Exercise for diabetic pregnant women

Department of Obstetrics and Gynecology, Vrije Universiteit Brussel, Bruxelles, Brussels Capital, Belgium
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 02/2006; 3(3):CD004225. DOI: 10.1002/14651858.CD004225.pub2
Source: PubMed

ABSTRACT Diabetes in pregnancy may result in unfavourable maternal and neonatal outcomes. Exercise was proposed as an additional strategy to improve glycaemic control. The effect of exercise during pregnancies complicated by diabetes needs to be assessed.
To evaluate the effect of exercise programs, alone or in conjunction with other therapies, compared to no specific program or to other therapies, in pregnant women with diabetes on perinatal and maternal morbidity and on the frequency of prescription of insulin to control glycaemia. To compare the effectiveness of different types of exercise programs on perinatal and maternal morbidity.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 December 2005).
All known randomised controlled trials evaluating the effect of exercise in diabetic pregnant women on perinatal outcome and maternal morbidity.
We evaluated relevant studies for meeting the inclusion criteria and methodological quality. Three review authors abstracted the data. For all data analyses, we entered data based on the principle of intention to treat. We calculated relative risks and 95% confidence intervals for dichotomous data.
Four trials, involving 114 pregnant women with gestational diabetes, were included in the review. None included pregnant women with type 1 or type 2 diabetes. Women were recruited during the third trimester and the intervention was performed for about six weeks. The programs generally consisted in exercising three times a week for 20 to 45 minutes. We found no significant difference between exercise and the other regimen in all the outcomes evaluated.
There is insufficient evidence to recommend, or advise against, diabetic pregnant women to enrol in exercise programs. Further trials, with larger sample size, involving women with gestational diabetes, and possibly type 1 and 2 diabetes, are needed to evaluate this intervention.

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    • "Cela ne 126 permet pas la mise en place de recommandations spé cifiques. 127 Né anmoins, Ceysens et al. soulignent que les femmes enceintes 128 peuvent pratiquer une AP si elles le dé sirent, ce changement de 129 comportement e ´ tant bé né fique pour leur santé a ` long terme [22]. 130 2.3.3. "
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    ABSTRACT: Les bénéfices de l’activité physique (AP) sur la santé physique et mentale ont conduit à la mise en place de recommandations internationales spécifiques pour les femmes enceintes. Durant la grossesse, il est recommandé de pratiquer de l’activité physique aérobie (marche, vélo) à raison de 30 minutes 3 fois par semaine à une intensité de 60 à 90 % de la fréquence cardiaque maximale, ainsi que du renforcement musculaire 1 à 2 fois par semaine. Les programmes d’AP durant la grossesse ont montré des effets bénéfiques en termes de prévention et de traitement des complications telles que le diabète gestationnel ou le surpoids. Les bienfaits de l’AP durant la grossesse ainsi que les risques liés à la sédentarité restent encore mal connus par les femmes enceintes et devraient être diffusés par le personnel médical spécialiste de la périnatalité.
    Gynécologie Obstétrique & Fertilité 10/2014; 42(12). DOI:10.1016/j.gyobfe.2014.09.014 · 0.58 Impact Factor
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    • "There were no statistically significant differences between the group that performed exercise and the controls for any one of the endpoints evaluated. The authors' conclusion was that the evidence was insufficient to either recommend or contraindicate exercise for pregnant women with diabetes and that larger randomized clinical trials should be conducted to further evaluate this form of intervention (Ceysens et al., 2011). Despite the consistent lack of evidence on the effects of exercise on maternal and perinatal prognosis in women with gestational diabetes, the American Association of Diabetes (ADA) suggests a program of moderate exercise as part of the therapeutic management of women with gestational diabetes as long as there are no medical or obstetrical contraindications to this level of physical activity (ADA, 2004). "
    Gestational Diabetes, 11/2011; , ISBN: 978-953-307-581-5
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    ABSTRACT: Diabetes mellitus is one of the most common medical complications of pregnancy; gestational diabetes mellitus (GDM) accounts for approximately 90-95% of all cases. GDM is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. It has been demonstrated that good metabolic control maintained throughout pregnancy can reduce maternal and fetal complications in diabetes. Diet is the mainstay of treatment in GDM, but physical activity is a helpful adjunctive therapy when euglycemia is not achieved by diet alone. When diet and exercise fail to maintain euglycemia, exogenous insulin is used and the new insulin currently available on the market may help. Traditionally, insulin therapy has been considered the gold standard for management. The American College of Obstetricians and Gynecologists and the American Diabetes Association do not currently recommend oral hypoglycemic agents as a treatment for GDM. Concerns regarding safety demand further well-designed studies.
    Expert Review of Obstetrics &amp Gynecology 12/2007; 3(1):73-91. DOI:10.1586/17474108.3.1.73
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Gilles Ceysens