Exercise for diabetic pregnant women
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.
Available from: Paquito Bernard
- "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 . 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.
Available from: José Roberto da Silva Júnior
- "Furthermore, aquatic exercise during pregnancy may decrease maternal stress, discomfort and improve health-promoting behaviors [14,15]. However, there is insufficient evidence on aquatic exercise due to poor methodological and reporting quality and heterogeneity of non-randomized clinical trials [10,16]. Specifically in relation to GDM, there are no clinical trials testing aquatic exercise as an adjunctive treatment. "
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ABSTRACT: Gestational diabetes mellitus (GDM) is increasing worldwide and has been associated with adverse perinatal outcomes and high risk for chronic disease both for the mother and for the child. Physical exercise is feasible for diabetic pregnant women and contributes to better glycemic control and to a decrease in adverse perinatal outcomes. However, there are no randomized controlled trials (RCT) assessing the effects of aquatic physical exercise on GDM control and adverse maternal and fetal outcomes.Methods/design: An RCT will be conducted at Instituto de Medicina Integral Prof Fernando Figueira (IMIP), Brazil. A total of 72 pregnant women will be studied; 36 gestational diabetics will undergo an aquatic physical exercise program in a thermal pool, 3 times per week over 2 months. The primary endpoint will be glucose level control and use of insulin; secondary endpoints will be the following maternal and fetal outcomes: weight gain during pregnancy, blood pressure, pre-eclampsia diagnosis, intrauterus growth restriction, preterm birth, Cesarean section, macrosomia and maternal or neonatal intensive care admission. Endpoints between intervention and control group will analyzed by t test for unpaired data and chi2 test, and the level of significance will set at <0.05.
The physical proprieties of water make aquatic exercises ideal for pregnant women. An aquatic physical exercise program developed for GDM women will be trialed in a thermal pool and under the supervision of physiotherapist to ensure compliance. It is expected that this study will provide evidence as to the effect of aquatic physical exercise on GDM control.Trial registration: NCT01940003.
Available from: Catherine Chamberlain
- "Our finding that there is the limited evidence for GDM screening among indigenous women is similar to a review examining the evidence-base among non-indigenous women 26, although our analysis has shown that the quality and quantity of evidence for indigenous women is significantly more limited. This review makes similar conclusions to other major studies among non-indigenous women with regard to the risks of DIP 12, low rates of screening during and after pregnancy205,206, and the challenges with nutritional and exercise interventions to prevent or reduce GDM207–209. A review of research gaps for the general community also identified a need for more research into effective treatment and management strategies for women with DIP and for improved post-pregnancy follow-up210. "
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ABSTRACT: BACKGROUND: Recently proposed international guidelines for screening for Gestational Diabetes Mellitus (GDM) recommend additional screening in early pregnancy for sub-populations at a high risk of Type 2 Diabetes Mellitus (T2DM), such as indigenous women. However, there are criteria that should be met to ensure the benefits outweigh the risks of population-based screening. This review examines the published evidence for early screening for indigenous women as related to these criteria. METHODS: Any publications were included that referred to diabetes in pregnancy (DIP) among indigenous women in Australia, Canada, New Zealand and the United States (n = 145). The risk of bias was appraised. RESULTS: There is sufficient evidence describing the epidemiology of DIP, demonstrating that it imposes a significant disease burden on indigenous women and their infants at birth and across the lifecourse (n = 120 studies). Women with pre-existing T2DM have a higher risk than women who develop GDM during pregnancy. However, there was insufficient evidence to address the remaining five criteria, including: understanding current screening practice and rates (n = 7); acceptability of GDM screening (n = 0); efficacy and cost of screening for GDM (n = 3); availability of effective treatment after diagnosis (n = 6); and effective systems for follow-up after pregnancy (n = 5). CONCLUSIONS: Given the impact of DIP, particularly undiagnosed T2DM, GDM screening in early pregnancy offers potential benefits for indigenous women. However, researchers, policy-makers and clinicians must work together with communities to develop effective strategies for implementation and minimising the potential risks. Evidence of effective strategies for primary prevention, GDM treatment and follow-up after pregnancy are urgently needed. Copyright © 2013 John Wiley & Sons, Ltd.
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