Effects of Antenatal Exercises on Clinical Outcomes in Pregnant Females With Gestational Diabetes Mellitus
Condition: Gestational Diabetes
MeSH terms: Diabetes, Gestational; Diabetes Mellitus
Study type: Interventional

Summary: 
      Gestational diabetes mellitus (GDM) GDM is the most common complication that affects the
      health of the child and mother during pregnancy. Objectives was to determine the effects of
      Antenatal exercises on glucose levels, mode of delivery and APGAR Score in females with
      gestational diabetes mellitus.

      This Randomized controlled trial study was conducted on N= 72 pregnant females at department
      of Gynecology and Obstetrics, Mian Munshi DHQ Hospital, Lahore after Ethical approval of
      synopsis from institutional Review Board of the University of Lahore . The data was entered
      and analyzed using SPSS Version 24. .
    

Detailed description: 
      Gestational diabetes mellitus (GDM) is defined as glucose intolerance resulting in
      hyperglycemia of variable severity with onset during pregnancy. During pregnancy, GDM is the
      most common complication occurs and it affects the health of the child and mother.

      This study aim was to investigate the effect of antenatal exercise on clinical outcomes in
      pregnant females with gestational diabetes mellitus.

      Study Design: Randomized controlled trial. Settings: It was conducted at department of
      Gynecology and Obstetrics, Mian Munshi DHQ Hospital, Lahore.

      Sample Size:

      The calculated sample size is 30 in each group using APGAR scale as outcome measure. After
      adding 20% drop out the sample size will become 30+6 = 36 in each group.

      Sampling Technique: Purposive sampling technique

      Outcome measuring Tools -

      • APGAR scale DATA COLLECTION PROCEDURE

      All the participants visited from the gynecology department after the diagnosis of GDM was
      considered after the initial screening test. Following the inclusion and exclusion criteria
      before adding them to the study. These patients were allotted in two groups i.e. group A and
      group B via the lottery method. Informed consent were taken in written form showing that they
      are willing to participate in the study. The therapist had assessed the patients before the
      start of rehabilitation program:

      Group A includes participants received the routine physical therapy only. Group B includes
      participants were given exercise program from 20- 24 weeks of gestation to till the date of
      delivery, with addition of the routine physical therapy plan.

      Group A: Routine Physical Therapy (RPT) + Insulin therapy Group A- (n=36) participants
      received only routine treatment for gestational diabetes mellitus which includes insulin
      therapy and diet control programs guided by a gynecologist and routine physical therapy which
      includes walk for 1 hr which includes proper warm up and cool down periods, three times in a
      week from 20-24 weeks of gestation to till delivery.

      Group -B-Antenatal + RPT + Insulin therapy+ Exercise Group B- (n=36) participants completed
      routine therapy and antenatal exercises which includes Aerobic and strengthening Exercises
      with workout 3 days a week, for 2 weeks (6 sessions under the supervision of physiotherapist
      and remaining was performed at home along with routine treatment for gestational diabetes
      mellitus which includes insulin therapy and diet control program as guided by gynecologist.
      The exercise program was started with quarter-hour moderate-intensity aerobic activity and
      slowly rising the duration to a maximum of half-hour each exercise session. A 10-15-minute
      warm-up physical exercise, and a 10-15-minute cool-down period was included. The duration of
      the exercise was assessed by using target pulse rate, the Borg scale (rate of perceived
      exertion), or the 'talk test.' American College of Obstetricians and Gynecologists Guideline
      corresponded to exercise of moderate-intensity were followed. Aerobic exercise includes a
      brisk walk to train the main muscle groups which includes, chest muscles, deltoid,
      quadriceps, and calf muscles were targeted the main muscle groups .In sitting position,
      strengthening exercise were performed in which one end of the Thera band was placed under the
      foot, hold for 5 seconds then released along with 10 repetitions. The movements were
      involvement of wall push-ups, shoulder flexion, shoulder abduction, knee extension and ankle
      plantar flexion. It was guided that pregnant women avoid exercise promptly if they experience
      any signs such as dizziness, dyspnea, amniotic fluid leaking or vaginal bleeding. Besides,
      group participant will wear loose-fitting clothing and keep hydrated while exercising in an
      environment with adequate temperature and moisture. All sessions of the exercise under
      supervision were fully documented on successful completion.

      Confidentiality of all the details were ensured. A blind study (to remove chance of bias), in
      which random allocation of women between two categories, via the lottery system was executed.

      Follow Ups Total 3 sessions per week were given to the patients for 60 min., from 20- 24
      weeks of gestation to till the time of delivery. Home plan was given to the participants and
      follow up was done whenever participants came to gynecology department.

      PROFORMA/QUESTIONNAIRE

      Title "Effects of Antenatal exercises on clinical outcomes in pregnant females with
      gestational diabetes mellitus: A Randomized Controlled Trial" Name………………... Age ………………….
      Height ………………. Weight ………………… Phone no …………………. Gestation age …………… Borg scale ……………. BMI
      ………………. Evaluation Sheet

      Group A (RPT+ Insulin therapy)

      Outcome variables:

        1. Glucose level ………….

        2. Delivery:

           i) Normal delivery ii) C-Section

        3. APGAR Score:

           i) 1st min ……………. ii) 5th min …………….

        4. Gestational age at birth ………

      Outcome variables:

      GROUP B (RPT+ Antenatal exercises+ Insulin therapy)

        1. Glucose level ………….

        2. Delivery:

           i) Normal delivery ii) C-Section

        3. APGAR Score:

           i) 1st min ……………. ii) 5th min ……………. iii)

        4. Gestational age at birth………
    

Intervention name(s): routine physical therapy; routine physical therapy and antenatal exercises
Intervention type(s): Other; Other
Intervention description(s): G- A 36 participants received only routine treatment for GDM which includes insulin therapy and diet control guided by gynecologist and routine physical therapy which includes walk for 1 hr with proper warm up and cool down periods, three times in a week from 20-24 weeks of gestation to till delivery.; G- B 36 participants receive routine therapy (insulin therapy and diet control) and Aerobic and strengthening Exercises for 3 days a week, for 2 weeks 6 sessions under the supervision of physiotherapist and remaining was performed at home. Exercise was started from 15 min and reach to 30 mins gradually.10-15-minute warm-up, cool-down period was included by using ACOG Guideline. Aerobic exercise includes a brisk walk and strengthening exercise were performed with hold for 5 seconds and 10 repetitions. Exercise should stop if they experience any signs of dizziness, dyspnea, amniotic fluid leaking or vaginal bleeding. Confidentiality and blindness ensure by random allocation.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: G- A 36 participants received only routine treatment for GDM G- B 36 participants receive routine therapy (insulin therapy and diet control) and Aerobic and strengthening Exercises.
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Antenatal Exercise; APGAR Score; C-section; Mode of delivery; Pregnancy