Exercise during pregnancy and gestational diabetes-related adverse effects: a randomised controlled trial

Barakat, Rubén; Peláez, Mireia; López, Carmina; Lucı́a, Alejandro; Ruiz, Jonatan R.

doi:10.1136/bjsports-2012-091788

Cited by 148 publications

(258 citation statements)

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“…[28][29][30][31][32][33][34][35][36][37][38] Reasons for refusal to provide IPD included lack of time, 39,40 problems with data sharing 41 and conflicts of interest. 42,43 Data were lost in two trials. 44,45 Sixteen randomised controlled trials (RCTs) (including 2265 women) were identified too late in the project to be analysed, and thus we refrained from approaching the authors.…”

Section: Network Meta-analysismentioning

confidence: 99%

Effects of antenatal diet and physical activity on maternal and fetal outcomes: individual patient data meta-analysis and health economic evaluation

Rogozińska

Marlin

Jackson

et al. 2017

Health Technol Assess

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235

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BackgroundDiet- and physical activity-based interventions in pregnancy have the potential to alter maternal and child outcomes.ObjectivesTo assess whether or not the effects of diet and lifestyle interventions vary in subgroups of women, based on maternal body mass index (BMI), age, parity, Caucasian ethnicity and underlying medical condition(s), by undertaking an individual patient data (IPD) meta-analysis. We also evaluated the association of gestational weight gain (GWG) with adverse pregnancy outcomes and assessed the cost-effectiveness of the interventions.Data sourcesMEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects and Health Technology Assessment database were searched from October 2013 to March 2015 (to update a previous search).Review methodsResearchers from the International Weight Management in Pregnancy Collaborative Network shared the primary data. For each intervention type and outcome, we performed a two-step IPD random-effects meta-analysis, for all women (except underweight) combined and for each subgroup of interest, to obtain summary estimates of effects and 95% confidence intervals (CIs), and synthesised the differences in effects between subgroups. In the first stage, we fitted a linear regression adjusted for baseline (for continuous outcomes) or a logistic regression model (for binary outcomes) in each study separately; estimates were combined across studies using random-effects meta-analysis models. We quantified the relationship between weight gain and complications, and undertook a decision-analytic model-based economic evaluation to assess the cost-effectiveness of the interventions.ResultsDiet and lifestyle interventions reduced GWG by an average of 0.70 kg (95% CI –0.92 to –0.48 kg; 33 studies, 9320 women). The effects on composite maternal outcome [summary odds ratio (OR) 0.90, 95% CI 0.79 to 1.03; 24 studies, 8852 women] and composite fetal/neonatal outcome (summary OR 0.94, 95% CI 0.83 to 1.08; 18 studies, 7981 women) were not significant. The effect did not vary with baseline BMI, age, ethnicity, parity or underlying medical conditions for GWG, and composite maternal and fetal outcomes. Lifestyle interventions reduce Caesarean sections (OR 0.91, 95% CI 0.83 to 0.99), but not other individual maternal outcomes such as gestational diabetes mellitus (OR 0.89, 95% CI 0.72 to 1.10), pre-eclampsia or pregnancy-induced hypertension (OR 0.95, 95% CI 0.78 to 1.16) and preterm birth (OR 0.94, 95% CI 0.78 to 1.13). There was no significant effect on fetal outcomes. The interventions were not cost-effective. GWG, including adherence to the Institute of Medicine-recommended targets, was not associated with a reduction in complications. Predictors of GWG were maternal age (summary estimate –0.10 kg, 95% CI –0.14 to –0.06 kg) and multiparity (summary estimate –0.73 kg, 95% CI –1.24 to –0.23 kg).LimitationsThe findings were limited by the lack of standardisation in the components of intervention, residual heterogeneity in effects across studies for most analyses and the unavailability of IPD in some studies.ConclusionDiet and lifestyle interventions in pregnancy are clinically effective in reducing GWG irrespective of risk factors, with no effects on composite maternal and fetal outcomes.Future workThe differential effects of lifestyle interventions on individual pregnancy outcomes need evaluation.Study registrationThis study is registered as PROSPERO CRD42013003804.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Network Meta-analysismentioning

confidence: 99%

Effects of antenatal diet and physical activity on maternal and fetal outcomes: individual patient data meta-analysis and health economic evaluation

Rogozińska

Marlin

Jackson

et al. 2017

Health Technol Assess

Self Cite

235

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“…Seven randomized controlled trials, published between 2009 and 2012, are summarized in Table 1 [32][33][34][35][36][37][38]. In contrast to observational data, a recent summary of five of these studies concluded that they could find no clear effect on preventing GDM [39].…”

Section: Can Exercise Prevent Gdm?mentioning

confidence: 99%

“…Regular exercise in pregnancy has been shown to be protective against the development of pre-eclampsia in non diabetic pregnancies [58], and may provide similar protection for women with GDM. In addition, a recently published study examining the role of moderate-intensity exercise in reducing the comorbidities of GDM has reported a one-third reduction in the risk of undergoing acute or elective cesarean delivery for women who developed GDM (exercise OR: 1.30; 95% CI: 0.44-3.84 vs control OR: 1.99; 95% CI: 0.98-4.06) [38]. Taken together, these findings suggest that regular prenatal exercise may reduce the risk of pregnancy complications in women with GDM [59].…”

Section: Short-and Long-term Maternal Health Consequences Of Gdmmentioning

confidence: 99%

“…Studies in high-risk populations may not require as many participants, particularly if the incidence of GDM in the control group is higher and the effect of exercise training may be more protective. Reduced 2-h blood glucose (116.8 vs 123.9 mg/dl; p = 0.012) [38] High-risk population (overweight or obese women and/or other risk factors for insulin resistance) 2 ) to a standard exercise program or routine care control for a 12 week duration, beginning at 18-22 weeks gestation [34]. The intervention program included a weekly supervised 60-min exercise session, containing a combination of aerobic, strength and balance exercises.…”

Section: Can Exercise Prevent Gdm?mentioning

confidence: 99%

“…First, there have only been a limited number of trials conducted in a small number of women. With the exception of two recently published trials [34,38], all of the other trials have included less than 100 patients. Therefore, it is likely that a lack of statistical power and the failure to control for significant confounding factors, such as diet and gestational weight gain, may have contributed to nonsignificant findings in both individual trials and the published meta-analysis.…”

Section: Can Exercise Prevent Gdm?mentioning

confidence: 99%

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The Role of Exercise in Reducing the Risks of Gestational Diabetes Mellitus

Hopkins

Artal

2013

Womens Health (Lond Engl)

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Women's Health (2013) 9(6), [569][570][571][572][573][574][575][576][577][578][579][580][581] support the demands of fetal growth. A progressive and marked insulin resistance develops in maternal skeletal muscle, beginning around mid-pregnancy and progressing during the third trimester to levels that approximate the insulin resistance seen in T2DM [9]. Hormones and adipo kines secreted from the placenta, including TNF-a, placental lactogen, placental growth hormone, cortisol and progesterone, are probable triggers of insulin resistance in pregnancy, owing to rapid reversal at delivery [10].Normal pregnancy is characterized by increased insulin secretion from pancreatic b cells to compensate for peripheral insulin resistance. This can be displayed as a hyperbolic relationship between insulin sensitivity (the inverse of insulin resistance) and insulin secretion from pancreatic b cells (Figure 2). The development of GDM occurs when a mother does not secrete enough insulin in order to be able to meet the metabolic stress of peripheral insulin resistance. The reciprocal relation ship is preserved in most GDM women, but occurs at much lower level of insulin secretion. That is, women with GDM secrete 40-70% less insulin for any degree of insulin resistance [11,12]. Therefore, pregnancy-induced insulin resistance may unmask the b-cell dysfunction characteristic of GDM [13].Serial assessments of insulin sensitivity starting before pregnancy have also demonstrated slightly greater insulin resistance persisting into the third trimester in women with GDM compared with normal pregnant women [11]. This resistance applies to both the action of insulin Gestational diabetes mellitus & maternal obesityGestational diabetes mellitus (GDM) is the most common medical complication of pregnancy and is defined as glucose intolerance or high blood glucose concentrations (hyperglycemia), with onset or first recognition during pregnancy. The prevalence of GDM varies from 1 to 20% and is rising worldwide in line with increasing trends of maternal obesity and Type 2 diabetes mellitus (T2DM) [1,2]. The incidence of GDM rises disproportionately with increasing obesity. A recent meta-analysis of 20 population-based studies estimated that the risk of developing GDM is 2.14-fold higher for overweight (BMI: 25.0-29.9), 3.56-fold higher for obese (BMI: ≥30.0) and 8.56-fold higher for severely obese women (BMI: ≥40.0) compared with normal weight pregnant women (BMI: <25.0) [3]. Obesity and GDM have been recognized as independent risk factors for a number of adverse maternal and fetal outcomes, including diabetes, hypertension, operative deliveries, macrosomia and neonatal complications [4][5][6]. More recently, we have begun to understand that maternal obesity and GDM are also associated with significant lifelong consequences for the next generation [7,8]. As obesity and GDM share many of the same health consequences, obese women and their offspring are at a greater risk for adverse outcomes (Figure 1). Pathophysiology of GDMDuring normal pregnancy,...

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Implementation of Antenatal Lifestyle Interventions Into Routine Care

et al. 2022

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ImportanceLifestyle interventions in pregnancy optimize gestational weight gain and improve pregnancy outcomes, with implementation recommended by the US Preventive Services Task Force. Yet, implementation research taking these efficacy trials into pragmatic translation remains limited.ObjectiveTo evaluate success factors for implementing pregnancy lifestyle interventions into antenatal care settings in a meta-analysis, using the penetration, implementation, participation, and effectiveness (PIPE) impact metric.Data SourcesData from a previous systematic review that searched across 9 databases, including MEDLINE, Embase, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Health Technology Assessment Database, were obtained, in 2 stages, up to May 6, 2020.Study SelectionRandomized clinical trials reporting gestational weight gain in singleton pregnancies.Data Extraction and SynthesisThe association of penetration, implementation, and participation with effectiveness of antenatal lifestyle interventions in optimizing gestational weight gain was estimated using random-effects meta-analyses. The Cochrane risk of bias tool, version 1.0, was used to assess risk of bias.Main Outcomes and MeasuresPenetration (reach), implementation (fidelity), participation, and effectiveness of randomized clinical trials of lifestyle interventions in pregnancy.ResultsNinety-nine studies with 34 546 participants were included. Only 14 studies reported penetration of target populations. Overall, 38 studies (38.4%) had moderate fidelity, 25 (25.2%) had high fidelity, and 36 (36.4%) had unclear fidelity. Participation was reported in 84 studies (84.8%). Lifestyle interventions were associated with reducing gestational weight gain by 1.15 kg (95% CI, –1.40 to –0.91 kg).Conclusions and RelevanceThe findings of this systematic review and meta-analysis suggest that, despite the large body of evidence on efficacy of lifestyle interventions during pregnancy in optimizing gestational weight gain, little guidance is available to inform implementation of this evidence into practice. There is a need to better elucidate implementation outcomes in trial design alongside pragmatic implementation research to improve the health of women who are pregnant and the next generation.

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Exercise during pregnancy and gestational diabetes-related adverse effects: a randomised controlled trial

Abstract: Regular moderate-intensity exercise performed over the second-third trimesters of pregnancy can be used to attenuate important GDM-related adverse outcomes.

Cited by 148 publications

References 45 publications

Effects of antenatal diet and physical activity on maternal and fetal outcomes: individual patient data meta-analysis and health economic evaluation

Effects of antenatal diet and physical activity on maternal and fetal outcomes: individual patient data meta-analysis and health economic evaluation

The Role of Exercise in Reducing the Risks of Gestational Diabetes Mellitus

Implementation of Antenatal Lifestyle Interventions Into Routine Care

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