Obstetrics and Gynecology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Graduate Program in Health Sciences, Gynecology and Obstetrics, Porto Alegre, Brazil.
J Diabetes. 2017 Nov;9(11):1023-1032. doi: 10.1111/1753-0407.12519. Epub 2017 Feb 28.
Exercise is an important part of gestational diabetes mellitus (GDM) lifestyle management. However, no meta-analysis has analyzed the effects of exercise programs on fasting blood glucose (FBG) in women with GDM. A systematic review with meta-analysis was performed to evaluate the effects of weekly supervised exercise (EXE) or physical activity counseling (PA) in women with GDM compared with usual prenatal care (UPN) on glycemic control.
Eligible trials were identified from Medline, EMBASE, Web of Science, Scopus and SportDiscus up to December 2016. Data were retrieved from randomized controlled trials comparing UPN with UPN plus weekly supervised (at least once a week) prenatal exercise or PA counseling for which FBG values before and after intervention were available. Random-effects meta-analysis was performed for mean difference in FBG after exercise intervention.
The search yielded 781 publications, of which 82 were assessed for eligibility and eight were included in the meta-analysis. The overall effect on absolute FBG concentrations was not significant (P = 0.11) compared with UPN. However, PA versus UPN showed a significant reduction in absolute FBG concentrations (weighted mean difference -3.88 mg/dL; 95% confidence interval -7.33, -0.42 mg/dL; I 48%; P < 0.15).
Physical activity counseling in women with GDM showed a significant effect compared with UPN on FBG concentrations, possibly due to a longer follow-up time compared with the EXE groups. This result highlights the importance of an early intervention that lasts to delivery for best practice of GDM management.
运动是妊娠期糖尿病（GDM）生活方式管理的重要组成部分。然而，目前尚无荟萃分析评估运动方案对 GDM 患者空腹血糖（FBG）的影响。本系统评价通过荟萃分析评估与常规产前保健（UPN）相比，GDM 妇女接受每周监督运动（EXE）或体力活动咨询（PA）对血糖控制的影响。
通过 Medline、EMBASE、Web of Science、Scopus 和 SportDiscus 检索至 2016 年 12 月期间发表的研究，纳入比较 UPN 联合每周监督（至少每周一次）产前运动或 PA 咨询与单纯 UPN 对 FBG 影响的随机对照试验。对运动干预后 FBG 的均数差值进行随机效应荟萃分析。
共检索到 781 篇文献，其中 82 篇文献被评估为符合纳入标准，8 篇文献被纳入荟萃分析。与 UPN 相比，运动干预对绝对 FBG 浓度的总体影响无统计学意义（P=0.11）。然而，PA 与 UPN 相比，绝对 FBG 浓度明显降低（加权均数差值-3.88mg/dL；95%置信区间-7.33，-0.42mg/dL；I 2=48%；P<0.15）。
与 UPN 相比，GDM 妇女接受 PA 咨询对 FBG 浓度的影响更为显著，这可能与与 EXE 组相比，随访时间更长有关。该结果强调了早期干预对 GDM 管理最佳实践的重要性，干预应持续至分娩。
