Abstract
Gestational Diabetes Mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Regular exercise is important for a healthy pregnancy and can lower the risk of developing GDM. For women with GDM, exercise is safe and can affect the pregnancy outcomes beneficially. A single exercise bout increases skeletal muscle glucose uptake, minimizing hyperglycemia. Regular exercise training promotes mitochondrial biogenesis, improves oxidative capacity, enhances insulin sensitivity and vascular function, and reduces systemic inflammation. Exercise may also aid in lowering the insulin dose in insulin-treated pregnant women. Despite these benefits, women with GDM are usually inactive or have poor participation in exercise training. Attractive individualized exercise programs that will increase adherence and result in optimal maternal and offspring benefits are needed. However, as women with GDM have a unique physiology, more attention is required during exercise prescription. This review (i) summarizes the cardiovascular and metabolic adaptations due to pregnancy and outlines the mechanisms through which exercise can improve glycemic control and overall health in insulin resistance states, (ii) presents the pathophysiological alterations induced by GDM that affect exercise responses, and (iii) highlights cardinal points of an exercise program for women with GDM.
Highlights
Gestational Diabetes Mellitus (GDM) is a distinct subcategory of Diabetes Mellitus, defined as any degree of glucose intolerance with onset or first recognition during pregnancy [1,2]
GDM were able to maintain a lower average force output despite reaching similar fatigue levels as their control counterparts. These findings suggest a possible link of exercise intolerance with the reduced cerebral oxygenation/cortical activation during physiological stress in women with GDM that should be taken into consideration when designing the exercise program
Regular exercise training during pregnancy promotes adaptations in the skeletal muscles, resulting in improved oxidative capacity, increased expression of proteins involved in mitochondrial biogenesis, enhanced lipid oxidation, and improved insulin sensitivity and glucose uptake
Summary
Gestational Diabetes Mellitus (GDM) is a distinct subcategory of Diabetes Mellitus, defined as any degree of glucose intolerance with onset or first recognition during pregnancy [1,2]. Well recognized risk factors for developing GDM include being overweight or obese, excessive weight gain during pregnancy, family history of GDM or Diabetes Mellitus type 2 (T2DM), high parity and advanced maternal age. In women with GDM, the increased insulin resistance, together with a relative inability of the pancreatic β-cells to adapt to the increased needs, are suggested as the main pathophysiological events leading to glucose intolerance and hyperglycemia [9]. Complications of GDM include preeclampsia, macrosomia, neonatal hypoglycemia, large for gestational age offspring and an increased risk for caesarean delivery [10]. Women with a personal history of GDM have an increased risk for developing T2DM later in life [10]. The offspring of mothers with GDM are at increased risk of developing various diseases in later life. Fetal programming (i.e., how embryonic/fetal environment determines responses that carry into adulthood and predisposes to certain postnatal diseases) is still under investigation, GDM seems to be a disease that may directly (and indirectly through intermediate outcomes) lead to T2DM, hypertension, obesity, and dyslipidemia in late childhood and adulthood [9,10]
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