Diet and exercise for pregnant women for preventing gestational diabetes mellitus

Diet and exercise in pregnancy may have some effect for preventing gestational diabetes and appears to be effective for reducing gestational weight gain compared with usual care.

Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment, blinding of outcome assessment).

Summary

A Cochrane review included 5 studies with a total of 1115 women and their babies. 4 of the 5 included trials had small sample sizes with one large trial that recruited 855 women. The used interventions in the different trials were 35–45 -minutes supervised sessions 3 times a week, an individualised exercise plan with an energy expenditure goal of 900 kcal per week, home-based stationary cycling for a maximum of 5 sessions of 40 minutes aerobic exercise per week, home-based supervised stationary cycling for 3 sessions of 25 minutes, or a weekly supervised 60-minute group exercise session plus a 45-minute home exercise program at least twice per week The length of the exercise period varied. When comparing women receiving additional exercise interventions with those having routine antenatal care, there was no significant difference in gestational diabetes mellitus (GDM) incidence (RR 1.10, 95% CI 0.66 to 1.84; 3 trials, n=826), caesarean section (RR 1.33, 95% CI 0.97 to 1.84; 2 trials, n=934) or operative vaginal birth (RR 0.83, 95% CI 0.58 to 1.17; 2 trials, n=934). No trial reported the infant primary outcomes prespecified in the review. None of the 5 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.

Another Cochrane review included 23 studies with a total of 8 918 women and their babies. When a diet and exercise intervention was compared with no intervention, there was a trend towards lower risk of GDM and caesarean section (table ). No difference was found in pre-eclampsia, high blood pressure, a large for age baby at birth, or perineal trauma. Reduced weight gain during pregnancy was shown for women receiving the combined diet and exercise intervention (table ).

Clinical comments

The time period for the exercise might be too short to produce a difference in the outcomes.

Date of latest search: 11 February 2014

Ədəbiyyat

1. Han S, Middleton P, Crowther CA. Exercise for pregnant women for preventing gestational diabetes mellitus. Cochrane Database Syst Rev 2012;(7):CD009021.
2. Shepherd E, Gomersall JC, Tieu J et al. Combined diet and exercise interventions for preventing gestational diabetes mellitus. Cochrane Database Syst Rev 2017;(11):CD010443.