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Cited by 139Gestational Diabetes Research and ManagementPhysical Activity and HealthDiabetes, Cardiovascular Risks, and Lipoproteins

Exercise for pregnant women for preventing gestational diabetes mellitus

Open access
Han, Shanshan, Middleton, Philippa, Crowther, Caroline A·2012·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd009021.pub2PMC PMC11534277
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Abstract

BACKGROUND: Gestational diabetes mellitus (GDM) affects a significant number of women each year. GDM is associated with a wide range of adverse outcomes for women and their babies. Recent observational studies have found physical activity during normal pregnancy decreases insulin resistance and therefore might help to decrease the risk of developing GDM. OBJECTIVES: To assess the effects of physical exercise for pregnant women for preventing glucose intolerance or GDM. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (2 April 2012), ClinicalTrials.gov (2 April 2012) and the WOMBAT Perinatal Trials Registry (2 April 2012). SELECTION CRITERIA: Randomised and cluster-randomised trials assessing the effects of exercise for preventing pregnancy glucose intolerance or GDM. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of included studies. MAIN RESULTS: We included five trials with a total of 1115 women and their babies (922 women and their babies contributed outcome data). Four of the five included trials had small sample sizes with one large trial that recruited 855 women and babies. All five included trials had a moderate risk of bias. When comparing women receiving additional exercise interventions with those having routine antenatal care, there was no significant difference in GDM incidence (three trials, 826 women, risk ratio (RR) 1.10, 95% confidence interval (CI) 0.66 to 1.84), caesarean section (two trials, 934 women, RR 1.33, 95% CI 0.97 to 1.84) or operative vaginal birth (two trials, 934 women, RR 0.83, 95% CI 0.58 to 1.17). No trial reported the infant primary outcomes prespecified in the review.None of the five included trials found significant differences in insulin sensitivity. Evidence from one single large trial suggested no significant difference in the incidence of developing pregnancy hyperglycaemia not meeting GDM diagnostic criteria, pre-eclampsia or admission to neonatal ward between the two study groups. Babies born to women receiving exercise interventions had a non-significant trend to a lower ponderal index (mean difference (MD) -0.08 gram x 100 m(3), 95% CI -0.18 to 0.02, one trial, 84 infants). No significant differences were seen between the two study groups for the outcomes of birthweight (two trials, 167 infants, MD -102.87 grams, 95% CI -235.34 to 29.60), macrosomia (two trials, 934 infants, RR 0.91, 95% CI 0.68 to 1.22), or small-for-gestational age (one trial, 84 infants, RR 1.05, 95% CI 0.25 to 4.40) or gestational age at birth (two trials, 167 infants, MD -0.04 weeks, 95% CI -0.37 to 0.29) or Apgar score less than seven at five minutes (two trials, 919 infants, RR 1.00, 95% CI 0.27 to 3.65). None of the trials reported long-term outcomes for women and their babies. No information was available on health services costs. AUTHORS' CONCLUSIONS: There is limited randomised controlled trial evidence available on the effect of exercise during pregnancy for preventing pregnancy glucose intolerance or GDM. Results from three randomised trials with moderate risk of bias suggested no significant difference in GDM incidence between women receiving an additional exercise intervention and routine care.Based on the limited data currently available, conclusive evidence is not available to guide practice. Larger, well-designed randomised trials, with standardised behavioural interventions are needed to assess the effects of exercise on preventing GDM and other adverse pregnancy outcomes including large-for-gestational age and perinatal mortality. Longer-term health outcomes for both women and their babies and health service costs should be included. Several such trials are in progress. We identified another seven trials which are ongoing and we will consider these for inclusion in the next update of this review.

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Authors
Han, S., Middleton, P., & Crowther, C. A.
Affiliations
Women's and Children's Hospital (AU)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2012-07-11
Volume
2012
Issue
7
Pages
CD009021-CD009021
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd009021.pub2
PMC
PMC11534277
OpenAlex
W2127923944
Cited by
139
References
0
Citations by year
2025: 3 · 2024: 6 · 2023: 6 · 2022: 4 · 2021: 14 · 2020: 12 · 2019: 7 · 2018: 7 · 2017: 11 · 2016: 16 · 2015: 24 · 2014: 12 · 2013: 16 · 2012: 1
FWCI
2.77
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
gestational diabetes mellitus, exercise during pregnancy, physical activity, impaired glucose tolerance, insulin resistance, cesarean section, instrumental delivery, preeclampsia, neonatal admission, birth weight, prenatal care, risk of bias, risk of bias assessment, risk of bias assessment tools
MeSH terms
Birth Weight, Cesarean Section, Female, Humans, Hyperglycemia, Infant, Newborn, Insulin Resistance, Pre-Eclampsia, Pregnancy, Prenatal Care, Exercise, Incidence, Randomized Controlled Trials as Topic, Diabetes, Gestational

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