The Effect of Exercise Interventions on Gestational Diabetes: A Systematic Review
Keywords:Blood sugar, Diabetes, Exercise, Gestational
Objective: Gestational diabetes mellitus (GDM) is the most common metabolic disease occurring during pregnancy and it has been observed that GDM rates have increased significantly worldwide in the last 20 years. It has been reported that being physically active during pregnancy is beneficial for the fetus and mother, and that exercise can be effective in preventing possible complications associated with GDM. The purpose of this systematic review is to evaluate the effects of exercise interventions on glycemic index, gestational age, obstetric and neonatal outcomes in gestational diabetes. This study was prepared according to the PRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) guideline.
Materials and Methods: Articles to be included in the study; articles between 2012-2022 were searched in Web of Science, Cochrane Library, PUBMED, Scopus and Science Direct electronic databases. In the scans, the terms “gestational diabetes”, “exercise” and “combined exercise”, “pregnancy” or “pregnant” and “diabetes” and “exercise”, and “gestational diabetes” and “exercise” and MeSH terms the keywords were used and clinical studies were filtered out.
Results: Nine randomized controlled studies with 1228 pregnant women with GDM were included in the review. As a result of the compiled randomized controlled studies, it was found that the exercise intervention in pregnant women diagnosed with GDM changed the fasting blood glucose level between 0.3-1.2 mmol and the 2-hour postprandial blood glucose level between 0.2-0.5 mmol, so exercise was an effective factor on fasting and postprandial blood sugar levels.
Conclusion: This systematic review suggests that women diagnosed with GDM can improve their physical activity motivation during pregnancy and in the prevention of complications that may arise due to glycemic management, insulin use, blood sugar level, maternal and neonatal glucose intolerance with exercise intervention. Interventions should aim to follow-up participants postpartum to understand the long-term benefits of antenatal exercise intervention.
American College of Obstetricians and Gynecologists. (2005). ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 61, April 2005. Human papillomavirus. Obstetrics and gynecology, 105(4), 905-918.
American Diabetes Association. (2011). Standards of medical care in diabetes—2011. Diabetes care, 34(Supplement_1), S11-S61.
American Diabetes Association. (2017). American Diabetes Association Standards of medical care in diabetes–2017. Diabetes care, 40(Suppl. 1), S1.
American College of Obstetricians and Gynecologists. (2000). Fetal macrosomia: ACOG practice bulletin no. 22. Washington, DC: ACOG.
American Diabetes Association. (2017). American Diabetes Association Standards of medical care in diabetes–2017. Diabetes care, 40(Suppl. 1), S1.
Andersen, M. B., Fuglsang, J., Ostenfeld, E. B., Poulsen, C. W., Daugaard, M., & Ovesen, P. G. (2021). Postprandial interval walking—effect on blood glucose in pregnant women with gestational diabetes. American Journal of Obstetrics & Gynecology MFM, 3(6), 100440.
Alexander, G. K., Taylor, A. G., Innes, K. E., Kulbok, P., & Selfe, T. K. (2008). Contextualizing the effects of yoga therapy on diabetes management: a review of the social determinants of physical activity. Family & community health, 31(3), 228.
Babbar, S., & Shyken, J. (2016). Yoga in pregnancy. Clinical obstetrics and gynecology, 59(3), 600-612.
Balaji, P. A., Varne, S. R., & Ali, S. S. (2012). Physiological effects of yogic practices and transcendental meditation in health and disease. North American journal of medical sciences, 4(10), 442.
Ballas, J., Moore, T. R., & Ramos, G. A. (2012). Management of diabetes in pregnancy. Current diabetes reports, 12, 33-42.
Barakat, R., Pelaez, M., Lopez, C., Lucia, A., & Ruiz, J. R. (2013). Exercise during pregnancy and gestational diabetes-related adverse effects: a randomised controlled trial. British journal of sports medicine, 47(10), 630-636.
Boulinguiez, A., Staels, B., Duez, H., & Lancel, S. (2017). Mitochondria and endoplasmic reticulum: Targets for a better insulin sensitivity in skeletal muscle?. Biochimica et Biophysica Acta (BBA)-Molecular and Cell Biology of Lipids, 1862(9), 901-916.
Brody, S. C., Harris, R., & Lohr, K. (2003). Screening for gestational diabetes: a summary of the evidence for the US Preventive Services Task Force. Obstetrics & Gynecology, 101(2), 380-392.
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. 2003a. Gestational diabetes mellitus. CMAJ, 169: S99–S105.
Cashin, A. G., & McAuley, J. H. (2019). Clinimetrics: Physiotherapy Evidence Database (PEDro) Scale. Journal of physiotherapy, 66(1), 59-59.
Chamberlain, C., McNamara, B., Williams, E. D., Yore, D., Oldenburg, B., Oats, J., & Eades, S. (2013). Diabetes in pregnancy among indigenous women in Australia, Canada, New Zealand and the United States: a systematic review of the evidence for screening in early pregnancy. Diabetes/Metabolism Research and Reviews, 29(4), 241-256.
Chasan-Taber, L., Schmidt, M. D., Pekow, P., Sternfeld, B., Manson, J. E., Solomon, C. G., ... & Markenson, G. (2008). Physical activity and gestational diabetes mellitus among Hispanic women. Journal of Women's Health, 17(6), 999-1008.
Cheng, A. Y. (2013). Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada. Introduction. Canadian journal of diabetes, 37, S1-3.
Committee on Obstetric Practice. (2009). ACOG Committee Opinion No. 435: postpartum screening for abnormal glucose tolerance in women who had gestational diabetes mellitus. Obstet Gynecol, 113(6), 1419-1421.
Coll, C. V., Domingues, M. R., Gonçalves, H., & Bertoldi, A. D. (2017). Perceived barriers to leisure-time physical activity during pregnancy: A literature review of quantitative and qualitative evidence. Journal of science and medicine in sport, 20(1), 17-25.
Colberg, S. R., Sigal, R. J., Fernhall, B., Regensteiner, J. G., Blissmer, B. J., Rubin, R. R., ... & Braun, B. (2010). Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes care, 33(12), e147-e167.
Colberg, S. R., Castorino, K., & Jovanovič, L. (2013). Prescribing physical activity to prevent and manage gestational diabetes. World journal of diabetes, 4(6), 256.
Crowther, C. A., Hague, W. M., Middleton, P. F., Baghurst, P. A., McPhee, A. J., Tran, T. S., ... & IDEAL Study Group. (2012). The IDEAL study: investigation of dietary advice and lifestyle for women with borderline gestational diabetes: a randomised controlled trial-study protocol. BMC Pregnancy and Childbirth, 12, 1-8.
Cremona, A., O'Gorman, C., Cotter, A., Saunders, J., & Donnelly, A. (2018). Effect of exercise modality on markers of insulin sensitivity and blood glucose control in pregnancies complicated with gestational diabetes mellitus: a systematic review. Obesity science & practice, 4(5), 455-467.
Cypryk, K., Szymczak, W., Czupryniak, L., Sobczak, M., & Lewiński, A. (2008). Gestational diabetes mellitus-an analysis of risk factors. Endokrynologia Polska, 59(5), 393-397.
Dissemination, C. F. R. A. (2009). Systematic reviews: CRD’s guidance for undertaking reviews in healthcare. York: University of York NHS Centre for Reviews & Dissemination.
Downs, D. S., DiNallo, J. M., Birch, L. L., Paul, I. M., & Ulbrecht, J. S. (2017). Randomized face-to-face vs. home exercise interventions in pregnant women with gestational diabetes. Psychology of Sport and Exercise, 30, 73-81.
Gilbert, E. S. (2010). Manual of high risk pregnancy and delivery. Elsevier Health Sciences.
Halse, R. E., Wallman, K. E., Dimmock, J. A., Newnham, J. P., & Guelfi, K. J. (2015). Home-Based Exercise Improves Fitness and Exercise Attitude and Intention in Women with GDM. Medicine and science in sports and exercise, 47(8), 1698-1704.
Harrison, A. L., Taylor, N. F., Shields, N., & Frawley, H. C. (2018). Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review. Journal of physiotherapy, 64(1), 24-32.
Hedderson, M. M., Gunderson, E. P., & Ferrara, A. (2010). Gestational weight gain and risk of gestational diabetes mellitus. Obstetrics and gynecology, 115(3), 597.
Kim, C., McEwen, L. N., Piette, J. D., Goewey, J., Ferrara, A., & Walker, E. A. (2007). Risk perception for diabetes among women with histories of gestational diabetes mellitus. Diabetes care, 30(9), 2281-2286.
Kim, S. Y., England, L., Wilson, H. G., Bish, C., Satten, G. A., & Dietz, P. (2010). Percentage of gestational diabetes mellitus attributable to overweight and obesity. American journal of public health, 100(6), 1047-1052.
Kuntsevich, V., Bushell, W. C., & Theise, N. D. (2010). Mechanisms of yogic practices in health, aging, and disease. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine, 77(5), 559-569.
Landon, M. B., Spong, C. Y., Thom, E., Carpenter, M. W., Ramin, S. M., Casey, B., ... & Anderson, G. B. (2009). A multicenter, randomized trial of treatment for mild gestational diabetes. New England Journal of Medicine, 361(14), 1339-1348.
Lawrence, J. M. (2011). Women with diabetes in pregnancy: different perceptions and expectations. Best Practice & Research Clinical Obstetrics & Gynaecology, 25(1), 15-24.
Mack, L. R., & Tomich, P. G. (2017). Gestational diabetes: diagnosis, classification, and clinical care. Obstetrics and Gynecology Clinics, 44(2), 207-217.
Maher, C. G., Sherrington, C., Herbert, R. D., Moseley, A. M., & Elkins, M. (2003). Reliability of the PEDro scale for rating quality of randomized controlled trials. Physical therapy, 83(8), 713-721.
Metzger, B. E., Buchanan, T. A., Coustan, D. R., De Leiva, A., Dunger, D. B., Hadden, D. R., ... & Zoupas, C. (2007). Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus. Diabetes care, 30(Supplement_2), S251-S260.
Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., ... & Stewart, L. A. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic reviews, 4(1), 1-9.
Odabaşı, A. R., Yüksel, H., Kafkas, S., Sezer, S. D., Güner, Z., Minegül, E. B. E. N., & Ergün, O. N. U. R. (2006). Fetal and Placental Anthropometry and Blood Glucose Levels in Women at Low Risk of Gestational Diabetes Mellitus. Meandros Medical And Dental Journal, 7(3), 13-18.
Petry, C. J. (2010). Gestational diabetes: risk factors and recent advances in its genetics and treatment. British Journal of Nutrition, 104(6), 775-787.
Practice, A. C. O. (2002). ACOG Committee opinion. Number 267, January 2002: exercise during pregnancy and the postpartum period. Obstetrics and gynecology, 99(1), 171-173.
Qazi, W. A., Babur, M. N., Malik, A. N., & Begum, R. (2020). Effects of structured exercise regime on Glycosylated Hemoglobin and C reactive protein in patients with Gestational Diabetes Mellitus-A randomized controlled trial. Pakistan Journal of Medical Sciences, 36(7), 1449.
Rönö, K., Stach-Lempinen, B., Klemetti, M. M., Kaaja, R. J., Pöyhönen-Alho, M., Eriksson, J. G., & Koivusalo, S. B. (2014). Prevention of gestational diabetes through lifestyle intervention: study design and methods of a Finnish randomized controlled multicenter trial (RADIEL). BMC pregnancy and childbirth, 14(1), 1-11.
Salman, S., Satman, İ., Yılmaz, C., İmamoğlu, Ş., & Dinççağ, N. (2020). TEMD Diabetes Mellitus ve Komplikasyonlarının Tanı. Tedavi ve İzlem Kılavuzu.
Setji, T. L., Brown, A. J., Feinglos, M. N. (2005). Gestational diabetes mellitus. Clinical Diabetes, 23(1): 17-24.
Smith, S. A., & Michel, Y. (2006). A pilot study on the effects of aquatic exercises on discomforts of pregnancy. Journal of Obstetric, Gynecologic & Neonatal Nursing, 35(3), 315-323.
Verhagen, A. P., De Vet, H. C., De Bie, R. A., Kessels, A. G., Boers, M., Bouter, L. M., & Knipschild, P. G. (1998). The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. Journal of clinical epidemiology, 51(12), 1235-1241.
Wang, C., & Yang, H. X. (2016). Diagnosis, prevention and management of gestational diabetes mellitus. Chronic diseases and translational medicine, 2(04), 199-203.
Wing, R. R., Goldstein, M. G., Acton, K. J., Birch, L. L., Jakicic, J. M., Sallis Jr, J. F., ... & Surwit, R. S. (2001). Behavioral science research in diabetes: lifestyle changes related to obesity, eating behavior, and physical activity. Diabetes care, 24(1), 117-123.
World Health Organization. (1999). Definition, diagnosis and classification of diabetes mellitus and its complications: report of a WHO consultation. Part 1, Diagnosis and classification of diabetes mellitus (No. WHO/NCD/NCS/99.2). World health organization.
Wu, Y., Xu, M., & Zheng, G. (2022). Application of diversified and quantitative management model of exercise intervention in patients with gestational diabetes mellitus. The Journal of Maternal-Fetal & Neonatal Medicine, 35(25), 5001-5007.
Xie, Y., Zhao, H., Zhao, M., Huang, H., Liu, C., Huang, F., & Wu, J. (2022). Effects of resistance exercise on blood glucose level and pregnancy outcome in patients with gestational diabetes mellitus: a randomized controlled trial. BMJ Open Diabetes Research and Care, 10(2), e002622.
Yaping, X., Huifen, Z., Meijing, Z., Huibin, H., Chunhong, L., Fengfeng, H., & Jingjing, W. (2021). Effects of moderate-intensity aerobic exercise on blood glucose levels and pregnancy outcomes in patients with gestational diabetes mellitus: a randomized controlled trial. Diabetes Therapy, 12(9), 2585-2598.
Youngwanichsetha, S., Phumdoung, S., & Ingkathawornwong, T. (2014). The effects of mindfulness eating and yoga exercise on blood sugar levels of pregnant women with gestational diabetes mellitus. Applied Nursing Research, 27(4), 227-230.
Zhang, C., Tobias, D. K., Chavarro, J. E., Bao, W., Wang, D., Ley, S. H., & Hu, F. B. (2014). Adherence to healthy lifestyle and risk of gestational diabetes mellitus: prospective cohort study. Bmj, 349.
How to Cite
Copyright (c) 2023 WORLD WOMEN STUDIES JOURNAL
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.