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== Description  ==
== Description  ==
<div>Gestational Diabetes Mellitus (GDM) is characterised by hyperglycaemia first recognised in pregnancy. Its prevalence varies widely in the literature, but is thought to effect 4-7.5% of all pregnancies&nbsp;<ref name="1" /><ref name="2">Lawreance, J.M., Contereras, R., Chen, W. and Sacks, D.A. (2008) 'Trends in the prevelance of preexisting diabetes mellitus and GDM among a racially/ethnically diverse population of pregnant women, 1999-2005', Diabetes Care, 31(5), 899-904.</ref>&nbsp;and is increasing <ref name="1">Dabelea, D., Snell-Bergeon, J.K., Hartsfield, C.L., Bischoff, K.J., Hamman, R.F., McDuffie, R.S. (2005) 'Increasing Prevelance of Gestational Diabetes Mellitus (GDM) Over Time and by Birth Cohort', Diabetes Care, 28(3), 579-584.</ref>&nbsp;more common among older women, obese women and certain ethnic groups<ref name="2" />. It usually presents after the beginning of the second trimester<ref name="4">Alwan, N., Tuffnell,D.J., West, J. (2009) 'Treatments for Gestational Diabetes', The Cochrane Library, Issue 3.</ref>.<br></div>
[[File:Pregnant lady.jpeg|right|frameless]]
Gestational diabetes (GM) is hyperglycaemia with blood glucose values above normal but below those diagnostic of [[Diabetes|diabete]]<nowiki/>s. Gestational diabetes occurs during pregnancy
* Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery. These women and possibly their children are also at increased risk of type 2 diabetes in the future<ref>WHO [https://www.who.int/news-room/fact-sheets/detail/diabetes Diabetes] Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes (accessed 4.4.2021)</ref>.
* Gestational diabetes is diagnosed through prenatal screening, rather than through reported symptoms.
* It is more common among older women, [[Obesity|obese]] women, and certain ethnic groups<ref name="p2">Lawreance, J.M., Contereras, R., Chen, W. and Sacks, D.A. (2008) 'Trends in the prevelance of preexisting diabetes mellitus and GDM among a racially/ethnically diverse population of pregnant women, 1999-2005', Diabetes Care, 31(5), 899-904.</ref>. It usually presents after the beginning of the second trimester<ref name="p4">Alwan, N., Tuffnell,D.J., West, J. (2009) 'Treatments for Gestational Diabetes', The Cochrane Library, Issue 3.</ref>.<br>


== Pathological Process<br> ==
== Epidemiology  ==
GMs prevalence varies widely in the literature, but is thought to affect 4-7.5% of all pregnancies&nbsp;<ref name="p1">Dabelea, D., Snell-Bergeon, J.K., Hartsfield, C.L., Bischoff, K.J., Hamman, R.F., McDuffie, R.S. (2005) 'Increasing Prevelance of Gestational Diabetes Mellitus (GDM) Over Time and by Birth Cohort', Diabetes Care, 28(3), 579-584.</ref><ref name="p2" />&nbsp;and is increasing. <ref name="p1" />&nbsp;


In pregnancy, women develop insulin resistance, which stems from increased maternal adiposity and several hormones produced during pregnancy block the action of insulin at a cellular level, i.e. Tumor Necrosis Factor Alpha, human placental lactogen and placental growth hormone. As a result, blood glucose levels rise and more insulin is produced in response. As the pregnancy develops, the insulin demands increase further, and insulin resistance also increases due to rising levels of pregnancy hormones. However, this is a normal physiological change in pregnancy. Beta cells in the pancreas increase insulin production to compensate for this, and so in normal pregnancy blood glucose level changes are small compared to the large changes in insulin resistance. In GDM, women have been shown to have less of a degree of compensation at the Beta cell than non-GDM women&nbsp;<ref name="6">Bergman, R.N.(1989) 'Toward a physiological un derstanding of glucose tolerance: minimal model approach', Diabetes, 51, 2207-2213.</ref>. &lt;10% of GDM women have been shown to have antibodies to pancreatic islets of Beta cells in their circulation. It has been postulated thaqt their GDM may stem from autoimmune damage to Beta cells&nbsp;<ref name="7">Kim, C. and Ferrera, S. (eds.) (2010) Gestational Diabetes During and After Pregnancy, London: Springer-Verlag.</ref>. Some GDM cases have been shown to be due to genetic defects in Beta cells <ref name="7" />. Others may be chronic hyperglycaemia first detected at pregnancy, which may explain why most GDM women go on to develop Diabetes Mellitus (DM). The exact mechanism for increased insulin resistance is still largely unclear. Maternal obesity may contribute as upregulation of cytokines and adipokines impacts insulin pathways and skeletal muscle insulin sigalling is impaired&nbsp;<ref name="7" />.
Gestational diabetes affects around 2 to 10% of pregnancies in the United States of America.


== Consequences of Gestational Diabetes Mellitus ==
Women with gestational diabetes (GDM) have an increased 35 to 60% risk of developing [[Diabetes Mellitus Type 2|diabetes mellitus]] over 10 to 20 years after pregnancy<ref>Rodriguez BS, Mahdy H. [https://www.ncbi.nlm.nih.gov/books/NBK545196/ Gestational diabetes]. StatPearls [Internet]. 2020 Aug 23.Available from: (accessed 4.4.2021)</ref>


=== For Mother  ===
== Pathological Process  ==


<span style="line-height: 1.5em;">GDM is r</span><span style="line-height: 1.5em;">elated to higher rates of:</span>
In pregnancy, the placenta produces hormones that help the baby grow and develop. These hormones also block the action of the woman’s [[insulin]]. ie [[Insulin Resistance|insulin resistance]]. Because of this insulin resistance, the need for insulin in pregnancy is 2 to 3 times higher than normal. Those already with insulin resistance may not be able to cope with the extra demand for insulin production and the blood glucose levels will be higher resulting in gestational diabetes being diagnosed.


<span style="line-height: 1.5em;" />Pre-eclampsia
When the pregnancy is over and blood glucose levels usually return to normal and the gestational diabetes disappears, however this insulin resistance increases the risk of developing type 2 diabetes in later life.<ref>Diabetes Australia [https://www.diabetesaustralia.com.au/about-diabetes/gestational-diabetes/ GM] Available from:https://www.diabetesaustralia.com.au/about-diabetes/gestational-diabetes/<nowiki/>(accessed 4.4.2021)</ref>


<span style="line-height: 1.5em;">Caesarean section</span><ref name="8">HAPO Study Cooperative Research Group (2009) 'Hyperglycaemia and Pregnancy Outcome Study: Associations with neonatal anthropometrics', Diabetes, 58, 453-459.</ref>
== Consequences of Gestational Diabetes Mellitus  ==
 
[[File:Cesarian.jpeg|right|frameless]]
<span style="line-height: 1.5em;">GDM in subsequent pregnancies<ref name="9">Catalano, P.M., Kirwen, T.P., Hougel-de Mouzon, S., King, J. (2003) 'Gestational Diabetes and Insulin Resistance: rolein short- and long-term implications for mother and fetus', J Nutr, 133, 1674S-1683S.</ref></span>
'''For Mother'''
 
GDM typically resolves after birth. However, there have been many studies detailing the significantly increased risk of developing DM Type II after having GDM, particularly in the first 5 years postpartum&nbsp;<ref name="6">Kim, C., Newton, K.M., Knopp, R.H. (2002) 'Gestational Diabetes and the incidence of Type 2 Diabetes: a systematic review', Diabetes Care, 25(10), 1862-1868.</ref>.
 
<br>
 
=== For Baby  ===
 
*Macrosomnia: leading to higher rates of injury to mother and baby&nbsp;<ref name="9" />, and higher rates of childhood overweight and obesity&nbsp;<ref name="10">Hillier, T.A., Pedula, K.L., Schmidt, M.M., Mullen, J.A., Charles, M., Pettit, D.J. (2007) 'Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycaemia', Diabetes Care, 30, 2287-2292.</ref>
*Fetal hyperglycaemia and hyperinsulinimia
*Preterm delivery
*Intensive neonatal care
*High neonatal body fat percentage
*Clinical neonatal hypoglycaemia&nbsp;<ref name="8" />
 
== Diagnositc Procedures  ==
 
=== Risk Factors ===
 
Several factors have been identified which increase the risk of women developing GDM. These include:
 
Older age
 
Ethnicity, namely black, Native American, Pacific Islander, Hispanic, South or East Asian and Indigenous Australian
 
High pre-pregnancy BMI
 
Family history of diabetes
 
Previous GDM
 
Multigravid women
 
Excessive weight gain during pregnancy


Short stature
Gestational diabetes mellitus <span style="line-height: 1.5em;">is r</span><span style="line-height: 1.5em;">elated to higher rates of:</span>
* <span style="line-height: 1.5em;">[[Cesarean Section|Cesarean section]]</span><ref name="p8">HAPO Study Cooperative Research Group (2009) 'Hyperglycaemia and Pregnancy Outcome Study: Associations with neonatal anthropometrics', Diabetes, 58, 453-459.</ref>
* Gestational diabetes mellitus <span style="line-height: 1.5em;">in subsequent pregnancies<ref name="p9">Catalano, P.M., Kirwen, T.P., Hougel-de Mouzon, S., King, J. (2003) 'Gestational Diabetes and Insulin Resistance: rolein short- and long-term implications for mother and fetus', J Nutr, 133, 1674S-1683S.</ref></span>
Gestational diabetes mellitus typically resolves after birth. However, there have been many studies detailing the significantly increased risk of developing type II diabetes mellitus after having gestational diabetes mellitus, particularly in the first 5 years postpartum&nbsp;<ref name="p6">Bergman, R.N.(1989) 'Toward a physiological un derstanding of glucose tolerance: minimal model approach', Diabetes, 51, 2207-2213.</ref>. 


Smoking<ref name="6">Di Cianni, G., Volpe, L., Lencioni, C., Miccoli, R., Cuccuru, I., Ghio, A., (2003) 'Prevalence and risk factors for gestational diabetes assessed by universal screening', Diabetes Research
'''For Baby'''
and Clinical Practice,62(2), 131–137.</ref><ref name="7">Tieu, J., Middleton, P., McPhee, A.J., Crowther, C.A. (2010) 'Screening for Gestational Diabetesand subsequent management for improving maternal and infant health', The Cochrane Library, Issue 7.</ref>
*Macrosomia (child born much larger than usual): leads to higher rates of injury to mother and baby&nbsp;<ref name="p9" />, higher rates of [[Childhood Obesity|childhood obesity]]&nbsp;<ref name="p0">Hillier, T.A., Pedula, K.L., Schmidt, M.M., Mullen, J.A., Charles, M., Pettit, D.J. (2007) 'Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycaemia', Diabetes Care, 30, 2287-2292.</ref>  
*Fetal hyperglycemia and hyperinsulinemia
*Preterm delivery
*Intensive neonatal care
*High neonatal body fat percentage
*Clinical neonatal hypoglycemia&nbsp;<ref name="p8" />


== Risk Factors  ==
* Older age
* Ethnicity (namely black, Native American, Pacific Islander, Hispanic, South or East Asian, and Indigenous Australian)
* High pre-pregnancy BMI
* Family history of diabetes
* Previous episode of gestational diabetes mellitus
* Multigravid women
* Excessive weight gain during pregnancy
* Short stature
* Smoking<ref name="p6" /><ref name="p7">Kim, C. and Ferrera, S. (eds.) (2010) Gestational Diabetes During and After Pregnancy, London: Springer-Verlag.</ref>
== Screening for Gestational Diabetes Mellitus  ==


Gestational diabetes mellitus can only be confirmed by an abnormal glucose tolerance test.


Local regimens use various screening tools in conjunction with these risk factors to identify women in need of further testing.
[https://extranet.who.int/rhl/topics/preconception-pregnancy-childbirth-and-postpartum-care/antenatal-care/who-recommendation-diagnosis-gestational-diabetes-pregnancy-0 The World Health Organization classify gestational diabetes mellitus] if one or more of the following criteria are met:
* Fasting plasma glucose 5.1–6.9 mmol/L (92–125 mg/dL)
* 1-hour plasma glucose 10.0 mmol/L (180 mg/dL) following a 75 g oral glucose load 2-hour plasma glucose 8.5–11.0 mmol/L (153–199 mg/dL) following a 75 g oral glucose load


=== Screening for Gestational Diabetes Mellitus  ===
== '''Medical Management / Interventions'''  ==
[[File:Healthy food 2.jpg|right|frameless]]
'''[[Nutrition|Diet]]'''
* Dietary interventions<span style="line-height: 1.5em;">&nbsp;have long been a cornerstone of treatment for GDM. Women diagnosed with GDM are routinely referred to a dietician. The challenge of GDM management for dieticians is striking the delicate balance between keeping maternal insulin low without restricting fetal growth. A Cochrane review in 2008 examined three trials investigating the effects of diet on preventing GDM, found inconclusive results&nbsp;<ref name="p9" />.</span>
'''[[Diabetes|Medication]]'''
* When dietary management fails, insulin is considered the safest treatment, as free insulin cannot cross the placenta.  Although insulin is time tested first-line therapy, its use involves practical challenges. Recent evidence is supportive of the use of OHA (oral hypoglycaemic agents ), especially metformin and glibenclamide. Metformin, when compared with insulin, is associated with less weight gain, better satisfaction, and acceptance and with a lower risk of maternal hypoglycemia.<ref>Anwar A, Ahmad K, Karagianni E, Lindow S. Medical Management of Gestational Diabetes. Open Journal of Obstetrics and Gynecology. 2018 Apr 2;8(04):400.</ref>
'''Exercise'''
* see section below


GDM can only be confirmed by an abnormal glucose tolerance test. The World Health Organisation classify GDM as:  
== Physiotherapy in the&nbsp;<span style="line-height: 1.5em;">Management</span><span style="line-height: 1.5em;">&nbsp;of Gestational Diabetes Mellitus</span>  ==
[[File:Pregnant Woman With Dumbells.jpeg|right|frameless|268x268px]]
[[Therapeutic Exercise|Exercise]] is proven to reduce blood sugar, fasting blood glucose, and glycated hemoglobin. <ref>Padayachee C, Coombes JS. Exercise guidelines for gestational diabetes mellitus. World journal of diabetes. 2015 Jul 25;6(8):1033.</ref><ref name=":1">Harrison AL, Shields N, Taylor NF, Frawley HC. Exercise improves glycaemic control in women diagnosed with gestational diabetes mellitus: a systematic review. Journal of physiotherapy. 2016 Oct 1;62(4):188-96.
</ref>


*A fasting blood glucose level of &gt;7mmol/l
Recent evidence suggests that :
*A blood glucose level of &gt;7.8mmol/l 2 hours after a 75g glucose drink<ref name="4" />
* A program of either '''[[Aerobic Exercise|aerobic exercise]]''' or '''[[Strength Training|resistance]]''' [[Strength Training|training]] appears equally effective, as long as it is performed at least at a '''moderate intensity or greater''', for '''20 to 30 minutes''', '''three to four times a week''', to provide a repeated stimulus that facilitates improved blood glucose uptake and induces increases in insulin sensitivity.<ref name=":1" />
* The exercise program should suit an individual's preference for adherence to exercise<ref name=":1" />
* Greater supervision, either face-to-face or via phone follow-up, and use of home-based exercises involving little or no equipment like brisk walking, [[yoga]], resistance exercise with bands are appeared to be associated with higher levels of adherence.<ref name=":1" />
* Exercises given should include large muscle groups and less pressure on joints like walking, static cycling, [[Aquatherapy|swimming]].<ref>Wang C, Guelfi KJ, Yang HX. Exercise and its role in gestational diabetes mellitus. Chronic diseases and translational medicine. 2016 Dec 1;2(4):208-14.</ref><span style="line-height: 1.5em;"></span>
== Physiotherapy in the&nbsp;<span style="line-height: 1.5em;">Prevention</span><span style="line-height: 1.5em;">&nbsp;of Gestational Diabetes Mellitus</span> ==
[[File:Pregnant lady swimming.jpg|right|frameless]]
Regular exercise has shown to prevent the occurrence of gestational diabetes mellitus.
* Ming wk, et. al (2018) had concluded that regular exercise '''(light-to-moderate)'''  for '''30–60 min''', '''three times a week''', during pregnancy is safe and worthy of promotion in '''normal-weight women with uncomplicated, single pregnancies.''' .<ref>Ming WK, Ding W, Zhang CJ, Zhong L, Long Y, Li Z, Sun C, Wu Y, Chen H, Chen H, Wang Z. The effect of exercise during pregnancy on gestational diabetes mellitus in normal-weight women: a systematic review and meta-analysis. BMC pregnancy and childbirth. 2018 Dec;18(1):440.</ref>
* A randomized clinical trial has shown that '''cycling''' exercise initiated early in pregnancy and performed at least '''30 minutes''', '''3 times per week''', is associated with a significant reduction in the frequency of gestational diabetes mellitus in '''overweight/obese pregnant women.'''<ref>Wang, C., Wei, Y., Zhang, X., Zhang, Y., Xu, Q., Sun, Y., Su, S., Zhang, L., Liu, C., Feng, Y. and Shou, C., 2017. A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women. ''American journal of obstetrics and gynecology'', ''216''(4), pp.340-351.</ref>
* There was a significant reduction in GDM due to higher physical activity.<ref>Aune D, Sen A, Henriksen T, Saugstad OD, Tonstad S. Physical activity and the risk of gestational diabetes mellitus: a systematic review and dose–response meta-analysis of epidemiological studies.</ref>
'''Some examples to be considered:'''
# Exercises that are considered safe:<ref name=":2">ACOG Committee on Obstetric Practice. Committee opinion# 267: exercise during pregnancy and the postpartum period. Obstetrics & Gynecology. 2002 Jan 1;99(1):171-3.
</ref>
* Walking
* Swimming
* Stationary cycling
* low-impact aerobics
* Yoga, modified
* [[Pilates]], modified
* Running or jogging
* Racquet sports
* Strength training
2.Exercises that should be avoided:<ref name=":2" />
* Scuba diving
* Sky diving
* Hot yoga or Hot pilates
* Activities with a high risk of fall (skiing, off-road cycling, gymnastics, horseback riding)
* Contact sports( ice hockey, boxing, soccer, and basketball)
See also
* [[Physical Activity and Pregnancy]]


<br>
== Medical Management / Interventions<br>  ==
=== Diet ===
=== Medication ===
<div>When dietary management fails, insulin is considered the safest treatment, as free insulin cannot cross the placenta. Alpha-glucosidase inhibitors (acarbose) and biguanides (metformin) cross placenta but are still used increasingly. However, there are insufficient data to determine the long term effects of these on mother and baby&nbsp;<references />.</div>
=== Weight Management  ===
== The Role for Physiotherapy<br>  ==
=== Physiotherapy in the Prevention of Gestational Diabetes Mellitus<br>  ===
=== Physiotherapy in the Management of Gestational Diabetes Mellitus  ===
== Key Evidence  ==
add text here relating to key evidence with regards to any of the above headings<br>
== Resources <br>  ==
add appropriate resources here
== Case Studies  ==
add links to case studies here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br>
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
<div class="researchbox">
<rss>Feed goes here!!|charset=UTF-8|short|max=10</rss>
</div>
== References  ==
== References  ==


References will automatically be added here, see [[Adding References|adding references tutorial]].
<references />


<references />
[[Category:Womens_Health]]
[[Category:Pregnancy]]
[[Category:Postpartum]]
[[Category:Pelvis]]
[[Category:Conditions]]
[[Category:Pelvis - Conditions]]

Latest revision as of 07:01, 21 August 2022

Original Editor - Clara Caplice Top Contributors - Clara Caplice, Redisha Jakibanjar, Nicole Hills, Lucinda hampton, WikiSysop, Manisha Shrestha, 127.0.0.1, Kim Jackson and Kanza Imtiaz

Description[edit | edit source]

Pregnant lady.jpeg

Gestational diabetes (GM) is hyperglycaemia with blood glucose values above normal but below those diagnostic of diabetes. Gestational diabetes occurs during pregnancy

  • Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery. These women and possibly their children are also at increased risk of type 2 diabetes in the future[1].
  • Gestational diabetes is diagnosed through prenatal screening, rather than through reported symptoms.
  • It is more common among older women, obese women, and certain ethnic groups[2]. It usually presents after the beginning of the second trimester[3].

Epidemiology[edit | edit source]

GMs prevalence varies widely in the literature, but is thought to affect 4-7.5% of all pregnancies [4][2] and is increasing. [4] 

Gestational diabetes affects around 2 to 10% of pregnancies in the United States of America.

Women with gestational diabetes (GDM) have an increased 35 to 60% risk of developing diabetes mellitus over 10 to 20 years after pregnancy[5]

Pathological Process[edit | edit source]

In pregnancy, the placenta produces hormones that help the baby grow and develop. These hormones also block the action of the woman’s insulin. ie insulin resistance. Because of this insulin resistance, the need for insulin in pregnancy is 2 to 3 times higher than normal. Those already with insulin resistance may not be able to cope with the extra demand for insulin production and the blood glucose levels will be higher resulting in gestational diabetes being diagnosed.

When the pregnancy is over and blood glucose levels usually return to normal and the gestational diabetes disappears, however this insulin resistance increases the risk of developing type 2 diabetes in later life.[6]

Consequences of Gestational Diabetes Mellitus[edit | edit source]

Cesarian.jpeg

For Mother

Gestational diabetes mellitus is related to higher rates of:

Gestational diabetes mellitus typically resolves after birth. However, there have been many studies detailing the significantly increased risk of developing type II diabetes mellitus after having gestational diabetes mellitus, particularly in the first 5 years postpartum [9].

For Baby

  • Macrosomia (child born much larger than usual): leads to higher rates of injury to mother and baby [8], higher rates of childhood obesity [10]
  • Fetal hyperglycemia and hyperinsulinemia
  • Preterm delivery
  • Intensive neonatal care
  • High neonatal body fat percentage
  • Clinical neonatal hypoglycemia [7]

Risk Factors[edit | edit source]

  • Older age
  • Ethnicity (namely black, Native American, Pacific Islander, Hispanic, South or East Asian, and Indigenous Australian)
  • High pre-pregnancy BMI
  • Family history of diabetes
  • Previous episode of gestational diabetes mellitus
  • Multigravid women
  • Excessive weight gain during pregnancy
  • Short stature
  • Smoking[9][11]

Screening for Gestational Diabetes Mellitus[edit | edit source]

Gestational diabetes mellitus can only be confirmed by an abnormal glucose tolerance test.

The World Health Organization classify gestational diabetes mellitus if one or more of the following criteria are met:

  • Fasting plasma glucose 5.1–6.9 mmol/L (92–125 mg/dL)
  • 1-hour plasma glucose 10.0 mmol/L (180 mg/dL) following a 75 g oral glucose load 2-hour plasma glucose 8.5–11.0 mmol/L (153–199 mg/dL) following a 75 g oral glucose load

Medical Management / Interventions[edit | edit source]

Healthy food 2.jpg

Diet

  • Dietary interventions have long been a cornerstone of treatment for GDM. Women diagnosed with GDM are routinely referred to a dietician. The challenge of GDM management for dieticians is striking the delicate balance between keeping maternal insulin low without restricting fetal growth. A Cochrane review in 2008 examined three trials investigating the effects of diet on preventing GDM, found inconclusive results [8].

Medication

  • When dietary management fails, insulin is considered the safest treatment, as free insulin cannot cross the placenta.  Although insulin is time tested first-line therapy, its use involves practical challenges. Recent evidence is supportive of the use of OHA (oral hypoglycaemic agents ), especially metformin and glibenclamide. Metformin, when compared with insulin, is associated with less weight gain, better satisfaction, and acceptance and with a lower risk of maternal hypoglycemia.[12]

Exercise

  • see section below

Physiotherapy in the Management of Gestational Diabetes Mellitus[edit | edit source]

Pregnant Woman With Dumbells.jpeg

Exercise is proven to reduce blood sugar, fasting blood glucose, and glycated hemoglobin. [13][14]

Recent evidence suggests that :

  • A program of either aerobic exercise or resistance training appears equally effective, as long as it is performed at least at a moderate intensity or greater, for 20 to 30 minutes, three to four times a week, to provide a repeated stimulus that facilitates improved blood glucose uptake and induces increases in insulin sensitivity.[14]
  • The exercise program should suit an individual's preference for adherence to exercise[14]
  • Greater supervision, either face-to-face or via phone follow-up, and use of home-based exercises involving little or no equipment like brisk walking, yoga, resistance exercise with bands are appeared to be associated with higher levels of adherence.[14]
  • Exercises given should include large muscle groups and less pressure on joints like walking, static cycling, swimming.[15]

Physiotherapy in the Prevention of Gestational Diabetes Mellitus[edit | edit source]

Pregnant lady swimming.jpg

Regular exercise has shown to prevent the occurrence of gestational diabetes mellitus.

  • Ming wk, et. al (2018) had concluded that regular exercise (light-to-moderate) for 30–60 min, three times a week, during pregnancy is safe and worthy of promotion in normal-weight women with uncomplicated, single pregnancies. .[16]
  • A randomized clinical trial has shown that cycling exercise initiated early in pregnancy and performed at least 30 minutes, 3 times per week, is associated with a significant reduction in the frequency of gestational diabetes mellitus in overweight/obese pregnant women.[17]
  • There was a significant reduction in GDM due to higher physical activity.[18]

Some examples to be considered:

  1. Exercises that are considered safe:[19]
  • Walking
  • Swimming
  • Stationary cycling
  • low-impact aerobics
  • Yoga, modified
  • Pilates, modified
  • Running or jogging
  • Racquet sports
  • Strength training

2.Exercises that should be avoided:[19]

  • Scuba diving
  • Sky diving
  • Hot yoga or Hot pilates
  • Activities with a high risk of fall (skiing, off-road cycling, gymnastics, horseback riding)
  • Contact sports( ice hockey, boxing, soccer, and basketball)

See also

References[edit | edit source]

  1. ↑ WHO Diabetes Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes (accessed 4.4.2021)
  2. ↑ 2.0 2.1 Lawreance, J.M., Contereras, R., Chen, W. and Sacks, D.A. (2008) 'Trends in the prevelance of preexisting diabetes mellitus and GDM among a racially/ethnically diverse population of pregnant women, 1999-2005', Diabetes Care, 31(5), 899-904.
  3. ↑ Alwan, N., Tuffnell,D.J., West, J. (2009) 'Treatments for Gestational Diabetes', The Cochrane Library, Issue 3.
  4. ↑ 4.0 4.1 Dabelea, D., Snell-Bergeon, J.K., Hartsfield, C.L., Bischoff, K.J., Hamman, R.F., McDuffie, R.S. (2005) 'Increasing Prevelance of Gestational Diabetes Mellitus (GDM) Over Time and by Birth Cohort', Diabetes Care, 28(3), 579-584.
  5. ↑ Rodriguez BS, Mahdy H. Gestational diabetes. StatPearls [Internet]. 2020 Aug 23.Available from: (accessed 4.4.2021)
  6. ↑ Diabetes Australia GM Available from:https://www.diabetesaustralia.com.au/about-diabetes/gestational-diabetes/(accessed 4.4.2021)
  7. ↑ 7.0 7.1 HAPO Study Cooperative Research Group (2009) 'Hyperglycaemia and Pregnancy Outcome Study: Associations with neonatal anthropometrics', Diabetes, 58, 453-459.
  8. ↑ 8.0 8.1 8.2 Catalano, P.M., Kirwen, T.P., Hougel-de Mouzon, S., King, J. (2003) 'Gestational Diabetes and Insulin Resistance: rolein short- and long-term implications for mother and fetus', J Nutr, 133, 1674S-1683S.
  9. ↑ 9.0 9.1 Bergman, R.N.(1989) 'Toward a physiological un derstanding of glucose tolerance: minimal model approach', Diabetes, 51, 2207-2213.
  10. ↑ Hillier, T.A., Pedula, K.L., Schmidt, M.M., Mullen, J.A., Charles, M., Pettit, D.J. (2007) 'Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycaemia', Diabetes Care, 30, 2287-2292.
  11. ↑ Kim, C. and Ferrera, S. (eds.) (2010) Gestational Diabetes During and After Pregnancy, London: Springer-Verlag.
  12. ↑ Anwar A, Ahmad K, Karagianni E, Lindow S. Medical Management of Gestational Diabetes. Open Journal of Obstetrics and Gynecology. 2018 Apr 2;8(04):400.
  13. ↑ Padayachee C, Coombes JS. Exercise guidelines for gestational diabetes mellitus. World journal of diabetes. 2015 Jul 25;6(8):1033.
  14. ↑ 14.0 14.1 14.2 14.3 Harrison AL, Shields N, Taylor NF, Frawley HC. Exercise improves glycaemic control in women diagnosed with gestational diabetes mellitus: a systematic review. Journal of physiotherapy. 2016 Oct 1;62(4):188-96.
  15. ↑ Wang C, Guelfi KJ, Yang HX. Exercise and its role in gestational diabetes mellitus. Chronic diseases and translational medicine. 2016 Dec 1;2(4):208-14.
  16. ↑ Ming WK, Ding W, Zhang CJ, Zhong L, Long Y, Li Z, Sun C, Wu Y, Chen H, Chen H, Wang Z. The effect of exercise during pregnancy on gestational diabetes mellitus in normal-weight women: a systematic review and meta-analysis. BMC pregnancy and childbirth. 2018 Dec;18(1):440.
  17. ↑ Wang, C., Wei, Y., Zhang, X., Zhang, Y., Xu, Q., Sun, Y., Su, S., Zhang, L., Liu, C., Feng, Y. and Shou, C., 2017. A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women. American journal of obstetrics and gynecology, 216(4), pp.340-351.
  18. ↑ Aune D, Sen A, Henriksen T, Saugstad OD, Tonstad S. Physical activity and the risk of gestational diabetes mellitus: a systematic review and dose–response meta-analysis of epidemiological studies.
  19. ↑ 19.0 19.1 ACOG Committee on Obstetric Practice. Committee opinion# 267: exercise during pregnancy and the postpartum period. Obstetrics & Gynecology. 2002 Jan 1;99(1):171-3.
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