规律运动预防妊娠期糖尿病复发：一项随机对照试验

Regular Exercise to Prevent the Recurrence of Gestational Diabetes Mellitus: A Randomized Controlled Trial.

作者信息

Guelfi Kym J, Ong Ming Jing, Crisp Nicole A, Fournier Paul A, Wallman Karen E, Grove J Robert, Doherty Dorota A, Newnham John P

机构信息

School of Sport Science, Exercise and Health and the School of Women's and Infants' Health, the University of Western Australia, Perth, Western Australia, Australia.

出版信息

Obstet Gynecol. 2016 Oct;128(4):819-827. doi: 10.1097/AOG.0000000000001632.

DOI:10.1097/AOG.0000000000001632

PMID:27607876

Abstract

OBJECTIVE

To investigate the effect of a supervised home-based exercise program on the recurrence and severity of gestational diabetes mellitus (GDM) together with other aspects of maternal health and obstetric and neonatal outcomes.

METHODS

This randomized controlled trial allocated women with a history of GDM to an exercise intervention (14-week supervised home-based stationary cycling program) or to a control group (standard care) at 13±1 weeks of gestation. The primary outcome was a diagnosis of GDM. Secondary outcomes included maternal fitness, psychological well-being, and obstetric and neonatal outcomes. A sample size of 180 (90 in each group) was required to attain 80% power to detect a 40% reduction in the incidence of GDM.

RESULTS

Between June 2011 and July 2014, 205 women provided written consent and completed baseline assessments. Of these, 33 (16%) were subsequently excluded as a result of an elevated baseline oral glucose tolerance test (OGTT), leaving 172 randomized to exercise (n=85) or control (n=87). Three women miscarried before the assessment of outcome measures (control=2; exercise=1). All remaining women completed the postintervention OGTT. The recurrence rate of GDM was similar between groups (control 40% [n=34]; exercise 40.5% [n=34]; P=.95) and the severity of GDM at diagnosis was unaffected by the exercise program with similar glucose and insulin responses to the OGTT (glucose 2 hours post-OGTT 7.7±1.5 compared with 7.6±1.6 mmol/L; P>.05). Maternal fitness was improved by the exercise program (P<.01) and psychological distress was reduced (P=.02). There were no differences in obstetric and neonatal outcomes between groups (P>.05).

CONCLUSION

Supervised home-based exercise started at 14 weeks of gestation did not prevent the recurrence of GDM; however, it was associated with important benefits for maternal fitness and psychological well-being.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, https://clinicaltrials.gov, NCT01283854.

摘要

目的

探讨一项有监督的家庭锻炼计划对妊娠期糖尿病（GDM）复发及严重程度的影响，以及对孕产妇健康其他方面、产科和新生儿结局的影响。

方法

这项随机对照试验将有妊娠期糖尿病病史的女性在妊娠13±1周时分配至锻炼干预组（为期14周的有监督的家庭固定式自行车锻炼计划）或对照组（标准护理）。主要结局是妊娠期糖尿病的诊断。次要结局包括孕产妇健康状况、心理健康以及产科和新生儿结局。需要180例样本量（每组90例）才能达到80%的检验效能，以检测妊娠期糖尿病发病率降低40%的情况。

结果

在2011年6月至2014年7月期间，205名女性提供了书面同意并完成了基线评估。其中，33例（16%）因基线口服葡萄糖耐量试验（OGTT）升高而随后被排除，剩余172例被随机分为锻炼组（n = 85）或对照组（n = 87）。3名女性在结局指标评估前流产（对照组2例；锻炼组1例）。所有其余女性均完成了干预后的OGTT。两组间妊娠期糖尿病的复发率相似（对照组40% [n = 34]；锻炼组40.5% [n = 34]；P = 0.95），且锻炼计划对诊断时妊娠期糖尿病的严重程度无影响，两组对OGTT的血糖和胰岛素反应相似（OGTT后2小时血糖，锻炼组为7.7±1.5 mmol/L，对照组为7.6±1.6 mmol/L；P > 0.05）。锻炼计划改善了孕产妇健康状况（P < 0.01）并减轻了心理困扰（P = 0.02）。两组间产科和新生儿结局无差异（P > 0.05）。