Exercise improves glycaemic control in women with gestational diabetes mellitus

Ms Anne L Harrison1,2, Professor Nora Shields1,3, Professor Nicholas F Taylor1,4, Associate Professor Helena C Frawley1,5

1School of Allied Health, La Trobe University, Melbourne, Australia, 2Department of Physiotherapy, Weribee Mercy Hospital, Mercy Hospitals Victoria, Melbourne, Australia, 3Northern Health, Epping, Australia, 4Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia, 5Centre for Allied Health Research and Education, Cabrini Health, Malvern, Australia

Aim: To investigate if exercise improves postprandial glycaemic control in women with gestational diabetes mellitus.

Method: A systematic review of randomised controlled trials including pregnant women diagnosed with gestational diabetes mellitus where the intervention was exercise, performed more than once a week, sufficient to achieve an aerobic effect or changes in muscle metabolism. Outcome measures included postprandial blood glucose, fasting blood glucose, glycated haemoglobin, requirement for insulin, adverse events and adherence.

Results: Eight trials involving 588 participants were included; seven of these trials (544 participants) had data that were suitable for meta-analysis. Five trials scored ≥ 6 on the PEDro scale, indicating a relatively low risk of bias. Meta-analysis showed that exercise, as an adjunct to standard care, significantly improved postprandial glycaemic control (MD –0.33 mmol/L, 95% CI –0.49 to –0.17) and lowered fasting blood glucose (MD –0.31 mmol/L, 95% CI –0.56 to –0.05) when compared with standard care alone, with no increase in adverse events. Effects of similar magnitude were found for aerobic and resistance exercise programs, if performed at a moderate intensity or greater, for 20 to 30 minutes, three to four times per week. Meta-analysis did not show that exercise significantly reduced the requirement for insulin. All studies reported that complications or other adverse events were either similar or reduced with exercise.

Significance of the findings to allied health: Adding exercise to usual care of gestational diabetes mellitus reduces postprandial blood glucose, fasting blood glucose and glycated haemoglobin. Exercise is safe and may reduce maternal and neonatal complications in gestational diabetes mellitus.