-analysis of 20 population-based studies estimated that the risk of developing GDM is 2.14-fold higher for overweight (BMI: 25.0-29.9), 3.56-fold higher for obese (BMI: ≥30.0) and 8.56-fold higher for severely obese women (BMI: ≥40.0) compared with normal weight pregnant women (BMI: <25.0) [3]. Obesity and GDM have been recognized as independent risk factors for a number of adverse maternal and fetal outcomes, including diabetes, hypertension, operative deliveries, macrosomia and neonatal complications [4][5][6]. More recently, we have begun to understand that maternal obesity and GDM are also associated with significant lifelong consequences for the next generation [7,8]. As obesity and GDM share many of the same health consequences, obese women and their offspring are at a greater risk for adverse outcomes (Figure 1). Pathophysiology of GDMDuring normal pregnancy,...

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Diet or exercise, or both, for preventing excessive weight gain in pregnancy

Muktabhant

Lawrie

Lumbiganon

et al. 2015

Cochrane Database of Systematic Reviews

462

441

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High-quality evidence indicates that diet or exercise, or both, during pregnancy can reduce the risk of excessive GWG. Other benefits may include a lower risk of caesarean delivery, macrosomia, and neonatal respiratory morbidity, particularly for high-risk women receiving combined diet and exercise interventions. Maternal hypertension may also be reduced. Exercise appears to be an important part of controlling weight gain in pregnancy and more research is needed to establish safe guidelines. Most included studies were carried out in developed countries and it is not clear whether these results are widely applicable to lower income settings.

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Regular Exercise During Pregnancy to Prevent Gestational Diabetes

Abstract: : ClinicalTrials.gov, www.clinicaltrials.gov, NCT00476567.

Cited by 176 publications

References 25 publications

Perinatal exercise improves glucose homeostasis in adult offspring

Perinatal exercise improves glucose homeostasis in adult offspring

The Role of Exercise in Reducing the Risks of Gestational Diabetes Mellitus

Diet or exercise, or both, for preventing excessive weight gain in pregnancy

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