# Exercise as it relates to Disease/Gestational Diabetes in Pregnant woman and the benefits of physical activity

Gestational Diabetes Mellitus (GDM) in pregnancy is a metabolic short term condition and is one of the most common complications during pregnancy. It can be characterised when blood glucose levels are higher than normal for the first time during pregnancy and not previously diagnosed with other forms of diabetes. This is a results of an inability of the insulin receptors to receive glucose. Glucose is the main source of energy and insulin is what allows the glucose to be uptaken by the tissue. Due to the hormonal changes in the female body during pregnancy these receptors decrease in sensitivity. GDM affects 1 in 20 pregnancies each year in Australia, however it commonly goes undiagnosed. GDM retracts after birth and blood glucose levels return to normal. Even so, after pregnancy the risk of developing type II Diabetes significantly increases to both the mother and child.
Typically, 3 to 8% of pregnant woman will develop gestational diabetes and it generally occurs around the 24th – 28th week.
Risk factors for gestational diabetes include:
* Polycystic ovarian syndrome (PCOS)
* BMI >25
* Family history
* Having gestational diabetes in a previous pregnancy
* Age (higher risk if 30 years or older).
* Being known to have insulin resistance
* Previously having a large baby
* A previous unexplained stillbirth
* Lifestyle (poor diet, smoking, inactivity)
Gestational Diabetes is also common in indigenous Australian’s, Torres Strait Islanders, Vietnamese, Chinese, middle eastern, Polynesian or Melanesian background

## Symptoms

GDM doesn’t often have any symptoms which is why it is commonly undiagnosed. It is typical of a woman to have a glucose-screen tests around the 3rd trimester to eliminate any risk of complications. Even so, having high levels of glucose in the blood may cause some of the following:
* Tiredness
* Excessive thirst
* Passing a lot of urine
* Blurred vision

## Complications

GDM poses serious short- and long-term consequences for both mother and child. Monitoring and good management of blood glucose levels can limit and avoid complications.

##### Complications for the mother include

* 20-50% increase risk of developing type II diabetes within 5–10 years after giving birth.
* Preeclampsia
* Increased risk of maternal infection postpartum
* Increased risk of thrombosis
* Hypertension
* Miscarriage
* Still born
* Increased risk of maternal infection postpartum
* Caesarean section (due to large baby)
* Preterm delivery

##### Complications for the fetus

* Birth injuries
* Macrosomia/Increased weight
* Fetal distress
* Stillbirth
* Glucose intolerance
* Memory deficits in childhood
* Increase risk of developing type II diabetes
* Congenital malformation (birth defect. Most commonly cleft palate)
* Hypoglycaemia, hypocalcaemia and hypomagnesaemia

## Treatment/Management

Managing GDM is done by monitoring blood glucose levels and maintaining a sufficient level. 4 to 6 mmol/L in a fasting state is recommended. Diabetes Australia recommends blood glucose monitoring (monitors are provided by Doctors and each patient is trained to use them at home) but also adopting a healthy eating diet and include physical activity. Insulin injection is only recommended if lifestyle changes are not improving the blood glucose levels. 10-20% of woman will need insulin injections during the pregnancy.

### Physical Activity

Studies show that moderate exercise helps to improve the body’s ability to process glucose, keeping blood sugar levels at a reasonable level. Research also suggests that being physically active before pregnancy reduce the risk of developing GDM during the pregnancy by 56%. Further being active before and during reduces the risk by 75%

##### Before Pregnancy

| Frequency | 3-7days/wk |
| Intensity | moderate |
| Time | 30 minutes minimum |
| Type | aerobic |
| Example | walking/cycling |
| Frequency | 3-7days/wk |
| Intensity | vigorous |
| Time | 30 minutes minimum |
| Type | anaerobic |
| Example | interval training/strength training |
To gain the most health benefit, alternate both moderate exercise and vigorous exercise on different days.

##### During pregnancy

| Frequency | 3-7days/wk |
| Intensity | moderate |
| Time | 15min/day gradually increasing to 60 min/day |
| Type | aerobic |
| Example | walking/cycling/household cleaning |
* Flexibility exercise such as yoga have been recommended 2 days/wk
Caution should be noted and exercise should not be undertaken if experiencing; weakness, dizziness and light headed.

##### Post Birth

To prevent developing type II diabetes, if GDM had been developed during pregnancy, physical activity is highly recommended for both mother and child as the risk of development is significantly increased 5 to 10 years after birth. Research as well as the American College of Sport Medicine guidelines all suggest similar amounts of physical activity which reflect the Australian’s physical activity and sedentary behavior guidelines. These guidelines are outline below
Adults age 18–64 years
| Frequency | preferably all days, 7days/wk |
| Intensity | moderate or vigorous |
| Time | accumulate 5hrs of moderate or 2.5hrs of vigorous throughout the week. |
| Type | aerobic and anaerobic |
| Example | walking, cycling, strength training |
Children age 5–12 years
| Frequency | everyday |
| Intensity | moderate to vigorous |
| Time | 60min minimum /day |
| Type | aerobic and/or anaerobic |
| Example | team sports, cycling |
Click on this link to view more detail and the sedentary behaviour guideline

## Further reading

* Diabetes Australia
* American Diabetes Association – Gestation Diabetes
* Australian Diabetes Council – Healthy Eating
* Australian Diabetes Council – Physical Activity

## References

* 1 2 3 4 5 6 7 8 Diabetes Australia. (2014). Gestational Diabetes. Accessed from http://www.diabetesaustralia.com.au/Living-with-Diabetes/Gestational-Diabetes/, viewed 20th September
* 1 2 3 4 5 6 7 Sanchez, P. (2011). Nursing Care of Clients with Diabetes mellitus. In Burke, K. (Ed.)., & Lemone, P. (Ed.). Medical surgical nursing: critical thinking in client care. Vol. 1 chapter 20. NSW, Australia:Pearson.
* 1 2 The Department of Health. (2013). What is Diabetes. Accessed from http://www.health.gov.au/internet/main/publishing.nsf/Content/pq-diabetes, viewed 20th September
* 1 2 3 4 5 6 Durstine, J., Moore, G., Painter, P., Roberts, S. (Eds). (2009) ACSM’s exercise management for persons with chronic diseases and disabilities, 3rd edition, Human Kinetics, United States of America
* 1 2 Dempsey, F., Butler, F., William, F. (2005). No need for a pregnant Pause: Physical Activity May Reduce the occurrence of Gestational Diabetes Mellitus and Preeclampsia. Vol. 33 No.3:141-149, The American College of Sports Medicine, United States of America
* 1 2 3 Tobias, D., et al (2011). Physical Activity Before and During Pregnancy and Rick of Gestational Diabetes Mellitus; a meta-analysis. Vol. 34 no.1:223-229, Diabetes Care, American diabetes association, United States of America
* ↑ Metzger, B., et al. (2007). Summary and Recommendations of the fifth international workshop conference on gestational diabetes mellitus. Vol. 30 No. supplement 2, Diabetes Care, American diabetes association, United States of America
* 1 2 3 Dempsey, J., Sorensen, T., Williams, M., Lee, M., Miller, R., Dashow, E., Luthy, D. (2003). Prospective Study of Gestational Diabetes Mellitus Risk in Relation to Maternal Recreational Physical Activity before and during Pregnancy. Vol. 159, No. 7, American Journal of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States of America
* 1 2 The Department of Health. (2014). Australia’s Physical Activity and Sedentary behaviour guidelines. Accessed from http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines viewed 24th Septmeber
* 1 2 Downs, D., Ulbrecht, J. (2006). Understanding Exercise Beliefs and Behaviours in Woman with Gestational Diabetes Mellitus. Vol. 29 No. 2, Diabetes Care, American diabetes association, United States of America
* ↑ Thompson, W., Gordon, N., Pescatello, L., (Eds). (2010) ACSM’s guidelines for exercise testing and prescription, 8th edition, Wolters Kluwer health, United States of America
* ↑ Artal, R., et al (2006). A lifestyle intervention of weight-gain restriction: diet and exercise in obese woman with gestation diabetes mellitus. No.32: 596-601, NRC Research Press Web, Canada