1. Pregnant women with risk factors for developing gestational diabetes mellitus (GDM) randomized to exercise interventions were less likely to develop GDM than controls who received standard prenatal care without exercise.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Gestational diabetes mellitus (GDM) is a common disease in pregnancy, with a worldwide prevalence estimated to be between 2 and 14%. GDM is associated with complications including pre-eclampsia, macrosomia, and neonatal hypoglycemia. Previous meta-analyses examining the effect of exercise on reducing GDM risk in the general population found conflicting evidence. The current meta-analysis examined randomized controlled trials (RCTs) that employed an exercise intervention for GDM prevention, specifically in pregnant women at high-risk of developing GDM, and where both control and intervention groups were already receiving standard prenatal care. The meta-analysis included 9 eligible RCTs with a variety of exercise program designs, with variations in the type of exercise, exercise duration, amount of supervision, and gestational weeks of the intervention. On average though, the results showed there was a lower likelihood of GDM with exercise interventions in high-risk pregnant women.
In depth [meta-analysis]: The study included RCTs involving pregnant women with various risk factors for GDM, including high BMI, sedentariness, unbalanced diet, family history, non-white ethnicity, previous macrosomia or GDM, and maternal age over 25 years. Patients in the control groups continued to have standard prenatal care, whereas the intervention group underwent an exercise program in addition to their prenatal care. In total, there were 9 eligible RCTs, conducted in Europe, Oceania, the USA, and China. Altogether, there were 1,738 patients with 866 I the intervention and 872 in control. There were variations in the delivery of the exercise program, with 5 studies incorporating a motivation aspect, 7 studies involving supervision of exercise, and 5 studies with programs lasting more than 20 weeks. The results showed that women in the exercise intervention were not as likely to develop GDM, with 21.4% of the intervention patients and 28.1% of the control patients developing GDM (OR 0.70, 95% CI 0.52-0.93, p = 0.02), and no between study heterogeneity (Q 10.08, p = 0.26). This difference was also significant for trials where more than 5% of the participants were of low educational level (OR 0.55, 95% CI 0.40-0.74, p = 0.0001), where motivation was incorporated into the intervention (OR 0.69, 95% CI 0.50-0.96, p = 0.03), and where the program was longer than 20 weeks (OR 0.54, 95% CI 0.40-0.74, p = 0.0001). Overall, this study demonstrated the potential for exercise programs to prevent GDM in pregnant women with GDM risk factors.
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