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Erschienen in:

23.12.2020 | Gestationsdiabetes | Leitthema

Körperliche Aktivität bei Gestationsdiabetes

Bedeutung für Prävention und Therapie

verfasst von: Dr. Nina Ferrari, Christine Joisten

Erschienen in: Die Diabetologie | Ausgabe 2/2021

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Zusammenfassung

Körperliche Aktivität während der Schwangerschaft wirkt in vielerlei Hinsicht positiv auf Mutter und Kind. Neben vielen anderen positiven Effekten kann das Risiko, einen Gestationsdiabetes mellitus (GDM) bzw. konsekutiv einen Diabetes mellitus Typ 2 zu entwickeln, minimiert werden. Es wird daher grundsätzlich allen Schwangeren ohne Kontraindikationen empfohlen, sich mindestens 150 min pro Woche zu bewegen. In Bezug auf GDM sollte körperliche Aktivität am besten jeden Tag 30 min postprandial an mindestens 3 Tagen in der Woche durchgeführt werden. Sportarten mit wenig Belastung auf Gelenke und einem geringen Sturzrisiko wie beispielsweise Schwimmen oder Walken werden empfohlen. Jedoch zeigt sich in der Realität, dass viele Frauen ihre körperliche Aktivität bereits während, aber auch nach der Schwangerschaft reduzieren. Neben physischen Gründen wie beispielsweise Wassereinlagerungen oder Rückenschmerzen sind viele Schwangere insbesondere in Bezug auf Art, Dauer, Intensität und Häufigkeit der körperlichen Aktivität verunsichert. Diese Verunsicherung findet sich auch bei Ärztinnen und Ärzten wider. Im Rahmen der vorliegenden Arbeit sollen daher die aktuellen Empfehlungen und ausgewählte Mechanismen dargelegt, v. a. aber auch praktische Hinweise für die Umsetzung und Motivation gegeben werden.

Ainscough KM, O’Brien EC, Lindsay KL et al (2019) Nutrition, behavior change and physical activity outcomes from the PEARS RCT—an mHealth-supported, lifestyle intervention among pregnant women with overweight and obesity. Front Endocrinol (Lausanne) 10:938

Alberico S, Montico M, Barresi V et al (2014) The role of gestational diabetes, pre-pregnancy body mass index and gestational weight gain on the risk of newborn macrosomia: results from a prospective multicentre study. BMC Pregnancy Childbirth 14:23PubMedPubMedCentral

Albright C, Maddock JE, Nigg CR (2005) Physical activity before pregnancy and following childbirth in a multiethnic sample of healthy women in Hawaii. Women Health 42:95–110PubMed

Amezcua-Prieto C, Olmedo-Requena R, Jímenez-Mejías E et al (2013) Changes in leisure time physical activity during pregnancy compared to the prior year. Matern Child Health J 17:632–638PubMed

Anonymous (2015) ACOG committee opinion no. 650: Physical activity and exercise during pregnancy and the postpartum period. Obstet Gynecol Clin North Am 126:e135–e142

Anonymous (2020) Physical activity and exercise during pregnancy and the postpartum period: ACOG committee opinion summary, number 804. Obstet Gynecol Clin North Am 135:991–993

Artal R, Masaki DI, Khodiguian N et al (1989) Exercise prescription in pregnancy: weight-bearing versus non-weight-bearing exercise. Am J Obstet Gynecol 161:1464–1469PubMed

Avery ND, Stocking KD, Tranmer JE et al (1999) Fetal responses to maternal strength conditioning exercises in late gestation. Can J Appl Physiol 24:362–376PubMed

Bao W, Tobias DK, Bowers K et al (2014) Physical activity and sedentary behaviors associated with risk of progression from gestational diabetes mellitus to type 2 diabetes mellitus: a prospective cohort study. JAMA Intern Med 174:1047–1055PubMedPubMedCentral

10.

Barakat R, Lucia A, Ruiz JR (2009) Resistance exercise training during pregnancy and newborn’s birth size: a randomised controlled trial. Int J Obes (Lond) 33:1048–1057

11.

Barakat R, Perales M (2016) Resistance exercise in pregnancy and outcome. Clin Obstet Gynecol 59:591–599PubMed

12.

Bauer C, Graf C, Platschek AM et al (2018) Reasons, motivational factors, and perceived personal barriers to engagement in physical activity during pregnancy vary within the BMI classes: the prenatal prevention project Germany. J Phys Act Health 15:204–211PubMed

13.

Boerschmann H, Pflüger M, Henneberger L et al (2010) Prevalence and predictors of overweight and insulin resistance in offspring of mothers with gestational diabetes mellitus. Diabetes Care 33:1845–1849PubMedPubMedCentral

14.

Boney CM, Verma A, Tucker R et al (2005) Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics 115:e290–e296PubMed

15.

Brown J, Alwan NA, West J et al (2017) Lifestyle interventions for the treatment of women with gestational diabetes. Cochrane Database Syst Rev 5:CD11970PubMed

16.

Brown J, Ceysens G, Boulvain M (2017) Exercise for pregnant women with gestational diabetes for improving maternal and fetal outcomes. Cochrane Database Syst Rev 6:CD12202PubMed

17.

Clapp JF 3rd, Kiess W (2000) Effects of pregnancy and exercise on concentrations of the metabolic markers tumor necrosis factor alpha and leptin. Am J Obstet Gynecol 182:300–306PubMed

18.

Colberg SR, Sigal RJ, Fernhall B et al (2010) Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care 33:e147–e167PubMedPubMedCentral

19.

Coll C, Domingues M, Santos I et al (2016) Changes in leisure-time physical activity from the prepregnancy to the postpartum period: 2004 Pelotas (Brazil) birth cohort study. J Phys Act Health 13:361–365PubMed

20.

Conway MR, Marshall MR, Schlaff RA et al (2018) Physical activity device reliability and validity during pregnancy and postpartum. Med Sci Sports Exerc 50:617–623PubMed

21.

Davenport MH, Sobierajski F, Mottola MF et al (2018) Glucose responses to acute and chronic exercise during pregnancy: a systematic review and meta-analysis. Br J Sports Med 52:1357–1366PubMed

22.

Drenowatz C, Hand GA, Shook RP et al (2015) The association between different types of exercise and energy expenditure in young nonoverweight and overweight adults. Appl Physiol Nutr Metab 40:211–217PubMed

23.

Duncombe D, Wertheim EH, Skouteris H et al (2009) Factors related to exercise over the course of pregnancy including women’s beliefs about the safety of exercise during pregnancy. Midwifery 25:430–438PubMed

24.

Ensenauer R, Chmitorz A, Riedel C et al (2013) Effects of suboptimal or excessive gestational weight gain on childhood overweight and abdominal adiposity: results from a retrospective cohort study. Int J Obes Relat Metab Disord 37:505–512

25.

Esefeld K, Kress S, Zimmer P et al (2018) Diabetes, Sport und Bewegung. Diabetol Stoffwechs 13:S199–S204

26.

Evenson KR, Barakat R, Brown WJ et al (2014) Guidelines for physical activity during pregnancy: comparisons from around the world. Am J Lifestyle Med 8:102–121PubMedPubMedCentral

27.

Evenson KR, Mottola MF, Owe KM et al (2014) Summary of international guidelines for physical activity after pregnancy. Obstet Gynecol Surv 69:407–414PubMedPubMedCentral

28.

Evenson KR, Savitz DA, Huston SL (2004) Leisure-time physical activity among pregnant women in the US. Paediatr Perinat Epidemiol 18:400–407PubMed

29.

Evenson KR, Wen F (2011) Prevalence and correlates of objectively measured physical activity and sedentary behavior among US pregnant women. Prev Med 53:39–43PubMed

30.

Ferrari N, Bae-Gartz I, Bauer C et al (2017) Exercise during pregnancy and its impact on mothers and offspring in humans and mice. J Dev Orig Health Dis 9(1):63–76PubMed

31.

Ferrari N, Graf C (2017) Recommendations for physical activity during and after pregnancy. Gesundheitswesen 79:S36–S39PubMed

32.

Ferrari N, Mallmann P, Brockmeier K et al (2014) Secular trends in pregnancy weight gain in German women and their influences on foetal outcome: a hospital-based study. BMC Pregnancy Childbirth 14:228PubMedPubMedCentral

33.

Gaston A, Cramp A (2011) Exercise during pregnancy: a review of patterns and determinants. J Sci Med Sport 14:299–305PubMed

34.

Georgiou HM, Lappas M, Georgiou GM et al (2008) Screening for biomarkers predictive of gestational diabetes mellitus. Acta Diabetol 45:157–165PubMed

35.

Golbidi S, Laher I (2013) Potential mechanisms of exercise in gestational diabetes. J Nutr Metab 2013:285948PubMedPubMedCentral

36.

Han S, Middleton P, Crowther CA (2012) Exercise for pregnant women for preventing gestational diabetes mellitus. Cochrane Database Syst Rev 7:CD9021

37.

Hopkins SA, Baldi JC, Cutfield WS et al (2011) Effects of exercise training on maternal hormonal changes in pregnancy. Clin Endocrinol 74:495–500

38.

Ibrahim S, Jarefors E, Nel DG et al (2015) Effect of maternal position and uterine activity on periodic maternal heart rate changes before elective cesarean section at term. Acta Obstet Gynecol Scand 94:1359–1366PubMed

39.

IQTIG (2018) Bundesauswertung zum Erfassungsjahr 2017 – Geburtshilfe – Qualitätsindikatoren

40.

Jeffreys RM, Stepanchak W, Lopez B et al (2006) Uterine blood flow during supine rest and exercise after 28 weeks of gestation. BJOG 113:1239–1247PubMed

41.

Katz VL, McMurray R, Berry MJ et al (1988) Fetal and uterine responses to immersion and exercise. Obstet Gynecol Clin North Am 72:225–230

42.

Kihlstrand M, Stenman B, Nilsson S et al (1999) Water-gymnastics reduced the intensity of back/low back pain in pregnant women. Acta Obstet Gynecol Scand 78:180–185PubMed

43.

Kirchner H, Osler ME, Krook A et al (2013) Epigenetic flexibility in metabolic regulation: disease cause and prevention? Trends Cell Biol 23:203–209

44.

Ko CW, Napolitano PG, Lee SP et al (2014) Physical activity, maternal metabolic measures, and the incidence of gallbladder sludge or stones during pregnancy: a randomized trial. Amer J Perinatol 31:39–48

45.

Kominiarek MA, Vyhmeister H, Balmert LC et al (2018) Activity tracking devices in group prenatal care: a feasibility study. Biores Open Access 7:165–176PubMedPubMedCentral

46.

Krans EE, Chang JC (2011) A will without a way: barriers and facilitators to exercise during pregnancy of low-income, African American women. Women Health 51:777–794PubMed

47.

Lindhardt CL, Rubak S, Mogensen O et al (2015) Healthcare professionals experience with motivational interviewing in their encounter with obese pregnant women. Midwifery 31:678–684PubMed

48.

Lowe LP, Metzger BE, Lowe WL Jr et al (2010) Inflammatory mediators and glucose in pregnancy: results from a subset of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study. J Clin Endocrinol Metab 95:5427–5434PubMedPubMedCentral

49.

McGee LD, Cignetti CA, Sutton A et al (2018) Exercise during pregnancy: obstetricians’ beliefs and recommendations compared to American Congress of Obstetricians and Gynecologists’ 2015 guidelines. Cureus 10:e3204PubMedPubMedCentral

50.

Melzer K, Schutz Y, Boulvain M et al (2010) Physical activity and pregnancy. Cardiovascular adaptations, recommendations and pregnancy outcomes. Sports Med 40:493–507PubMed

51.

Metzger BE (2007) Long-term outcomes in mothers diagnosed with gestational diabetes mellitus and their offspring. Clin Obstet Gynecol 50:972–979PubMed

52.

Moran CF, Holt VL, Martin DP (1997) What do women want to know after childbirth? Birth 24:27–34PubMed

53.

Mottola MF (2013) Physical activity and maternal obesity: cardiovascular adaptations, exercise recommendations, and pregnancy outcomes. Nutr Rev 71(Suppl 1):S31–S36PubMed

54.

Mottola MF, Artal R (2016) Fetal and maternal metabolic responses to exercise during pregnancy. Early Hum Dev 94:33–41PubMed

55.

Mottola MF, Davenport MH, Ruchat SM et al (2018) No. 367-2019 Canadian guideline for physical activity throughout pregnancy. J Obstet Gynaecol Can 40:1528–1537PubMed

56.

Mottola MF, Davenport MH, Ruchat SM et al (2018) 2019 Canadian guideline for physical activity throughout pregnancy. Br J Sports Med 52:1339–1346PubMed

57.

Mottola MF, Giroux I, Gratton R et al (2010) Nutrition and exercise prevent excess weight gain in overweight pregnant women. Med Sci Sports Exerc 42:265–272PubMedPubMedCentral

58.

Nascimento SL, Surita FG, Cecatti JG (2012) Physical exercise during pregnancy: a systematic review. Curr Opin Obstet Gynecol 24:387–394PubMed

59.

Nawaz H, Adams ML, Katz DL (2000) Physician-patient interactions regarding diet, exercise, and smoking. Prev Med 31:652–657PubMed

60.

Newton ER, May L (2017) Adaptation of maternal-fetal physiology to exercise in pregnancy: the basis of guidelines for physical activity in pregnancy. Clin Med Insights Womens Health 10:1179562X17693224PubMedPubMedCentral

61.

Ning Y, Williams MA, Butler CL et al (2005) Maternal recreational physical activity is associated with plasma leptin concentrations in early pregnancy. Hum Reprod 20:382–389PubMed

62.

Pereira MA, Rifas-Shiman SL, Kleinman KP et al (2007) Predictors of change in physical activity during and after pregnancy: Project Viva. Am J Prev Med 32:312–319PubMedPubMedCentral

63.

Petersen AM, Leet TL, Brownson RC (2005) Correlates of physical activity among pregnant women in the United States. Med Sci Sports Exerc 37:1748–1753PubMed

64.

Petrov Fieril K, Glantz A, Fagevik Olsen M (2015) The efficacy of moderate-to-vigorous resistance exercise during pregnancy: a randomized controlled trial. Acta Obstet Gynecol Scand 94:35–42PubMed

65.

Plagemann A (2011) Maternal diabetes and perinatal programming. Early Hum Dev 87:743–747PubMed

66.

Poudevigne MS, O’Connor PJ (2006) A review of physical activity patterns in pregnant women and their relationship to psychological health. Sports Med 36:19–38PubMed

67.

Poyatos-León R, García-Hermoso A, Sanabria-Martínez G et al (2015) Effects of exercise during pregnancy on mode of delivery: a meta-analysis. Acta Obstet Gynecol Scand 94:1039–1047PubMed

68.

Price BB, Amini SB, Kappeler K (2012) Exercise in pregnancy: effect on fitness and obstetric outcomes—a randomized trial. Med Sci Sports Exerc 44:2263–2269PubMed

69.

RCOG (2006) Exercise in pregnancy (RCOG Statement No. 4). https://www.rcog.org.uk/globalassets/documents/guidelines/statements/statement-no-4.pdf. Zugegriffen: 6. Juni 2016

70.

Richter EA, Hargreaves M (2013) Exercise, GLUT4, and skeletal muscle glucose uptake. Physiol Rev 93:993–1017PubMed

71.

Sanabria-Martínez G, García-Hermoso A, Poyatos-León R et al (2015) Effectiveness of physical activity interventions on preventing gestational diabetes mellitus and excessive maternal weight gain: a meta-analysis. BJOG 122:1167–1174PubMed

72.

Tian C, Hu C, He X et al (2016) Excessive weight gain during pregnancy and risk of macrosomia: a meta-analysis. Arch Gynecol Obstet 293:29–35PubMed

73.

Tie HT, Xia YY, Zeng YS et al (2014) Risk of childhood overweight or obesity associated with excessive weight gain during pregnancy: a meta-analysis. Arch Gynecol Obstet 289:247–257PubMed

74.

Van Der Wijden CL, Delemarre-Van De Waal HA, Van Mechelen W et al (2015) The relationship between moderate-to-vigorous intensity physical activity and insulin resistance, insulin-like growth factor (IGF-1)-system 1, leptin and weight change in healthy women during pregnancy and after delivery. Clin Endocrinol 82:68–75

75.

Van Poppel MN, Peinhaupt M, Eekhoff ME et al (2014) Physical activity in overweight and obese pregnant women is associated with higher levels of proinflammatory cytokines and with reduced insulin response through interleukin‑6. Diabetes Care 37:1132–1139PubMed

76.

Zhang C, Solomon CG, Manson JE et al (2006) A prospective study of pregravid physical activity and sedentary behaviors in relation to the risk for gestational diabetes mellitus. Arch Intern Med 166:543–548PubMed

Titel: Körperliche Aktivität bei Gestationsdiabetes
Bedeutung für Prävention und Therapie
verfasst von: Dr. Nina Ferrari
Christine Joisten
Publikationsdatum: 23.12.2020
Verlag: Springer Medizin
Schlagwörter: Gestationsdiabetes
Gestationsdiabetes
Erschienen in: Die Diabetologie / Ausgabe 2/2021
Print ISSN: 2731-7447
Elektronische ISSN: 2731-7455
DOI: https://doi.org/10.1007/s11428-020-00706-8

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Körperliche Aktivität bei Gestationsdiabetes

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