Exercise during gestational diabetes

Dr Takshita Sookan, on behalf of The Biokinetics Association of South Africa, elaborates on exercise during gestational diabetes and how a biokineticist can give expecting mothers peace of mind.

From as early as the 1940s, it was recognised that women who developed diabetes during pregnancy experienced abnormally high foetal and neonatal mortality. By the 1950s, the term gestational diabetes was applied to what was thought to be a transient condition that subsided after delivery.

Understanding gestational diabetes

Gestational diabetes mellitus (GDM) is the most common metabolic disturbance during pregnancy globally.⁴ It’s defined as any degree of glucose intolerance with the onset or first recognition during pregnancy, usually diagnosed in the second or third trimester.¹

 In 2017, the International Diabetes Federation estimated that GDM affects approximately 14% of pregnancies worldwide.⁸ In recent years, there has been an increase in the prevalence. This is due to multiple factors, such as physiological and genetic abnormalities, a family history of Type 2 diabetes, ethnicity, an increase in maternal obesity, physical inactivity and rising maternal age.^4,2

How is it diagnosed?

GDM is diagnosed through the screening of pregnant women for clinical risk factors and among at-risk women by testing for abnormal glucose tolerance.² The World Health Organisation standardised the testing for GDM using a 75g oral glucose tolerance test. The accepted normative values for diagnosis are: a fasting glucose ≥ 5,1 mmol/L, or a one-hour result ≥ 10,0 mmol/L, or a two-hour result ≥ 8,5 mmol/L.⁷ 

Side effects

A diagnosis of GDM is associated with an increased risk of adverse birth outcomes for both the mother and the infant. These complications include preeclampsia, infant macrosomia (larger than average size), neonatal hypoglycaemia, and increased risk of developing Type 2 diabetes later in life.

The possible effect on the infant includes the increased risk of developing Type 2 diabetes, cardiovascular complications and obesity later in life.^6,9

Therapeutic strategy

The primary aim of treating GDM is to optimise glycaemic control to improve pregnancy outcomes. Lifestyle interventions, such as modified diet and exercise, are usually recommended as the primary therapeutic strategy to achieve acceptable glycaemic control.⁹

Exercise

Exercise in individuals with diabetes has long been prescribed to help disease management by increasing insulin sensitivity and improving glycaemic control.⁶ Exercise is safe and can positively affect pregnancy outcomes.³

Eminent medical professional groups that provide guidelines on antenatal healthcare recommend exercise in pregnancy for women without contraindications to reduce the risk of developing GDM.

Exercise is deemed to be an important component of the lifestyle intervention for GDM.⁵ A single bout of exercise increases skeletal muscle glucose uptake, minimising hyperglycaemia.³ Regular exercise has the potential to prevent GDM.

The success of the exercise intervention is dependent on several factors, such as early initiation, correct intensity and frequency, and the management of gestational weight gain.⁶

Current recommendations to accrue health benefits include both aerobic and strength training exercises for women who have uncomplicated pregnancies, specifically 30 to 60 minutes of moderate intensity exercise, three to four times per week throughout the pregnancy.^5,6,7

The majority of research studies have provided an evidence-based approach to these recommendations. Research studies have looked at the impact of exercise on the risk and treatment of GDM and found that exercise was overall protective against GDM.^6,9

Work with a biokineticist

However, few women achieve these exercise goals during pregnancy.^5,6,7 There is also perception that exercising may harm the foetus. These challenges can be overcome by working with a biokineticist.

As registered healthcare professionals, biokineticists promote life through movement and use scientifically-based and individualised exercise prescription to enhance health and well-being.

For a woman with GDM, a biokineticist can optimise glycaemic control to improve pregnancy outcomes by enhancing muscle strength, endurance, cardiorespiratory fitness and flexibility through evidenced-based exercise. Working with a biokineticist can further reassure the mother to be on the overall safety of the exercises and provide peace of mind which will result in optimal positive outcomes.

Biokineticists are involved in many areas of treatment, including orthopaedic and neurological rehabilitation, health promotion, chronic disease management and sporting performance. They promote an active lifestyle to prevent non-communicable diseases, such as diabetes. Furthermore, they are specifically educated to prescribe and supervise exercise to individuals for the management and prevention of GDM.

 To find out more about biokinetics and to find a biokineticist near you, visit biokineticssa.org.za