Movement Behavior during Pregnancy and Adverse Maternal–Fetal Outcomes in Women with Gestational Diabetes: A Pilot Case-Control Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Participants
2.3. Pregnancy Data
2.4. Adverse Maternal–Fetal Outcomes
2.5. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- McIntyre, H.D.; Catalano, P.; Zhang, C.; Desoye, G.; Mathiesen, E.R.; Damm, P. Gestational diabetes mellitus. Nat. Rev. Dis. Prim. 2019, 5, 47. [Google Scholar] [CrossRef] [PubMed]
- Billionnet, C.; Mitanchez, D.; Weill, A.; Nizard, J.; Alla, F.; Hartemann, A.; Jacqueminet, S. Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012. Diabetologia 2017, 60, 636–644. [Google Scholar] [CrossRef] [PubMed]
- Zheng, J.; Wang, H.; Ren, M. Influence of exercise intervention on gestational diabetes mellitus: A systematic review and meta-analysis. J. Endocrinol. Investig. 2017, 40, 1027–1033. [Google Scholar] [CrossRef] [PubMed]
- Currie, L.M.; Woolcott, C.G.; Fell, D.B.; Armson, B.A.; Dodds, L. The association between physical activity and maternal and neonatal outcomes: A prospective cohort. Matern. Child Health J. 2014, 18, 1823–1830. [Google Scholar] [CrossRef] [PubMed]
- Barakat, R.; Perales, M.; Cordero, Y.; Bacchi, M.; Mottola, M.F. Influence of Land or Water Exercise in Pregnancy on Outcomes: A Cross-sectional Study. Med. Sci. Sports Exerc. 2017, 49, 1397–1403. [Google Scholar] [CrossRef] [PubMed]
- Aittasalo, M.; Raitanen, J.; Kinnunen, T.I.; Ojala, K.; Kolu, P.; Luoto, R. Is intensive counseling in maternity care feasible and effective in promoting physical activity among women at risk for gestational diabetes? Secondary analysis of a cluster randomized NELLI study in Finland. Int. J. Behav. Nutr. Phys. Act. 2012, 5, 104. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Davenport, M.H.; Ruchat, S.M.; Poitras, V.J.; Jaramillo Garcia, A.; Gray, C.E.; Barrowman, N.; Skow, R.J.; Meah, V.L.; Riske, L.; Sobierajski, F.; et al. Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: A systematic review and meta-analysis. Br. J. Sports Med. 2018, 52, 1367–1375. [Google Scholar] [CrossRef] [PubMed]
- ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet. Gynecol. 2018, 131, e49–e64. [CrossRef]
- Brown, J.; Ceysens, G.; Boulvain, M. Exercise for pregnant women with gestational diabetes for improving maternal and fetal outcomes. Cochrane Database Syst. Rev. 2017, 6, CD012202. [Google Scholar] [CrossRef]
- Barakat, R.; Pelaez, M.; Cordero, Y.; Perales, M.; Lopez, C.; Coteron, J.; Mottola, M.F. Exercise during pregnancy protects against hypertension and macrosomia: Randomized clinical trial. Am. J. Obstet. Gynecol. 2016, 214, 649.e1-8. [Google Scholar] [CrossRef]
- Wiebe, H.W.; Boulé, N.G.; Chari, R.; Davenport, M.H. The effect of supervised prenatal exercise on fetal growth. Obstet. Gynecol. 2015, 125, 1185–1194. [Google Scholar] [CrossRef]
- Hawkins, M.; Hosker, M.; Marcus, B.H.; Rosal, M.C.; Braun, B.; Stanek, E.J.; Markenson, G.; Chasan-Taber, L. A pregnancy lifestyle intervention to prevent gestational diabetes risk factors in overweight Hispanic women: A feasibility randomized controlled trial. Diabet. Med. 2015, 32, 108–115. [Google Scholar] [CrossRef] [PubMed]
- Chasan-Taber, L.; Silveira, M.; Lynch, K.E.; Pekow, P.; Solomon, C.G.; Markenson, G. Physical activity and gestational weight gain in Hispanic women. Obesity 2014, 22, 909–918. [Google Scholar] [CrossRef] [PubMed]
- Leng, J.; Liu, G.; Zhang, C.; Xin, S.; Chen, F.; Li, B.; Tian, H.; Yu, Z.; Tuomilehto, J.; Hu, G.; et al. Physical activity, sedentary behaviors and risk of gestational diabetes mellitus: A population-based cross-sectional study in Tianjin, China. Eur. J. Endocrinol. 2016, 174, 763–773. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Agha-Jaffar, R.; Oliver, N.; Johnston, D.; Robinson, S. Gestational diabetes mellitus: Does an effective prevention strategy exist? Nat. Rev. Endocrinol. 2016, 12, 533–546. [Google Scholar] [CrossRef] [PubMed]
- Venetis, C.A. Physical activity in pregnancy and offspring weight: What we know and what we don’t. BJOG Int. J. Obstet. Gynaecol. 2019, 126, 471. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Von Elm, E.; Altman, D.G.; Egger, M.; Pocock, S.J.; Gøtzsche, P.C.; Vandenbroucke, J.P. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. J. Clin. Epidemiol. 2008, 61, 344–349. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: A World Health Organization Guideline. Diabetes Res. Clin. Pract. 2014, 103, 341–363. [CrossRef]
- De Sales, R.L.; Silva, M.M.S.; Costa, N.M.B.; Euclydes, M.P.; Eckhardt, V.F.; Rodrigues, C.M.A.; Tinôco, A.L.A. Desenvolvimento de um inquérito para avaliação da ingestão alimentar de grupos populacionais. Rev. Nutr. 2006, 19, 539–552. [Google Scholar] [CrossRef] [Green Version]
- Ministério da Saúde. Guia Alimentar Para a População Brasileira; Ministério da Saúde: Brasília, Brazil, 2014; ISBN 978-85-334-2176-9.
- Chasan-Taber, L.; Schmidt, M.D.; Roberts, D.E.; Hosmer, D.; Markenson, G.; Freedson, P.S. Development and validation of a pregnancy physical activity questionnaire. Med. Sci. Sports Exerc. 2004, 36, 1750–1760. [Google Scholar] [CrossRef]
- Silva, F.T.; Júnior, E.A.; Santana, E.F.; Lima, J.W.; Cecchino, G.N.; Costa, F.D.S. Translation and cross-cultural adaptation of the Pregnancy Physical Activity Questionnaire (PPAQ) to the Brazilian population. Ceska Gynekol. 2015, 80, 290–298. [Google Scholar] [PubMed]
- Visser, M.; Koster, A. Development of a questionnaire to assess sedentary time in older persons—A comparative study using accelerometry. BMC Geriatr. 2013, 30, 80. [Google Scholar] [CrossRef] [PubMed]
- American College of Obstetricians and Gynecologists. ACOG Committee Opinion No 579: Definition of term pregnancy. Obstet Gynecol. 2013, 122, 1139–1140. [Google Scholar] [CrossRef] [PubMed]
- Committee on Practice Bulletins-Obstetrics. Macrosomia: ACOG Practice Bulletin, Number 216. Obstet Gynecol. 2020, 135, e18–e35. [Google Scholar] [CrossRef] [PubMed]
- Sociedade Brasileira de Pediatria. Diretrizes da Sociedade Brasileira de Pediatria. Hipoglicemia no Período Neonatal. Brasil. 2014. Available online: https://www.sbp.com.br/fileadmin/user_upload/2015/02/diretrizessbp-hipoglicemia2014.pdf (accessed on 27 October 2020).
- Tudor-Locke, C.; Craig, C.L.; Thyfault, J.P.; Spence, J.C. A step-defined sedentary lifestyle index: <5000 steps/day. Appl. Physiol. Nutr. Metab. 2013, 38, 100–114. [Google Scholar] [CrossRef] [PubMed]
- Oviedo-Caro, M.Á.; Bueno-Antequera, J.; Munguía-Izquierdo, D. Measuring Sedentary Behavior During Pregnancy: Comparison Between Self-reported and Objective Measures. Matern. Child Health J. 2018, 22, 968–977. [Google Scholar] [CrossRef]
- Nguyen, C.L.; Pham, N.M.; Lee, A.H.; Nguyen, P.T.H.; Chu, T.K.; Ha, A.V.V.; Duong, D.V.; Duong, T.H.; Binns, C.W. Physical activity during pregnancy is associated with a lower prevalence of gestational diabetes mellitus in Vietnam. Acta Diabetol. 2018, 55, 955–962. [Google Scholar] [CrossRef]
- Bisson, M.; Croteau, J.; Guinhouya, B.C.; Bujold, E.; Audibert, F.; Fraser, W.D.; Marc, I. Physical activity during pregnancy and infant’s birth weight: Results from the 3D Birth Cohort. BMJ Open Sport Exerc. Med. 2017, 3, e000242. [Google Scholar] [CrossRef]
- Liu, J.; Blair, S.N.; Teng, Y.; Ness, A.R.; Lawlor, D.A.; Riddoch, C. Physical activity during pregnancy in a prospective cohort of British women: Results from the Avon longitudinal study of parents and children. Eur. J. Epidemiol. 2011, 26, 237–247. [Google Scholar] [CrossRef] [Green Version]
- Borodulin, K.M.; Evenson, K.R.; Wen, F.; Herring, A.H.; Benson, A.M. Physical activity patterns during pregnancy. Med. Sci. Sports Exerc. 2008, 40, 1901–1908. [Google Scholar] [CrossRef] [Green Version]
- Da Silva, S.G.; Ricardo, L.I.; Evenson, K.R.; Hallal, P.C. Leisure-Time Physical Activity in Pregnancy and Maternal-Child Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Cohort Studies. Sports Med. 2017, 47, 295–317. [Google Scholar] [CrossRef] [PubMed]
- Peters, T.M.; Brazeau, A.S. Exercise in Pregnant Women with Diabetes. Curr. Diab. Rep. 2019, 19, 80. [Google Scholar] [CrossRef] [PubMed]
- Ehrlich, S.F.; Hedderson, M.M.; Brown, S.D.; Sternfeld, B.; Chasan-Taber, L.; Feng, J.; Adams, J.; Ching, J.; Crites, Y.; Quesenberry, C.P.; et al. Moderate intensity sports and exercise is associated with glycaemic control in women with gestational diabetes. Diabetes Metab. 2017, 43, 416–423. [Google Scholar] [CrossRef] [PubMed]
- Wang, C.; Zhu, W.; Wei, Y.; Feng, H.; Su, R.; Yang, H. Exercise intervention during pregnancy can be used to manage weight gain and improve pregnancy outcomes in women with gestational diabetes mellitus. BMC Pregnancy Childbirth 2015, 12, 255. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Church, T.S.; Blair, S.N.; Cocreham, S.; Johannsen, N.; Johnson, W.; Kramer, K.; Mikus, C.R.; Myers, V.; Nauta, M.; Rodarte, R.Q.; et al. Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: A randomized controlled trial. JAMA 2010, 304, 2253–2262. [Google Scholar] [CrossRef] [Green Version]
- Kampmann, U.; Madsen, L.R.; Skajaa, G.O.; Iversen, S.D.; Moeller, N.; Ovesen, P. Gestational diabetes: A clinical update. World J. Diabetes 2015, 6, 1065–1072. [Google Scholar] [CrossRef]
- Barakat, R.; Refoyo, I.; Coteron, J.; Franco, E. Exercise during pregnancy has a preventative effect on excessive maternal weight gain and gestational diabetes. A randomized controlled trial. Braz. J. Phys. Ther. 2019, 23, 148–155. [Google Scholar] [CrossRef]
- Savvaki, D.; Taousani, E.; Goulis, D.G.; Tsirou, E.; Voziki, E.; Douda, H.; Nikolettos, N.; Tokmakidis, S.P. Guidelines for exercise during normal pregnancy and gestational diabetes: A review of international recommendations. Hormones 2018, 17, 521–529. [Google Scholar] [CrossRef]
- Vargas-Terrones, M.; Nagpal, T.S.; Barakat, R. Impact of exercise during pregnancy on gestational weight gain and birth weight: An overview. Braz. J. Phys. Ther. 2019, 23, 164–169. [Google Scholar] [CrossRef]
- Dipietro, L.; Evenson, K.R.; Bloodgood, B.; Sprow, K.; Troiano, R.P.; Piercy, K.L.; Vaux-Bjerke, A.; Powell, K.E. Benefits of Physical Activity during Pregnancy and Postpartum: An Umbrella Review. Med. Sci. Sports Exerc. 2019, 51, 1292–1302. [Google Scholar] [CrossRef]
- Laredo-Aguilera, J.A.; Gallardo-Bravo, M.; Rabanales-Sotos, J.A.; Cobo-Cuenca, A.I.; Carmona-Torres, J.M. Physical activity programs during pregnancy are effective for the control of gestational diabetes mellitus. Int. J. Environ. Res. Public Health 2020, 17, 6151. [Google Scholar] [CrossRef] [PubMed]
- Physical Activity and Exercise during Pregnancy and the Postpartum Period. Obstet Gynecol. 2020, 135, e178–e188. [CrossRef] [PubMed] [Green Version]
- Mottola, M.F.; Davenport, M.H.; Ruchat, S.M.; Davies, G.A.; Poitras, V.J.; Gray, C.E.; Jaramillo Garcia, A.; Barrowman, N.; Adamo, K.B.; Duggan, M.; et al. 2019 Canadian guideline for physical activity throughout pregnancy. Br. J. Sports Med. 2018, 52, 1339–1346. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Zhu, G.; Qian, X.; Qi, L.; Xia, C.; Ming, Y.; Zeng, Z.; Liu, Y.; Yang, Y.; Zhang, M.; Zhang, H. The intention to undertake physical activity in pregnant women using the theory of planned behaviour. J. Adv. Nurs. 2020, 76, 1647–1657. [Google Scholar] [CrossRef]
- Walasik, I.; Szymusik, I.; Kwiatkowska, K.; Kaczyńska, K.K. Physical activity patterns among 9000 pregnant women in poland: A cross-sectional study. Int. J. Environ. Res. Public Health 2020, 17, 1771. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Anjana, R.M.; Sudha, V.; Lakshmipriya, N.; Anitha, C.; Unnikrishnan, R.; Bhavadharini, B.; Mahalakshmi, M.M.; Maheswari, K.; Kayal, A.; Ram, U.; et al. Physical activity patterns and gestational diabetes outcomes—The wings project. Diabetes Res. Clin. Pract. 2016, 116, 253–262. [Google Scholar] [CrossRef] [Green Version]
- Barakat, R.; Pelaez, M.; Lopez, C.; Lucia, A.; Ruiz, J.R. Exercise during pregnancy and gestational diabetes-related adverse effects: A randomised controlled trial. Br. J. Sports Med. 2013, 47, 630–636. [Google Scholar] [CrossRef] [Green Version]
- Bo, S.; Rosato, R.; Ciccone, G.; Canil, S.; Gambino, R.; Poala, C.B.; Leone, F.; Valla, A.; Grassi, G.; Ghigo, E.; et al. Simple lifestyle recommendations and the outcomes of gestational diabetes. A 2 × 2 factorial randomized trial. Diabetes Obes. Metab. 2014, 16, 1032–1035. [Google Scholar] [CrossRef]
- Colberg, S.R.; Sigal, R.J.; Yardley, J.E.; Riddell, M.C.; Dunstan, D.W.; Dempsey, P.C.; Horton, E.S.; Castorino, K.; Tate, D.F. Physical activity/exercise and diabetes: A position statement of the American Diabetes Association. Diabetes Care 2016, 39, 2065–2079. [Google Scholar] [CrossRef] [Green Version]
Variables | n | Total | Case | Control | p-Value |
---|---|---|---|---|---|
n, % | 24 (35.3) | 44 (64.7) | |||
Age, years | 68 | 32.06 ± 5.81 | 31.46 ± 4.79 | 32.39 ± 6.33 | 0.533 |
At least high school education, n (%) | 68 | 28 (40.2) | 8 (33.4) | 20 (45.4) | 0.251 |
Living with partner, n (%) | 68 | 57 (83.8) | 22 (91.7) | 35 (79.5) | 0.195 |
Family income over 1 minimum wage, n (%) | 68 | 25 (36.8) | 12 (50.0) | 13 (29.5) | 0.095 |
Gestational age, weeks
| 68 | 23 (33.8) 45 (66.2) | 9 (37.5) 15 (62.5) | 14 (31.8) 30 (68.2) | 0.636 |
Parity, n (%)
| 68 | 16 (23.5) 16 (23.5) 36 (52.9) | 4 (16.7) 6 (25.0) 14 (58.3) | 12 (27.3) 10 (22.7) 22 (50.0) | 0.613 |
Previous preterm birth, n (%) | 67 | 7 (10.4) | 3 (12.5) | 4 (9.3) | 0.695 |
Previous GDM, n (%) | 68 | 5 (7.4) | 2 (8.3) | 3 (6.8) | 1.000 |
Maternal family history of diabetes, n (%) | 67 | 47 (70.1) | 17 (70.8) | 30 (69.8) | 0.927 |
Pregestational BMI, kg/m2 | 68 | 28.50 (25.05–34.43) | 29.20 (24.63–35.48) | 28.50 (25.23–33.43) | 0.734 |
Maternal weight gain (kg) | 67 | 5.94 ± 7.18 | 6.04 ± 8.45 | 5.89 ± 6.53 | 0.934 |
Insulin therapy, n (%) | 68 | 25 (36.8) | 12 (50.0) | 13 (29.5) | 0.095 |
Hypertension, n (%) | 68 | 25 (36.8) | 12 (50.0) | 13 (29.5) | 0.095 |
Prenatal visits, n | 64 | 9.38 ± 3.24 | 9.35 ± 3.79 | 9.39 ± 2.94 | 0.960 |
Mode of delivery
| 68 | 25 (36.8) 43 (63.2) | 10 (41.7) 14 (58.3) | 15 (34.1) 29 (65.9) | 0.536 |
Measures | Total | Case | Control | p-Value | |||
---|---|---|---|---|---|---|---|
n | n | n | |||||
PA domains, MET-h/week | |||||||
Leisure/exercise | 21 | 0.00 (0.00–2.69) | 5 | 0.00 (0.00–0.00) | 16 | 0.00 (0.00–2.69) | 0.160 |
Transportation | 65 | 4.80 (1.50–7.53) | 22 | 3.08 (1.50–7.15) | 43 | 5.03 (1.73–8.66) | 0.204 |
Household/domestic | 67 | 52.37 (28.23–76.52) | 24 | 46.22 (26.74–76.01) | 43 | 55.61 (29.23–81.38) | 0.492 |
Occupational | 24 | 0.00 (0.00–48.00) | 8 | 0.00 (0.00–66.72) | 16 | 0.00 (0.00–48.00) | 0.928 |
PA intensities, MET-h/week | |||||||
Light | 68 | 67.75 (41.20–116.71) | 24 | 58.35 (43.11–97.42) | 44 | 71.38 (40.55–121.81) | 0.457 |
Moderate | 55 | 5.82 (1.92–19.88) | 18 | 3.06 (0.45–10.30) | 37 | 7.50 (3.63–22.87) | 0.044 * |
Vigorous | 6 | 0.00 (0.00–0.00) | 2 | 0.00 (0.00–0.00) | 4 | 0.00 (0.00–0.00) | 0.907 |
Pedometer-measured PA, steps/day | 63 | 3.673 (2.809–4.792) | 23 | 3.156 (2.703–4.727) | 40 | 3.930 (2.933–4.989) | 0.250 |
Sedentary behavior, min/day | 68 | 416 (243–568) | 24 | 418 (287–644) | 44 | 405 (229–567) | 0.626 |
Moderate PA (MET-h/week) | Case | Control | Unadjusted | Adjusted | ||
---|---|---|---|---|---|---|
n | n | OR (95%CI) | p-Value | OR # (95%CI) | p-Value | |
Tertile 1 (0.00–3.60 MET-h/week) | 12 | 11 | Reference | Reference | ||
Tertile 2 (3.72–11.50 MET-h/week) | 7 | 16 | 0.40 (0.12–1.34) | 0.138 | 0.46 (0.12–1.80) | 0.266 |
Tertile 3 (15.00–123.84 MET-h/week) | 5 | 17 | 0.27 (0.07–0.98) | 0.046 * | 0.21 (0.05–0.91) | 0.037 * |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Camargo, S.F.; Camargo, J.D.; Schwade, D.; Silva, R.M.; Cornetta, M.d.C.M.; Cobucci, R.N.; Costa, E.C. Movement Behavior during Pregnancy and Adverse Maternal–Fetal Outcomes in Women with Gestational Diabetes: A Pilot Case-Control Study. Int. J. Environ. Res. Public Health 2021, 18, 1114. https://doi.org/10.3390/ijerph18031114
Camargo SF, Camargo JD, Schwade D, Silva RM, Cornetta MdCM, Cobucci RN, Costa EC. Movement Behavior during Pregnancy and Adverse Maternal–Fetal Outcomes in Women with Gestational Diabetes: A Pilot Case-Control Study. International Journal of Environmental Research and Public Health. 2021; 18(3):1114. https://doi.org/10.3390/ijerph18031114
Chicago/Turabian StyleCamargo, Sávio F., Juliana D. Camargo, Daniel Schwade, Raíssa M. Silva, Maria da Conceição M. Cornetta, Ricardo N. Cobucci, and Eduardo C. Costa. 2021. "Movement Behavior during Pregnancy and Adverse Maternal–Fetal Outcomes in Women with Gestational Diabetes: A Pilot Case-Control Study" International Journal of Environmental Research and Public Health 18, no. 3: 1114. https://doi.org/10.3390/ijerph18031114