Exercise in women with gestational diabetes mellitus
An extensive and rigorous literature review has identied and pooled data from 588 women with Gestational Diabetes Mellitus (GDM) who had been randomly allocated to either exercise or not. The pooled analysis showed significant benefit from exercise in controlling the blood glucose after a meal. It also confirmed the significant benefits of exercise for fasting blood glucose and glycated haemoglobin. Both aerobic and resistance exercise were effective in achieving these benefits.
GDM is carbohydrate or glucose intolerance that has its onset during pregnancy. It is diagnosed through laboratory screening, using a pregnancy oral glucose tolerance test that is performed between 24 and 28 weeks gestation. The short-term adverse consequences of hyperglycaemia may include hypertension and pre-eclampsia for the mother, and birth trauma from excessive birth weight for the baby. There may also be longer-term consequences.
Controlling blood glucose is a key weapon in managing GDM. Management of GDM typically consists of dietary modifications, regular self-monitoring of acute capillary blood glucose levels after a meal, and – where diet modification does not achieve control of blood glucose – insulin therapy.
Exercise, particularly structured aerobic and/ or resistance training, can help manage type 2 diabetes mellitus through its ability to increase glucose uptake and improve insulin sensitivity. Exercise is widely recommended for women with uncomplicated pregnancies, and there is some evidence that it helps control blood glucose in GDM as well. However, there are several ways to measure blood glucose.
One of the most important is the level of blood glucose after a meal - but this is the one measure whose response to exercise in women with GDM is unknown. Until now: this review showed significant benefit from exercise in controlling the blood glucose after a meal (by 0.33 mmol/L). It also confirmed the significant benefits of exercise for fasting blood glucose (by 0.31 mmol/L) and glycated haemoglobin (by 0.33%).
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> From: Harrison et al., J Physiother 62 (2017) 188-196. All rights reserved to the Australian Physiotherapy Association. Click here for the online summary.