Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis

ObjectiveGestational diabetes mellitus (GDM), gestational hypertension (GH) and pre-eclampsia (PE) are associated with short and long-term health issues for mother and child; prevention of these complications is critically important. This study aimed to perform a systematic review and meta-analysis of the relationships between prenatal exercise and GDM, GH and PE.DesignSystematic review with random effects meta-analysis and meta-regression.Data sourcesOnline databases were searched up to 6 January 2017.Study eligibility criteriaStudies of all designs were included (except case studies) if published in English, Spanish or French, and contained information on the Population (pregnant women without contraindication to exercise), Intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone [“exercise-only”] or in combination with other intervention components [e.g., dietary; “exercise + co-intervention”]), Comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and Outcomes (GDM, GH, PE).ResultsA total of 106 studies (n=273 182) were included. ‘Moderate’ to ‘high’-quality evidence from randomised controlled trials revealed that exercise-only interventions, but not exercise+cointerventions, reduced odds of GDM (n=6934; OR 0.62, 95% CI 0.52 to 0.75), GH (n=5316; OR 0.61, 95% CI 0.43 to 0.85) and PE (n=3322; OR 0.59, 95% CI 0.37 to 0.9) compared with no exercise. To achieve at least a 25% reduction in the odds of developing GDM, PE and GH, pregnant women need to accumulate at least 600 MET-min/week of moderate-intensity exercise (eg, 140 min of brisk walking, water aerobics, stationary cycling or resistance training).Summary/conclusionsIn conclusion, exercise-only interventions were effective at lowering the odds of developing GDM, GH and PE.

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Prenatal exercise is not associated with fetal mortality: a systematic review and meta-analysis

British Journal of Sports Medicine ◽

10.1136/bjsports-2018-099773 ◽

2018 ◽

Vol 53 (2) ◽

pp. 108-115 ◽

Cited By ~ 13

Author(s):

Margie H Davenport ◽

Amariah J Kathol ◽

Michelle F Mottola ◽

Rachel J Skow ◽

Victoria L Meah ◽

...

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Perinatal Mortality ◽

Meta Analysis ◽

Moderate Intensity ◽

Fetal Mortality ◽

Type Of Exercise ◽

The Impact ◽

Prenatal Exercise ◽

Frequency Intensity

ObjectiveTo perform a systematic review of the relationship between prenatal exercise and fetal or newborn death.DesignSystematic review with random-effects meta-analysis and meta-regression.Data sourcesOnline databases were searched up to 6 January 2017.Study eligibility criteriaStudies of all designs were included (except case studies) if they were published in English, Spanish or French and contained information on the population (pregnant women without contraindication to exercise), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone [“exercise-only”] or in combination with other intervention components [eg, dietary; “exercise + co-intervention”]), comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and outcome (miscarriage or perinatal mortality).ResultsForty-six studies (n=2 66 778) were included. There was ‘very low’ quality evidence suggesting no increased odds of miscarriage (23 studies, n=7125 women; OR 0.88, 95% CI 0.63 to 1.21, I2=0%) or perinatal mortality (13 studies, n=6837 women, OR 0.86, 95% CI 0.49 to 1.52, I2=0%) in pregnant women who exercised compared with those who did not. Stratification by subgroups did not affect odds of miscarriage or perinatal mortality. The meta-regressions identified no associations between volume, intensity or frequency of exercise and fetal or newborn death. As the majority of included studies examined the impact of moderate intensity exercise to a maximum duration of 60 min, we cannot comment on the effect of longer periods of exercise.Summary/conclusionsAlthough the evidence in this field is of ‘very low’ quality, it suggests that prenatal exercise is not associated with increased odds of miscarriage or perinatal mortality. In plain terms, this suggests that generally speaking exercise is ‘safe’ with respect to miscarriage and perinatal mortality.

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Impact of prenatal exercise on both prenatal and postnatal anxiety and depressive symptoms: a systematic review and meta-analysis

British Journal of Sports Medicine ◽

10.1136/bjsports-2018-099697 ◽

2018 ◽

Vol 52 (21) ◽

pp. 1376-1385 ◽

Cited By ~ 36

Author(s):

Margie H Davenport ◽

Ashley P McCurdy ◽

Michelle F Mottola ◽

Rachel J Skow ◽

Victoria L Meah ◽

...

Keyword(s):

Systematic Review ◽

Depressive Symptoms ◽

Pregnant Women ◽

Exercise Intervention ◽

Meta Analysis ◽

Prenatal Depression ◽

Moderate Intensity ◽

Type Of Exercise ◽

Prenatal Exercise ◽

Frequency Intensity

ObjectiveTo examine the influence of prenatal exercise on depression and anxiety during pregnancy and the postpartum period.DesignSystematic review with random effects meta-analysis and meta-regression.Data sourcesOnline databases were searched up to 6 January 2017.Study eligibility criteriaStudies of all designs were included (except case studies) if they were published in English, Spanish or French and contained information on the Population (pregnant women without contraindication to exercise), Intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise), Comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and Outcome (prenatal or postnatal depression or anxiety).ResultsA total of 52 studies (n=131 406) were included. ‘Moderate’ quality evidence from randomised controlled trials (RCTs) revealed that exercise-only interventions, but not exercise+cointerventions, reduced the severity of prenatal depressive symptoms (13 RCTs, n=1076; standardised mean difference: −0.38, 95% CI −0.51 to –0.25, I2=10%) and the odds of prenatal depression by 67% (5 RCTs, n=683; OR: 0.33, 95% CI 0.21 to 0.53, I2=0%) compared with no exercise. Prenatal exercise did not alter the odds of postpartum depression or the severity of depressive symptoms, nor anxiety or anxiety symptoms during or following pregnancy. To achieve at least a moderate effect size in the reduction of the severity of prenatal depressive symptoms, pregnant women needed to accumulate at least 644 MET-min/week of exercise (eg, 150 min of moderate intensity exercise, such as brisk walking, water aerobics, stationary cycling, resistance training).Summary/ConclusionsPrenatal exercise reduced the odds and severity of prenatal depression.

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Gestational diabetes mellitus in HIV-infected pregnant women: A systematic review and meta-analysis

Diabetes Research and Clinical Practice ◽

10.1016/j.diabres.2019.107800 ◽

2019 ◽

Vol 155 ◽

pp. 107800 ◽

Cited By ~ 2

Author(s):

Belete Biadgo ◽

Sintayehu Ambachew ◽

Molla Abebe ◽

Mulugeta Melku

Keyword(s):

Diabetes Mellitus ◽

Systematic Review ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Pregnant Women ◽

Meta Analysis

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Physical Activity Programs during Pregnancy Are Effective for the Control of Gestational Diabetes Mellitus

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17176151 ◽

2020 ◽

Vol 17 (17) ◽

pp. 6151 ◽

Cited By ~ 3

Author(s):

José Alberto Laredo-Aguilera ◽

María Gallardo-Bravo ◽

Joseba Aingerun Rabanales-Sotos ◽

Ana Isabel Cobo-Cuenca ◽

Juan Manuel Carmona-Torres

Keyword(s):

Physical Activity ◽

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Pregnant Women ◽

Postprandial Glucose ◽

Moderate Intensity ◽

Randomized Controlled Studies ◽

Sufficient Intensity ◽

Type Of Exercise

Gestational diabetes mellitus has an incidence of 14% worldwide and nursing is responsible for its monitoring during pregnancy. Excessive weight gain during pregnancy is directly related to gestational diabetes mellitus development. Gestational diabetes mellitus (GDM) has negative repercussions on the evolution of the pregnancy and the fetus. The objective of this systematic review is to establish how physical activity influences pregnant women with gestational diabetes mellitus and to analyze what benefits physical activity has in the control of gestational diabetes mellitus. A systematic search was carried out in different databases (Cochrane, Superior Council of Scientific Investigations (CSIC), EBSCOhost, Pubmed, Scopus, Web os Science, and Proquest) for papers published within the last 12 years, taking into account different inclusion and exclusion criteria. Six randomized controlled studies and one observational case-control study of a high quality were selected. Fasting, postprandial glucose and HbcA1 were assessed, as well as the requirement and amount of insulin used. Thus, there is a positive relationship between the performance of physical activity and the control of gestational diabetes mellitus. Resistance, aerobic exercise, or a combination of both are effective for the control of glucose, HbcA1, and insulin. Due to the variability of the exercises of the analyzed studies and the variability of the shape of the different pregnant women, it does not permit the recommendation of a particular type of exercise. However, any type of physical activity of sufficient intensity and duration can have benefits for pregnant women with GDM. Pregnant women with gestational diabetes mellitus should exercise for at least 20–50 min a minimum of 2 times a week with at a least moderate intensity.

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Diagnostic accuracy of glycated hemoglobin for gestational diabetes mellitus: a systematic review and meta-analysis

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2018-1191 ◽

2019 ◽

Vol 57 (10) ◽

pp. 1435-1449 ◽

Cited By ~ 6

Author(s):

Paula B. Renz ◽

Fernando C. Chume ◽

João R.T. Timm ◽

Ana L. Pimentel ◽

Joíza L. Camargo

Keyword(s):

Diabetes Mellitus ◽

Systematic Review ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Diagnostic Accuracy ◽

Pregnant Women ◽

Glycated Hemoglobin ◽

Meta Analysis ◽

Individual Performance ◽

Index Test

Abstract Background We conducted a systematic review and meta-analysis to establish the overall accuracy of glycated hemoglobin (HbA1c) in the diagnosis of gestational diabetes mellitus (GDM) diagnosis. Methods We searched MEDLINE, EMBASE, SCOPUS and ClinicalTrials.gov up to October 2018, using keywords related to GDM, HbA1c and diagnosis. Studies were included that were carried out with pregnant women without previous diabetes that assessed the performance of HbA1c (index test) compared to the 75 g oral glucose tolerance test (OGTT) (reference test) for the diagnosis of GDM, that measured HbA1c by standardized methods and presented data necessary for drawing 2 × 2 tables. Results This meta-analysis included eight studies, totaling 6406 pregnant women, of those 1044 had GDM. The diagnostic accuracy of HbA1c was reported at different thresholds ranging from 5.4% (36 mmol/mol) to 6.0% (42 mmol/mol), and the area under the curve (AUC) was 0.825 (95% confidence interval [CI] 0.751–0.899), indicating a good level of overall accuracy. The pooled sensitivities and specificities were 50.3% (95% CI 24.8%–75.7%) and 83.7% (67.5%–92.7%); 24.7% (10.3%–48.5%) and 95.5% (85.7%–98.7%); 10.8% (5.7%–19.41%) and 98.7% (96.2%–99.5%); 12.9% (5.5%–27.5%) and 98.7% (97.6%–99.3%), for the cut-offs of 5.4% (36 mmol/mol), 5.7% (39 mmol/mol), 5.8% (40 mmol/mol) and 6.0% (42 mmol/mol), respectively. Conclusions We observed a high heterogeneity among the studies. The effect of ethnicities, different criteria for OGTT interpretation and the individual performance of HbA1c methods may have contributed to this heterogeneity. The HbA1c test presents high specificity but low sensitivity regardless of the threshold used to diagnose GDM. These findings point to the usefulness of HbA1c as a rule-in test. HbA1c should be used in association with other standard diagnostic tests for GDM diagnosis.

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Prognostic factors for cesarean section outcome of pregnant women with gestational diabetes mellitus: a systematic review and meta-analysis

Diabetes Metabolic Syndrome and Obesity Targets and Therapy ◽

10.2147/dmso.s188293 ◽

2019 ◽

Vol Volume 12 ◽

pp. 913-929

Author(s):

Jinjing Wang ◽

Kang Chen ◽

Xinye Jin ◽

Xueqiong Li ◽

Ping An ◽

...

Keyword(s):

Diabetes Mellitus ◽

Systematic Review ◽

Prognostic Factors ◽

Gestational Diabetes ◽

Cesarean Section ◽

Gestational Diabetes Mellitus ◽

Pregnant Women ◽

Meta Analysis

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Prevalence of Gestational Diabetes Mellitus in the Middle East and North Africa, 2000–2019: A Systematic Review, Meta-Analysis, and Meta-Regression

Frontiers in Endocrinology ◽

10.3389/fendo.2021.668447 ◽

2021 ◽

Vol 12 ◽

Author(s):

Rami H. Al-Rifai ◽

Noor Motea Abdo ◽

Marília Silva Paulo ◽

Sumanta Saha ◽

Luai A. Ahmed

Keyword(s):

Diabetes Mellitus ◽

Systematic Review ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Pregnant Women ◽

North Africa ◽

Meta Analysis ◽

Mena Region ◽

Pooled Prevalence ◽

Meta Regression

Women in the Middle East and North Africa (MENA) region are burdened with several risk factors related to gestational diabetes mellitus (GDM) including overweight and high parity. We systematically reviewed the literature and quantified the weighted prevalence of GDM in MENA at the regional, subregional, and national levels. Studies published from 2000 to 2019 reporting the prevalence of GDM in the MENA region were retrieved and were assessed for their eligibility. Overall and subgroup pooled prevalence of GDM was quantified by random-effects meta-analysis. Sources of heterogeneity were investigated by meta-regression. The risk of bias (RoB) was assessed by the National Heart, Lung, and Blood Institute’s tool. One hundred and two research articles with 279,202 tested pregnant women for GDM from 16 MENA countries were included. Most of the research reports sourced from Iran (36.3%) and Saudi Arabia (21.6%), with an overall low RoB. In the 16 countries, the pooled prevalence of GDM was 13.0% (95% confidence interval [CI], 11.5–14.6%, I2, 99.3%). Nationally, GDM was highest in Qatar (20.7%, 95% CI, 15.2–26.7% I2, 99.0%), whereas subregionally, GDM was highest in Gulf Cooperation Council (GCC) countries (14.7%, 95% CI, 13.0–16.5%, I2, 99.0%). The prevalence of GDM was high in pregnant women aged ≥30 years (21.9%, 95% CI, 18.5–25.5%, I2, 97.1%), in their third trimester (20.0%, 95% CI, 13.1–27.9%, I2, 98.8%), and who were obese (17.2%, 95% CI, 12.8–22.0%, I2, 93.8%). The prevalence of GDM was 10.6% (95% CI, 8.1–13.4%, I2, 98.9%) in studies conducted before 2009, whereas it was 14.0% (95% CI, 12.1–16.0%, I2, 99.3%) in studies conducted in or after 2010. Pregnant women in the MENA region are burdened with a substantial prevalence of GDM, particularly in GCC and North African countries. Findings have implications for maternal health in the MENA region and call for advocacy to unify GDM diagnostic criteria.Systematic Review RegistrationPROSPERO CRD42018100629

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