Effects of weekly supervised exercise or physical activity counseling on fasting blood glucose in women diagnosed with gestational diabetes mellitus: A systematic review and meta‐analysis of randomized trials

• Published in: Journal of diabetes Vol. 9; no. 11; pp. 1023 - 1032
• Main Authors: Bgeginski, Roberta, Ribeiro, Paula A.B., Mottola, Michelle F., Ramos, José Geraldo L.
• Format: Journal Article
• Language: English
• Published: Melbourne Wiley Publishing Asia Pty Ltd 01.11.2017; John Wiley & Sons, Inc
• Subjects: Adult; Birth Weight; Blood Glucose - metabolism; Counseling; Counseling - methods; Diabetes; Diabetes, Gestational - blood; Diabetes, Gestational - physiopathology; Diabetes, Gestational - therapy; Evidence-based medicine; Exercise; Exercise - physiology; Exercise Therapy - methods; Fasting - blood; Female; Gestational diabetes; Glucose monitoring; glycemic control; Humans; Hyperglycemia; Infant, Newborn; Insulin resistance; Life Style; Medical diagnosis; Meta-analysis; Physical fitness; Pregnancy; Randomized Controlled Trials as Topic; Systematic review; Womens health; 妊娠; 胰岛素抵抗; 血糖控制; 运动; 高血糖; hyperglycemia; glycemic control; 血糖控制; 胰岛素抵抗; pregnancy; 高血糖; exercise; 运动; insulin resistance; 妊娠
• ISSN: 1753-0393; 1753-0407
• DOI: 10.1111/1753-0407.12519

Highlights There was no overall effect of exercise when all interventions were tested. The sensitivity analysis showed that physical activity counseling, which was the intervention with a longer follow‐up, had significant effects on fasted blood glucose when compared to weekly‐supervised exercise in gestational diabetes mellitus (GDM). Physical activity counseling added to standard care may help motivate women with GDM to be active for longer periods and acquire benefits. Background Exercise is an important part of gestational diabetes mellitus (GDM) lifestyle management. However, no meta‐analysis has analyzed the effects of exercise programs on fasting blood glucose (FBG) in women with GDM. A systematic review with meta‐analysis was performed to evaluate the effects of weekly supervised exercise (EXE) or physical activity counseling (PA) in women with GDM compared with usual prenatal care (UPN) on glycemic control. Methods Eligible trials were identified from Medline, EMBASE, Web of Science, Scopus and SportDiscus up to December 2016. Data were retrieved from randomized controlled trials comparing UPN with UPN plus weekly supervised (at least once a week) prenatal exercise or PA counseling for which FBG values before and after intervention were available. Random‐effects meta‐analysis was performed for mean difference in FBG after exercise intervention. Results The search yielded 781 publications, of which 82 were assessed for eligibility and eight were included in the meta‐analysis. The overall effect on absolute FBG concentrations was not significant (P = 0.11) compared with UPN. However, PA versus UPN showed a significant reduction in absolute FBG concentrations (weighted mean difference −3.88 mg/dL; 95% confidence interval −7.33, −0.42 mg/dL; I 2 48%; P heterogeneity < 0.15). Conclusions Physical activity counseling in women with GDM showed a significant effect compared with UPN on FBG concentrations, possibly due to a longer follow‐up time compared with the EXE groups. This result highlights the importance of an early intervention that lasts to delivery for best practice of GDM management. 摘要 背景 运动是妊娠糖尿病(gestational diabetes mellitus,GDM)生活方式管理的重要组成部分。然而,目前还没有一项调查运动项目对GDM妇女空腹血糖(FBG)影响的meta分析。我们进行了一项系统回顾与meta分析,评估每周在指导下运动(weekly supervised exercise,EXE)或体力活动(physical activity,PA)咨询与常规产前保健(usual prenatal care,UPN)相比对GDM妇女血糖控制的影响。 方法 搜索Medline、EMBASE、Web of Science、Scopus与SportDiscus数据库截止至2016年12月,检索出比较UPN与UPN联合每周指导(至少每周一次)产前运动或PA咨询的随机对照试验,要求在干预前以及干预后都能够获得FBG数值。对于经运动干预后的FBG平均差异进行随机效应mata分析。 结果 检索后得到781篇文献,经评估后筛选出82篇,最终有8篇被纳入了meta分析。结果显示对FBG绝对浓度的总体影响与UPN相比无显著差异(P = 0.11)。然而,与UPN相比,PA咨询组的FBG绝对浓度显著更低(加权均数差为‐3.88 mg/dL;95%置信区间为‐7.33,‐0.42 mg/dL;I2为48%;异质性分析P < 0.15)。 结论 与UPN相比,PA咨询对GDM妇女FBG浓度的影响更显著,这可能是因为与EXE组相对随访时间更长的缘故。这项结果强调了对于最佳GDM实践管理而言,进行早期干预并持续至分娩的重要性。