Draft:Exercise Interventions in Women With Gestational Diabetes
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| Diabetes | |
|---|---|
 | |
| Universal symbol for diabetes | |
| Specialty | Obstetrics, Endocrinology |
| Complications | Excessive weight gain, Insulin resistance, gestational diabetes mellitus, preeclampsia, cesarean section, hypertension, macrosomia |
| Prevention | Weight control at least 5 years before conception, exercise frequently, adequate nutrition |
Obesity is a chronic disease defined by an individual possessing an abnormal or excessive amount of body fat, usually characterized by a measure of body mass index (BMI).[1] Furthermore, overweight and obesity in pregnant women has been shown to affect the process of pregnancy and can lead to the development of complications such as insulin resistance, excessive weight gain, gestational diabetes (GDM) and preeclampsia.[2] Maternal obesity can lead to hypertension, pre-eclampsia pregnancy, diabetes mellitus, and sepsis and can also lead to neonatal adverse effects like increased rate of cesarean sections, and embryo macrosomia[3].[4] Gestational Diabetes Mellitus (GDM) is defined as diabetes with first onset or recognition during pregnancy. [5] It is typically identified during the second or third trimester of pregnancy, representing insufficient insulin production or increased insulin resistance secondary to placental hormone release with resolution following birth.[5] Gestational diabetes is the most common medical condition in pregnancy, disproportionately affecting overweight or obese women and those from non-White populations.[5] It has been suggested that 10% increment in body mass index (BMI) prior to pregnancy was associated with a 10% increased risk for preeclampsia and GDM.
The prevalence of being either overweight or obese is highest amongst women, with 63% being at reproductive age.[4] In 2015, there were about 400 million obese adults worldwide, and this figure is estimated to reach 1 billion by the year 2030.[4] The prevalence of obesity among pregnant women in the United States was 29.1% fpr 2010 and has reached 32.2% in the year 2020.[4]
A weight gain 5 years before pregnancy has been reported to increase the risk of diabetes in pregnancy.[4] In comparison with normal-weight pregnant women, obese women has a greater risk of developing GDM during pregnancy.[4] Women who gave birth to twins and women who has a cesarean section were more likely to be obese.[4] In addition, there were metabolic complications due to obesity, which were significantly associated with metabolic syndrome, including pre-pregnancy diabetes, and pre-pregnancy hypertension.[4] Gestational Diabetes is caused by one or both of insulin resistance or insufficient insulin secretion.[5] Pregnancy hormones such as human placental lactogen and prolactin, can directly increase insulin production.[5] Genetic data suggests that pancreatic beta cell function is an important factor in the risk of developing gestational diabetes mellitus (GDM). [5] Women with gestational diabetes mellitus may have less beta cell capacity to increase insulin secretion, however, insulin resistance is an important pathophysiological mechanism in gestational diabetes mellitus. [5] Identifying an increased risk of GDM includes reduced high density lipoprotein cholesterol levels, raised triglyceride levels and hemoglobin A1c (HbA1c) above 5.7% (39 mmol/mol).[5] Risk factors of DM include a maternal age that is greater than 35 years and biochemical indicators of glucose intolerance and polycystic ovarian syndrome.[5] Infants from women with obesity and women who were overweight, had a greater neonatal weight and a greater risk for macrosomia, and an increased need for special care facilities for these infants.[4]
Maintaining a health weight and exercising at least 150 minutes per week with a moderate to high intensity before pregnancy, assists in prevention. Managing blood sugar with a proper diet with all essential nutrients also is a massive aide in prevention.
- Obesity/overweight
- Gestational Diabetes Mellitus
- A weight gain 5 years before pregnancy has been reported
- Maternal age (as a women's age increases over time, the risk of adverse effects increases)
- Previous pregnancy with the result in macrosomia[6]
- Systematic arterial hypertension[6]
- Previous diagnosis of diabetes
- Malnutrition
- Being of low income
Pathophysiology
[edit]In early pregnancy implements characteristics that include the accumulation of fat depots, followed by increased adipose tissue lipolysis and increased levels of plasma free fatty acids.[2] Metabolically, exercise plays a major role in the body's role in distributing nutrients to be absorbed, either indirectly through regulation of maternal leptin hormone and free fatty acid levels, or directly through placental regulation of maternal metabolism.[2]
Prevention
[edit]An adequate prevention implementation before pregnancy is ideal. Improving maternal weight and glycemia before conception is critical to prevent adverse effects during and after pregnancy.[7] A substantial weight loss of 10-12% seen in pre-pregnancy interventions related to following the National Diabetes Prevention Program (NDPP)[7], however, the highest ranked pregnancy research priority was promoting healthy diet and nutrition[8]. Consequently, during pregnancy, suboptimal dietary intake with excessive energy intake is a massive risk factor for maternal obesity[8], therefore, lifestyle interventions in pregnancy are effective in decreasing the risk of adverse effects and lowering additional weight gain.[8] The importance of regular physical activity is crucial, as declining activity in pregnancy eliminates any need to increase energy (dietary) intake.[8] As physical activity is proven to be safe during pregnancy, as well as an increase importance of remaining active during pregnancy, there are considerations to me mindful of.[8]
- Physical activity should be as short as possible, with the longest duration at 60 minutes[2]
- Intensity should be heavily monitored, and should correlate with a controlled heart rate[2]
- Duration and intensity should be gradually increase throughout the course of the pregnancy[2]
- A sufficient warm-up and cool-down in each session, with the duration being 5 to 10 minutes each[2]
Overall, pregnant women participating in regular physical activity has a decreased risk of mortality rate, cardiovascular disease, risk of GDM/obesity, adverse neonatal effects, and macrosomia.[2] These findings indicate that exercise may help reduce elevated glucose levels following meals in pregnant women who are overweight or obese. Research suggests that exercise can enhance glucose uptake in skeletal muscles and improve insulin sensitivity.[2]
References
[edit]- ^ "Obesity". www.who.int. Retrieved 2024-11-12.
- ^ a b c d e f g h i Muhammad, Harry Freitag Luglio; Pramono, Adriyan; Rahman, Muhammad Nurhadi (April 2021). "The safety and efficacy of supervised exercise on pregnant women with overweight/obesity: A systematic review and meta-analysis of randomized controlled trials". Clinical Obesity. 11 (2): e12428. doi:10.1111/cob.12428. ISSN 1758-8103. PMID 33167074.
- ^ "Fetal macrosomia-Fetal macrosomia - Symptoms & causes". Mayo Clinic. Retrieved 2024-11-12.
- ^ a b c d e f g h i j Andoula, Antoniou (March 20, 2021). "Investigation of the Effects of Obesity on Pregnant Women: A Systematic Review". International Journal of Caring Sciences: 13 – via CINAHL Plus.
- ^ a b c d e f g h i Morgan, Harriet D; Hamza, Malak; Morrison, Amy E; Campbell, Cathy; Cassar, Caroline Borg; Thayyil, Sheena; Meek, Claire L (2024-10-02). "Gestational diabetes mellitus: ensuring healthy futures". British Journal of Midwifery. 32 (10): 552–560. doi:10.12968/bjom.2024.0054. ISSN 0969-4900.
- ^ a b David, Lorena Soares; Lima, Cássio de Almeida; Santos, Viviane Maia; Pena, Geórgia das Graças; Brito, Maria Fernanda Santos Figueiredo; Silva, Rosângela Ramos Veloso; Pinho, Lucineia de (2023). "Prevalence and associated factors on overweight/obesity in pregnant women assisted by the Family Health Strategy". Revista Brasileira de Saúde Materno Infantil. 23. doi:10.1590/1806-9304202300000354-en. ISSN 1806-9304.
- ^ a b Ritchie, Natalie D.; Sauder, Katherine A.; Kostiuk, Marisa (July 2023). "Reducing Maternal Obesity and Diabetes Risks Prior to Conception with the National Diabetes Prevention Program". Maternal and Child Health Journal. 27 (7): 1133–1139. doi:10.1007/s10995-023-03624-5. ISSN 1092-7875. PMC 10247508. PMID 36943523.
- ^ a b c d e Hill, Briony; Skouteris, Helen; Boyle, Jacqueline A.; Bailey, Cate; Walker, Ruth; Thangaratinam, Shakila; Sundseth, Hildrun; Stephenson, Judith; Steegers, Eric; Redman, Leanne M.; Montanaro, Cynthia; Lim, Siew; Jorgensen, Laura; Jack, Brian; Borges, Ana Luiza Vilela (2020-03-18). "Health in Preconception, Pregnancy and Postpartum Global Alliance: International Network Pregnancy Priorities for the Prevention of Maternal Obesity and Related Pregnancy and Long-Term Complications". Journal of Clinical Medicine. 9 (3): 822. doi:10.3390/jcm9030822. ISSN 2077-0383. PMC 7141234. PMID 32197374.