Simple lifestyle recommendations and the outcomes of gestational diabetes. A 2×2 factorial randomized trial

Abstract

The benefits of exercise and behavioural recommendations in gestational diabetes mellitus (GDM) are controversial. In a randomized trial with a 2×2 factorial design, we examined the effect of exercise and behavioural recommendations on metabolic variables, and maternal/neonatal outcomes in 200 GDM patients. All women were given the same diet: group D received dietary recommendations only; group E was advised to briskly walk 20‐min/day; group B received behavioural dietary recommendations; group BE was prescribed the same as B + E. Dietary habits improved in all groups. In a multivariable regression model, fasting glucose did not change. Exercise, but not behavioural recommendations, was associated with the reduction of postprandial glucose (p < 0001), glycated haemoglobin (HbA1c; p < 0.001), triglycerides (p = 0.02) and C‐reactive protein (CRP; p < 0.001) and reduced any maternal/neonatal complications (OR = 0.50; 95%CI=0.28–0.89;p = 0.02). In GDM patients a simple exercise programme reduced maternal postprandial glucose, HbA1c, CRP, triglycerides and any maternal/neonatal complications, but not fasting glucose values.

The identification and treatment of women with hyperglycaemia in pregnancy: an analysis of individual participant data, systematic reviews, meta-analyses and an economic evaluation

“…'Other' diet and exercise trials Nine trials 204,206,208,209,212,[215][216][217]219 were too methodologically diverse to allow pooling of data. Six trials 206,209,212,215,217,219 compared two different types of diets, one trial 204 compared exercise to insulin use, one trial compared diet and insulin to diet alone, and one compared exercise with diet 216 ( Table 28).…”

“…In the three remaining trials, 204,208,216 a mixture of interventions was evaluated. Bo et al 216 gave the same diet to four groups of women; the first group also received diet recommendations, the second group was advised to walk briskly for 20 minutes each day, the third group received behavioural dietary recommendations and the fourth group received both of the second and third groups' interventions.…”

“…Bo et al 216 gave the same diet to four groups of women; the first group also received diet recommendations, the second group was advised to walk briskly for 20 minutes each day, the third group received behavioural dietary recommendations and the fourth group received both of the second and third groups' interventions. Bo et al 216 reported that exercise reduced postprandial glucose levels and a composite measure of maternal and neonatal complications, whereas behavioural interventions had no effect. Bung et al…”

Exercise improves glycaemic control in women diagnosed with gestational diabetes mellitus: a systematic review

“…[44][45][46][47][48][49][50][51] Consistent with standard diagnostic testing for GDM occurring between 24 to 28 weeks, participants were recruited from 24 weeks gestation through to 31 weeks gestation. Parity and past history of GDM (with previous pregnancies) were reported in two of the trials.…”

“…46,51 Five trials provided mean pre-pregnancy body mass index with a range of 25.4 to 27.6 kg/m 2 . [44][45][46][47]50 Intervention characteristics…”