School of Physical Education, China University of Geosciences, Wuhan, China.
Front Endocrinol (Lausanne). 2024 Oct 3;15:1347754. doi: 10.3389/fendo.2024.1347754. eCollection 2024.
Gestational Diabetes Mellitus (GDM) affects 14.0% of pregnancies globally, with a 35% post-pregnancy relapse and a 60% risk of Type 2 Diabetes (T2D) within 5-10 years. Challenges in long-term management, especially postpartum, include adherence and follow-up difficulties.
This study, based on a systematic review and meta-analysis, examined the practical effects of exercise therapy in the prevention, treatment, and prevention of progression from Gestational Diabetes Mellitus (GDM) to Type 2 Diabetes (T2D). Relevant research and clinical practices were retrieved from six major databases (PubMed, Scopus, Web of Science, Cochrane Library, MEDLINE, Science Direct). After analyzing the intervention effects of exercise therapy at different stages, factors favorably influencing the effectiveness of exercise intervention were identified during the more effective stages. Finally, a long-term and efficient exercise implementation plan for the comprehensive management of GDM was proposed.
In GDM prevention, exercise reduced the post-intervention risk by 37% compared to the control group (Relative Risk (RR)=0.63; 95% Confidence Interval (CI): 0.54 to 0.72; p=0.01). Studies on GDM treatment showed improved glucose control in the exercise group post-intervention (Mean Difference (MD)=-0.10; 95% CI: -0.16 to -0.04; p=0.04/MD=-0.27; 95% CI: -0.36 to -0.19; p<0.0001). However, exercise therapy didn't significantly affect the incidence of T2D post-GDM (RR=0.88; 95% CI: 0.69 to 1.11; p=0.39) due to challenges in quantified exercise prescriptions and the complexity of postpartum programs.
To enhance exercise therapy effectiveness in GDM management, the study recommends adopting an integrated model emphasizing personalized pregnancy plans, postpartum strategies, and long-term support. Leveraging frequent healthcare contact during pregnancy can establish and sustain exercise habits, fostering a lifelong pattern. While the study acknowledges limitations, this approach holds potential for improving glycemic metabolism and developing healthy exercise habits in subsequent generations. Future research should include longer follow-ups to validate the practical efficacy of this approach in preventing T2D after GDM.
https://www.crd.york.ac.uk/prospero, identifier CRD42023463617.
妊娠糖尿病（GDM）在全球范围内影响 14.0%的妊娠，产后复发率为 35%，产后 5-10 年内发生 2 型糖尿病（T2D）的风险为 60%。长期管理，特别是产后，面临的挑战包括坚持和随访困难。
本研究基于系统评价和荟萃分析，研究了运动疗法在预防、治疗和预防妊娠糖尿病（GDM）向 2 型糖尿病（T2D）进展方面的实际效果。从六个主要数据库（PubMed、Scopus、Web of Science、Cochrane Library、MEDLINE、Science Direct）中检索到相关研究和临床实践。在分析不同阶段运动疗法的干预效果后，确定了在更有效的阶段有利于运动干预效果的因素。最后，提出了一种用于 GDM 综合管理的长期有效的运动实施计划。
在 GDM 预防中，与对照组相比，运动降低了干预后的风险，降低了 37%（相对风险（RR）=0.63；95%置信区间（CI）：0.54 至 0.72；p=0.01）。关于 GDM 治疗的研究表明，运动组干预后葡萄糖控制得到改善（平均差异（MD）=-0.10；95%CI：-0.16 至-0.04；p=0.04/MD=-0.27；95%CI：-0.36 至-0.19；p<0.0001）。然而，由于量化运动处方和产后方案的复杂性，运动疗法对 GDM 后 T2D 的发病率没有显著影响（RR=0.88；95%CI：0.69 至 1.11；p=0.39）。
为了提高 GDM 管理中运动疗法的效果，该研究建议采用强调个性化妊娠计划、产后策略和长期支持的综合模式。利用怀孕期间频繁的医疗保健接触可以建立和维持运动习惯，培养终生的模式。尽管该研究存在局限性，但这种方法有可能改善血糖代谢并在后代中培养健康的运动习惯。未来的研究应包括更长的随访时间，以验证这种方法在预防 GDM 后 T2D 方面的实际效果。
https://www.crd.york.ac.uk/prospero，标识符 CRD42023463617。
