Globally, the incidence of gestational diabetes mellitus (GDM) is increasing yearly, becoming a high-incidence metabolic disorder. GDM can affect normal pregnancy and delivery processes, leading to an increased risk of adverse pregnancy outcomes. |
At present, most studies on aerobic exercise in patients with GDM focus on subjects exercising at home by themselves, while researchers inquired whether the exercise intervention was carried out as scheduled through telephone follow-up. Since researchers did not organize the exercise intervention on site, it may be difficult to control the exercise intensity, frequency, and quality of the exercise intervention. |
In this study, structured moderate-intensity aerobic exercise intervention with supervision and planning was carried out. The results showed that this regimen had a positive effect on blood glucose control and insulin use in GDM patients. In addition, this is a safe, non-pharmacological intervention strategy for this population. |
Introduction
Methods
Research Design
Research Ethics
Research Subjects
Sample Size Calculation
Intervention Measures
Intervention Measures of the Experimental Group
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(1) Moderate-intensity aerobic exercise: patients in the experimental group were given group exercise intervention in a special exercise room for pregnant women. Each intervention was carried out by three members of the research group, including the researcher who was assisted by a sports medicine expert. The experimental group was required to complete the exercise intervention three times per week for at least 6 weeks, with a total of at least 18 activities. In this study, the minimum acceptable number of exercises was set as 70% of the number of interventions in the study protocol from the time of enrollment to full-term pregnancy (37 weeks of gestation). That is, at least 13 interventions should have been completed [2]. The exercise time was set to 50–60 min, and the exercise intervention was in the form of aerobic exercise. Exercise included steps, neck extension, arm extension, leg movements, and movement of other body parts [29]. On site, sports medicine experts conducted organized exercise guidance for all the subjects and taught patients the basic movements [30]. During the first 2 weeks of intervention, each body part of the exercise was repeated twice under the guidance of sports medicine experts, and two sets of exercises were repeated. At the 3rd week, each part was repeated three times and two sets of exercises were repeated. From the 4th week to the delivery, each part was repeated for four times and two sets of exercises were repeated step by step. At the end of each exercise, patients would stretch for 5 min, followed by a short relaxation, to completely relax the muscles of the whole body [28,31]. Currently, exercise guidelines for pregnant women in most countries recommend moderate-intensity exercise [1,25,26]. According to American College of Sports Medicine (ACSM), moderate-intensity exercise is defined as having an absolute intensity of 3.0–5.9 mets, and Borg RPE scales are widely used to measure of perceived exercise intensity [32]. In the process of intervention, the patient’s heart rate was measured by an exercise bracelet, and moderate exercise intensity was assessed by the Brog Subjective Physical Sensation Scale combined with data from the exercise bracelet [1,25,26]. To maintain moderate intensity, subjects were required to monitor their heart rate during exercise and ensure that the heart rate did not exceed 140 beats/min [25]. However, in the Brog Subjective Physical Sensation Scale, women's score during moderate-intensity exercise is 13–14, which corresponds to the exercise perception of “a little hard” [30]. In the process of exercise intervention, to ensure the safety of patients, patients generally use the glucose meter uniformly configured in this study to measure peripheral blood glucose 1–2 h after eating the staple food, before starting the exercise plan, to prevent hypoglycemia [31]. In addition, patients were observed and treated in time if they had symptoms such as vaginal bleeding, dyspnea, and premature rupture of membranes during the intervention.
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(2) Routine care included routine prenatal care, personalized diabetes diet guidance, and online education: (1) routine prenatal care: basic antenatal examination and the establishment of antenatal examination files during pregnancy; (2) personalized dietary guidance: one-to-one dietary guidance is provided by nutritionists and diabetes nurses according to blood sugar levels, BMI, and other conditions. Dietary knowledge manuals were distributed and explained through food models to teach patients how to match food and give guidance on weight control, blood glucose monitoring, food diary, and other aspects. (3) Online education included the establishment of an online public account providing knowledge of diet, exercise, and basic introduction of GDM.
Intervention Measures for the Control Group
Evaluation Tools and Data Collection
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(1) Fasting blood glucose levels and average blood glucose 2 h after three meals were measured. In this study, the glucose meter and blood glucose test paper were uniformly configured to measure blood glucose levels in peripheral capillaries of patients during the study period. Engineers maintained and calibrated the glucose meter every month to ensure the accuracy of the instrument. On the first day after the inclusion of the subjects, the researchers trained and taught the two groups of patients to conduct the method of self-measuring peripheral capillary blood glucose using the glucose meter to assess it on the spot. This was incorporated to ensure the accuracy of blood glucose monitoring in patients during the intervention.
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(2) The number of people treated with insulin and the amount of insulin during the intervention were assessed. According to the American Diabetes Association guidelines [5], all patients in the control and experimental groups were initiated with insulin therapy if they consistently exceeded either of the following two glucose levels during the diet and exercise interventions: fasting glucose levels of no more than 5.3 mmol/l and postprandial glucose levels of no more than 6.7 mmol/l.
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(3) Maternal and infant pregnancy outcomes and complications during delivery included preterm delivery, prolonged labor, instrument delivery, cesarean section, macrosomia, neonatal BMI, neonatal Apgar score, premature rupture of membranes, neonatal asphoxia, and neonatal hypoglycemia.
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(4) Adverse events were measured by the number of patients with adverse events during exercise intervention. It was assessed whether the patient experienced discomfort during exercise, including vaginal bleeding, eclampsia, dyspnea, headache, contractions, reduced fetal movement, premature rupture of membranes, palpitation, chest tightness, chest pain, and cyanosis.
Data Analysis Method
Results
Comparison of General Data of GDM Patients Between the Two Groups
Project | Control group n = 46 | Experimental group n = 43 | Test value | P |
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Age (years, x̄ ± s) | 31.35 ± 4.72 | 31.47 ± 4.06 | − 0.125a | 0.901 |
Education (n, %) | Primary to junior high school 5 (10.87%) Technical secondary school to junior college 25 (54.35%) Bachelor degrees or above 16 (34.78%) | Primary to junior high school 5 (11.63%) Technical secondary school to junior college 18 (41.86%) Bachelor degrees or above 20 (46.51%) | – | 0.495 |
Parity number (parity,x̄ ± s) | 1.67 ± 0.63 | 1.53 ± 0.55 | 1.101a | 0.274 |
History of cesarean section (n, %) | 16 (34.8%) | 8 (18.6%) | 2.954b | 0.086 |
Family history of diabetes (n, %) | 8 (17.4%) | 6 (14.0%) | 0.198b | 0.656 |
Current gestational age (weeks, x̄ ± s)x̄ | 28.02 ± 2.30 | 28.14 ± 2.00 | − 0.257a | 0.798 |
Height (meters,x̄ ± s) | 1.59 ± 0.04 | 1.60 ± 0.05 | − 1.127a | 0.263 |
Weight before pregnancy (kg, x̄ ± s) | 55.49 ± 8.02 | 59.25 ± 11.42 | − 1.807a | 0.074 |
BMI before pregnancy (kg/m2, x̄ ± s) | 21.98 ± 2.96 | 23.08 ± 3.68 | − 1.558a | 0.123 |
Weight at diagnosis of GDM (kg, x̄ ± s) | 62.76 ± 9.46 | 65.11 ± 13.67 | − 0.949a | 0.345 |
Gestational age at diagnosis of GDM (weeks, x̄ ± s) | 25.17 ± 1.29 | 25.05 ± 1.33 | 0.460a | 0.647 |
OGTT: fasting blood glucose (mmol/l, x̄ ± s) | 4.94 ± 0.49 | 4.93 ± 0.46 | 0.126a | 0.900 |
OGTT: 1-h postprandial blood glucose (mmol/l, x̄ ± s) | 10.31 ± 1.67 | 10.01 ± 1.28 | 0.928a | 0.356 |
OGTT: 2-h postprandial blood glucose (mmol/l, x̄ ± s) | 8.76 ± 1.38 | 8.56 ± 1.17 | 0.750a | 0.455 |
Pre-intervention fasting blood glucose (mmol/l, x̄ ± s) | 5.29 ± 0.54 | 5.28 ± 0.61 | 0.035a | 0.972 |
Pre-intervention 2-h postprandial blood glucose (mmol/l, x̄ ± s) | 6.58 ± 0.73 | 6.48 ± 0.41 | 0.838a | 0.405 |
Comparison of Fasting and 2-h Postprandial Blood Glucose Between the Two Groups of GDM Patients
Comparisons of Fasting and 2-h Postprandial Blood Glucose Before and After Intervention Between the Two Groups of GDM Patients
Project | Control group n = 46 | t | P | Experimental group n = 43 | t | P |
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Mean fasting glucose (mmol/l, x̄ ± s) | Before intervention5.29 ± 0.54 | 2.555 | 0.014 | Before intervention5.28 ± 0.61 | 3.976 | 0.000 |
After intervention5.08 ± 0.17 | After intervention4.92 ± 0.15 | |||||
Mean 2-h postprandial blood glucose (mmol/l, x̄ ± s) | Before intervention6.58 ± 0.73 | 3.216 | 0.002 | Before intervention6.48 ± 0.41 | 5.994 | 0.000 |
After intervention6.25 ± 0.22 | After intervention6.11 ± 0.11 |
Comparison of Average Fasting and 2-h Postprandial Blood Glucose Levels Between the Two Groups of GDM Patients After Intervention
Project | Control group n = 46 | Experimental group n = 43 | t | P |
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Mean fasting glucose (mmol/l, x̄ ± s) | 5.08 ± 0.17 | 4.92 ± 0.15 | 4.694 | 0.000 |
Mean 2-h postprandial blood glucose (mmol/l, x̄ ± s) | 6.25 ± 0.22 | 6.11 ± 0.11 | 3.854 | 0.000 |
Insulin Use in the Two Groups of GDM Patients During the Intervention
Project | Control group n = 46 | Experimental group n = 43 | Test value | P |
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Insulin utilization rate (n, %) | 8 (17.4%) | 1 (2.3%) | – | 0.031 |
Usage of insulin (u/d,x̄ ± s) | 2.05 ± 5.04 | 0.28 ± 1.83 | − 2.33a | 0.02 |
Comparison of Pregnancy Outcomes Between the Two Groups of GDM Patients
Project | Control group (n = 46) | Experimental group (n = 43) | Test value | P |
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Premature rupture of membranes (n, %) | 8 (17.39%) | 9 (20.93%) | 0.180b | 0.671 |
Preterm birth (n, %) | 4 (8.70%) | 1 (2.3%) | – | 0.362 |
Prolonged labor (n, %) | 0 | 1 (2.3%) | – | 0.483 |
Cesarean section (n, %) | 24 (52.17%) | 16 (37.21%) | 2.011b | 0.156 |
Macrosomia (n, %) | 3 (6.52%) | 3 (7%) | – | 1.000 |
Newborn weight (g, x̄ ± s) | 3126.30 ± 420.86 | 3237.91 ± 419.05 | − 1.253a | 0.214 |
Newborn body length (cm, x̄ ± s) | 50.11 ± 1.06 | 49.88 ± 0.66 | 1.192a | 0.236 |
Neonatal BMI (kg/m2,x̄ ± s) | 12.41 ± 1.28 | 12.99 ± 1.47 | − 1.976a | 0.051 |
Neonatal 1 min Apgar (points,x̄ ± s) | 9.63 ± 0.97 | 9.72 ± 1.18 | − 0.395a | 0.694 |
Neonatal 5 min Apgar (points,x̄ ± s) | 9.89 ± 0.31 | 9.93 ± 0.34 | − 0.563a | 0.575 |
Neonatal 10 min Apgar (points,x̄ ± s) | 9.98 ± 0.15 | 10 ± 0.00 | − 0.966a | 0.336 |
Neonatal asphyxia (n, %) | 2 (4.35%) | 1 (2.3%) | – | 1.000 |
Neonatal hypoglycemia (n, %) | 1 (2.17%) | 0 | – | 1.000 |