Daly Niamh, Farren Maria, McKeating Aoife, OʼKelly Ruth, Stapleton Mary, Turner Michael J
UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland.
Obstet Gynecol. 2017 Nov;130(5):1001-1010. doi: 10.1097/AOG.0000000000002267.
To evaluate whether an intensive, medically supervised exercise intervention improved maternal glycemia and gestational weight gain in obese pregnant women when compared with routine prenatal care.
This randomized controlled trial compared a medically supervised exercise intervention with routine prenatal care. The primary outcome was a reduction in mean maternal fasting plasma glucose in the intervention group by 6.9 mg/dL at the time of a 75-g oral glucose tolerance test at 24-28 weeks of gestation. Secondary outcomes included excessive gestational weight gain. The intervention consisted of 50-60 minutes of exercise: warm-up, resistance or weights, aerobic exercises, and cool-down. All women received routine prenatal care. Power calculation determined that 24 women were required per group to detect a difference of 6.9 mg/dL in fasting plasma glucose between groups based on an independent-sample t test for statistical power of 80% at a type I error rate of 0.05. A sample size of 44 per group was planned to allow a dropout rate of 33%.
From November 2013 through August 2015, 88 women were randomized: 44 each to the exercise and control groups. Eight women in the control group and 11 in the intervention group did not complete the trial at 6 weeks postpartum (P=.61), but 43 in each group attended the 24- to 28-week glucose screen. There were no baseline maternal differences between groups. Classes commenced at a mean of 13 4/7±1 2/7 weeks of gestation. In early pregnancy, 51.1% (n=45/88) had an elevated fasting plasma glucose (92-125 mg/dL). There was no difference in the mean fasting plasma glucose at 24-28 weeks of gestation: 90.0±9.0 mg/dL (n=43) compared with 93.6±7.2 mg/dL (n=43) (P=.13) or in the incidence of gestational diabetes mellitus at 24-28 weeks of gestation: 48.8% (n=21/43) compared with 58.1% (n=25/43) (P=.51) in the control and exercise groups, respectively. At 36 weeks of gestation, excessive gestational weight gain greater than 9.1 kg was lower in the exercise group, 23.5% compared with 45.2% in the control group (P<.05).
An intensive, medically supervised exercise intervention for obese women from early pregnancy did not improve maternal glycemia. Pregnant women who are obese, however, should be advised to exercise because it attenuates excessive gestational weight gain.
International Standard Randomised Controlled Trials (ISRCTN) registry, ISRCTN 31045925.
评估与常规产前护理相比，强化的、有医学监督的运动干预是否能改善肥胖孕妇的母体血糖水平和孕期体重增加情况。
这项随机对照试验将有医学监督的运动干预与常规产前护理进行了比较。主要结局是在妊娠24 - 28周进行75克口服葡萄糖耐量试验时，干预组母体空腹血糖均值降低6.9毫克/分升。次要结局包括孕期体重过度增加。干预包括50 - 60分钟的运动：热身、阻力或举重、有氧运动以及放松运动。所有女性均接受常规产前护理。功效计算确定，基于独立样本t检验，每组需要24名女性以检测两组间空腹血糖有6.9毫克/分升的差异，统计功效为80%，I类错误率为0.05。计划每组样本量为44名，以允许33%的失访率。
从2013年11月至2015年8月，88名女性被随机分组：运动组和对照组各44名。对照组8名女性和干预组11名女性在产后6周未完成试验（P = 0.61），但每组各有43名女性参加了24至28周的血糖筛查。两组间母体基线无差异。课程平均在妊娠13又4/7±1又2/7周开始。在孕早期，51.1%（n = 45/88）的女性空腹血糖升高（92 - 125毫克/分升）。妊娠24 - 28周时，空腹血糖均值无差异：90.0±9.0毫克/分升（n = 43）与93.6±7.2毫克/分升（n = 43）（P = 0.13），妊娠24 - 28周时妊娠期糖尿病的发生率也无差异：对照组为48.8%（n = 21/43），运动组为58.1%（n = 25/43）（P = 0.51）。在妊娠36周时，运动组孕期体重过度增加超过9.1千克的比例较低，为23.5%，而对照组为45.2%（P < 0.05）。
从孕早期开始对肥胖女性进行强化的、有医学监督的运动干预并不能改善母体血糖水平。然而，肥胖孕妇应被建议进行运动，因为这可减轻孕期体重过度增加。
国际标准随机对照试验（ISRCTN）注册库，ISRCTN 31045925 。
