Therapeutic exercise for insulin-requiring gestational diabetics: effects on the fetus — results of a randomized prospective longitudinal study

Abstract

Regular physical activity is an established therapeutic adjunct in diabetes, but has not been offered to pregnant diabetics in the past; for sports might induce significant cardiovascular and hormonal changes that are able to reduce blood flow to the uterus and thus limit oxygen transfer to the fetus. Studying the impact of a medically supervised exercise program on gestational diabetes mellitus [GDM) in a randomised prospective longitudinal study, this paper aims to assess the effects of maternal moderate and strenuous exercise on the fetus. By evaluating shortterm fetal responses as reflected in heart rate patterns (FHR) and longterm-pregnancy complications and neonatal outcome, our results suggest that--in absence of ominous FHR changes or significant changes in uterine activity following the exercise sessions or increased diabetes-related peri- and neonatal morbidity--regular physical activity seems to be a safe therapeutic option for the fetus of GDM mothers.

Correlates of recreational physical activity in early pregnancy

“…For instance, in a small study of 20 gestational diabetics, Jovanovic-Peterson and Peterson reported that a combination of diet therapy and exercise was associated with a decrease in plasma glucose concentrations as compared to diet therapy alone 26 . This observation was later corroborated by other investigators 27 . Although most recent studies document no adverse infant outcomes associated with maternal physical activity during pregnancy 20 , some earlier reports suggested that infant birth weight may be reduced in women who are engaged in vigorous physical activity in pregnancy 21 .…”

“…Available information, though sparse, suggests that physical activity during pregnancy may be associated with a reduced occurrence of metabolic complications of pregnancy including gestational diabetes mellitus 5 and pre-eclampsia 6 . There is even some evidence that suggests that regular physical activity in pregnancy may have a role in the treatment of patients with gestational diabetes mellitus 26,27 . For instance, in a small study of 20 gestational diabetics, Jovanovic-Peterson and Peterson reported that a combination of diet therapy and exercise was associated with a decrease in plasma glucose concentrations as compared to diet therapy alone 26 .…”

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

“…Most researchers [2][3][4] performed complex interventions, usually not available in clinical setting, and the compliance with exercise was low [6].…”

A Will Without a Way: Barriers and Facilitators to Exercise During Pregnancy of Low-Income, African American Women

“…Exercise during pregnancy has been associated with a decrease in the incidence of preeclampsia and gestational diabetes, particularly in obese women with a body mass index (BMI) > 33 kg/m 2 (Jovanovic-Peterson, Durak, & Peterson, 1989;Bung et al, 1993;ACOG, 2001). In response, the American College of Obstetricians and Gynecologists (ACOG) currently recommends 30 minutes or more of exercise per day, on most days of the week during pregnancy (ACOG, 2002).…”