Effectiveness of Physical Activity on Gestational Diabetes

1. Effectiveness of Physical Activity on Gestational Diabetes PICO Question: What effect does physical activity (I) compared with inactivity during pregnancy (C) have on preventing gestational diabetes (O) in the pregnant population (P)? • Recommendations for Practice With Grade: • There were not consistent findings proving that exercise during pregnancy has any correlation to lowered gestational diabetes rates. • Grade Level: C • It is recommended for pregnant women to begin or continue a moderate physical exercise regimen (Deierlein et al., 2012). It is important for pregnant women to be able to participate in lifestyle modifications to help lower the body’s insulin resistance, including possible prescriptions and maintaining a healthy body weight for pregnancy (Barakat et al., 2013). • Grade Level: A • It is recommended for expecting mothers to be educated on the positive effects physical activity will have on fetal and maternal wellbeing. This physical education should also focus on reducing the risk of cesarean deliveries and newborn complications (Barakat et al., 2013). • Grade Level: A C A A • Synthesis of Findings: • During pregnancy, there is an increase in insulin resistance in the muscles and, as a result, maternal uptake of glucose into the muscles cells is reduced resulting in elevated maternal glucose circulating in the blood (Ruchat et al., 2012). • Exercise stimulates uptake of glucose, lowering blood glucose concentrations, and may reduce the underlying cause of GDM by reducing insulin resistance (Ruchat et al., 2012). • Physical activity prior to pregnancy and within the first trimester can drastically reduce the incidence of GDM as well as GDM-related macrosomnia in a newborn, a term for high weight newborns (Barakat et al., 2013). • A study by Stafne, et. al., (2012) found that during the second trimester of pregnancy, exercise had no effect on prevention or development of GDM and no improvement on insulin resistance. • Expecting mothers who participate in any moderate to vigorous physical activity (including work, recreation, transportation, outdoor activities) with a BMI of less than 25 kg/m2 have a 50% lower chance of developing GDM (Deierlein et al., 2012). • Exercise programs including both aerobic and aquatic activities were effective in short-term prevention of GDM (Barakat et al., 2011). • Review of Literature: • Barakat, R., Cordero, Y., Coteron, J., Luaces, M., & Montejo, R. (2011). Exercise during pregnancy improves maternal glucose screen at 24-28 weeks: A randomized controlled trial. British Journal of Sports Medicine, 46, 656-661. doi:10:1136/bjsports-2011-090009 • Level of Evidence: II • Barakat R., Pelaez M., Lopez C., Lucia A., & Jonatan R. (2013).  Exercise during pregnancy and gestational diabetes – related adverse effects: A randomized controlled trial. British Journal of Sports Medicine, 47(10), 1-7. • Level of Evidence:II • Deirlein, A. L., Siega-Riz, A. M., & Evenson, K. R. (2012). Physical activity during pregnancy and risk of hyperglycemia. Journal of Women’s Health, 21(7), 769-775. • Level of Evidence:  IV • Ruchat, S., Davenport, M., Giroux, I., Hillier, M., Batada, A., Sopper, M., McManus, R., Hammond, J., & Mottola, M. (2012). Effect of exercise intensity and duration on capillary glucose responses in pregnant women at low and high risk for gestational diabetes. Diabetes/Metabolism Research & Reviews, 28(8), 669-678. doi:10.1002/dmrr.2324 • Level of Evidence: II • Stafne, S., Salvesen, K., Romundstad, P., Eggebo, T., Carlsen, S., & Morkved, S. (2012). Regular exercise during pregnancy to prevent gestational diabetes: A randomized controlled trial. BJOG: An International Journal of Obstetrics and Gynecology. 119(1),30-36. doi:10.1097/AOG.0b013e3182393f86 • Level of Evidence: II • Method—Search Strategy: • An advanced search allowed for multiple databases including : CINAHL, MEDLINE, PsychINFO, Health Source: Nursing/academic edition, and the Cochrane Database of Systematic Reviews (CDSR) to provide relevant results. • After modifying search result options, key words such as  “gestational diabetes,” “physical activity,” “pregnancy,” “exercise intensity,” “exercise during pregnancy,” “prevention and control of diabetes,” “glucose monitoring,” and “glucose control” aided in finding the most relevant results for the PICO question. • All searches were limited to peer reviewed evidence based practice results published within the past ten years (2003-2013). • Additionally, the websites for the American Diabetes Association and Healthy People 2020 provided information related to clinical guidelines for suggestions regarding physical activity and gestational diabetes. Discussion: More research needs to be conducted based on gestational diabetes mellitus and the effect physical activity has on fetal and maternal wellbeing. Also, preventative measures such as education at prenatal clinics should be more heavily promoted in order to avoid complications such as gestational diabetes mellitus.