Daily Movement: If possible, CC should continue to engage in as much daily movement as possible to maximize her energy expenditure (to prevent excess weight gain during pregnancy) and to minimize excursions in her blood glucose levels after eating. She should continue standing and taking steps while working and during her leisure time, whenever possible.
Possible Precautions: Because she is young, CC has limited cardiovascular risk factors. Due to that fact and being pregnant, maximal exercise stress testing is neither necessary nor advisable before starting her exercise program. Because she will not initially be taking insulin or oral medications, her risk of developing hypoglycemia related to exercise is low. She should use a blood glucose monitor to determine the effects of physical activity and dietary changes on her glycemic control.
Women at high risk for GDM may be able to prevent it with lifestyle management during pregnancy. In those who develop GDM, dietary improvements and regular physical activity are frequently sufficient to manage hyperglycemia, although insulin and oral medications may be used when these changes are not enough. Management of blood glucose levels ensures better pregnancy outcomes and improves the health of both the mother and the fetus. Engaging in 30 min of moderate-intensity physical activity on most, if not all, days of the week has been adopted as a recommendation for all pregnant women.
Professional Practice Pearls
• GDM has been increasing in prevalence and is associated with a significantly elevated risk of the woman developing T2D in the next 5–10 years.
• This transient type of diabetes is usually diagnosed in pregnant women at 24 to 28 weeks of gestation using a 75-g oral glucose challenge (OGTT).
• Regular exercise participation during pregnancy likely reduces the risk of pregnancy complications like preeclampsia and shortens the duration of active labor.
• Higher levels of moderate physical activity of any type may reduce the risk of developing GDM during pregnancy and lower blood glucose levels in women who do develop it.
• A state of insulin resistance caused by placental hormone release during the third trimester greatly increases the pregnant woman’s insulin, resulting in hyperglycemia when pancreatic β-cells are unable to keep up with heightened insulin demands.
• Diet and exercise are the first line of treatment for GDM, although insulin and oral medications may be considered if lifestyle changes fail to control blood glucose levels.
• Uncontrolled hyperglycemia is potentially harmful to both mother and fetus, possibly resulting in macrosomic babies and other complications.
• Most moderate and vigorous aerobic exercise is acceptable during pregnancy with GDM, although some forms of exercise that increase risk of falls and traumatic injury should be avoided.
• For most healthy women who are not highly active or doing vigorous-intensity activity, moderate-intensity aerobic activity is recommended during pregnancy and postpartum.
• Women who habitually engage in vigorous or high amounts of activity or strength training can continue these activities during pregnancy and after giving birth.
• Pregnant women should engage in physical activity on most, if not all, days of the week for best glycemic results.
• Engaging in 30 min of moderate intensity physical activity on most days of the week, with a target of ≥150 min weekly, is recommended for women with GDM.
REFERENCES
American Diabetes Association: Diagnosis and classification of diabetes mellitus. Diabetes Care 36 (Suppl. 1):S67–S74, 2013a
American Diabetes Association: Standards of medical care in diabetes—2013. Diabetes Care 36 (Suppl. 1):S11–S66, 2013b
Artal R, Catanzaro RB, Gavard JA, Mostello DJ, Friganza JC: A lifestyle intervention of weight-gain restriction: diet and exercise in obese women with gestational diabetes mellitus. Appl Physiol Nutr Metab 32:596–601, 2007
Avery MD, Walker AJ: Acute effect of exercise on blood glucose and insulin levels in women with gestational diabetes. J Matern Fetal Med 10:52–58, 2001
Baptiste-Roberts K, Ghosh P, Nicholson WK: Pregravid physical activity, dietary intake, and glucose intolerance during pregnancy. J Womens Health (Larchmt) 20:1847–1851, 2011
Barakat R, Cordero Y, Coteron J, Luaces M, Montejo R: Exercise during pregnancy improves maternal glucose screen at 24-28 weeks: a randomised controlled trial. Br J Sports Med 46:656–661, 2012
Brankston GN, Mitchell BF, Ryan EA, Okun NB: Resistance exercise decreases the need for insulin in overweight women with gestational diabetes mellitus. Am J Obstet Gynecol 190:188–193, 2004
Ceysens G, Rouiller D, Boulvain M: Exercise for diabetic pregnant women. Cochrane Database Syst Rev CD004225, 2006
Chasan-Taber L, Schmidt MD, Pekow P, Sternfeld B, Manson JE, Solomon CG, Braun B, and Markenson G: Physical activity and gestational diabetes mellitus among Hispanic women. J Womens Health (Larchmt) 17:999–1008, 2008
Committee on Obstetric Practice: ACOG committee opinion. Exercise during pregnancy and the postpartum period. Number 267, January 2002. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 77:79–81, 2002
Davenport MH, Mottola MF, McManus R, Gratton R: A walking intervention improves capillary glucose control in women with gestational diabetes mellitus: a pilot study. Appl Physiol Nutr Metab 33:511–517, 2008
de Barros MC, Lopes MA, Francisco RP, Sapienza AD, Zugaib M: Resistance exercise and glycemic control in women with gestational diabetes mellitus. Am J Obstet Gynecol 203:556.e1–6, 2010
Dempsey JC, Butler CL, Sorensen TK, Lee IM, Thompson ML, Miller RS, Frederick IO, Williams MA: A case-control study of maternal recreational physical activity and risk of gestational diabetes mellitus. Diabetes Res Clin Pract 66:203–215, 2004a
Dempsey JC, Sorensen TK, Williams MA, Lee IM, Miller RS, Dashow EE, Luthy DA: Prospective study of gestational diabetes mellitus risk in relation to maternal recreational physical activity before and during pregnancy. Am J Epidemiol 159:663–670, 2004b
Dhulkotia JS, Ola B, Fraser R, Farrell T: Oral hypoglycemic agents vs insulin in management of gestational diabetes: a systematic review and metaanalysis. Am J Obstet Gynecol 203:457.e1–9, 2010
Dyck R, Klomp H, Tan LK, Turnell RW, Boctor MA: A comparison of rates, risk factors, and outcomes of gestational diabetes between aboriginal and non-aboriginal women in the Saskatoon health district. Diabetes Care 25:487–493, 2002
Dyck RF, Sheppard MS, Cassidy H, Chad K, Tan L, Van Vliet SH: Preventing NIDDM among aboriginal people: is exercise the answer? Description of a pilot project using exercise to prevent gestational diabetes. Int J Circumpolar Health 57 (Suppl. 1):375–378, 1998
Hapo Study Cooperative Research Group, Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, Hadden DR, McCance DR, Hod M, McIntyre HD, Oats JJ, Persson B, Rogers MS, Sacks DA: Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 358:1991–2002, 2008
Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A: Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 39:1423–1434, 2007
Iqbal R, Rafique G, Badruddin S, Qureshi R, Cue R, Gray-Donald K: Increased body fat percentage and physical inactivity are independent predictors of gestational diabetes mellitus in South Asian women. Eur J Clin Nutr 61:736–742, 2007
Melzer K, Schutz Y, Boulvain M, Kayser B: Physical activity and pregnancy: cardiovascular adaptations, recommendations and pregnancy outcomes. Sports Med