Aerobic or Resistance Exercise for Improved Glycaemic Control and Pregnancy Outcomes in Women with Gestational Diabetes Mellitus: A Systematic Review

Abstract

Exercise is often recommended in addition to diet and medication in the management of gestational diabetes mellitus (GDM). Our aim was to determine if strength training compared with aerobic exercise had an impact on glycaemic control, maternal and neonatal outcomes. The Cochrane library, Embase, PubMed, CINAHL, Medline, Google Scholar, and OpenGrey were searched. Over 758 pregnant women (mother-baby pairs) from 14 studies are included in this systematic review. Interventions ranged from cycling, aerobic exercises, walking, yoga, or combined aerobic and resistance exercises. Of the studies identified, none directly compared aerobic exercise with strength training. Half of the studies showed benefit in glycaemic control with additional exercise compared with usual physical activity. There was largely no impact on obstetric or neonatal outcomes. Studies on exercise in GDM have reiterated the safety of exercise in pregnancy and shown mixed effects on maternal glycaemic control, with no apparent impact on pregnancy outcomes. The heterogenicity of reported studies make it difficult to make specific recommendations on the optimum exercise modality for the management of GDM. The use of a core outcome set for GDM may improve reporting of studies on the role of exercise in its management.

Guidelines for Prenatal and Postpartum Resistance Training

“…Two common prenatal medical conditions that can impact a pregnant woman's ability to continue safe exercise are gestational diabetes and preeclampsia [13][14][15]. These conditions can develop during pregnancy and should be carefully monitored by the pregnant woman's primary care physician or obstetrician.…”

“…Gestational diabetes is impaired glucose intolerance that is diagnosed for the first time during pregnancy and is associated with other prenatal conditions such as preeclampsia, hypertension, preterm birth and higher incidence of induced labor and cesarean delivery [13,14]. It occurs in 2-10% of pregnancies and does not have any symptoms.…”

“…Moderate-intensity exercise training during pregnancy is associated with a lower incidence of gestational diabetes and reduced maternal weight gain [3,6,13,14]. Prenatal physical activity yields the best results in managing gestational diabetes and maternal weight gain when performed in a combination aerobic and resistance training.…”

“…Resistance training is a safe mode of physical exercise for women experiencing uncomplicated pregnancies and have been cleared by their healthcare provider to do so [12][13][14]29]. It can be beneficial in maintaining current strength, posture, and mood during pregnancy.…”

Physical Activity during Pregnancy and Risk of Gestational Diabetes Mellitus: A Meta-Review

“…Gestational diabetes mellitus, which is defined as new-onset maternal hyperglycemia in pregnancy that resolves after birth [ 17 ], is one of the most prevalent diseases in the modern world, a consequence of factors such as obesity, inadequate nutrition, or sedentary lifestyles [ 18 ]. In addition, it increases the risk of developing diabetes after pregnancy [ 19 ], and there is a possibility of fetal macrosomia, hyperbilirubinemia and hypoglycemia, infections, and obstetric trauma, also increasing the risk of complications during pregnancy and delivery. Physical activity prevents gestational diabetes mellitus by improving glycemic control, insulin resistance, and weight control during pregnancy [ 20 ].…”