Abstract
Background/objectivesObese pregnant women are at high risk of developing gestational diabetes mellitus (GDM), which might be reduced by sufficient physical activity (PA) and reduced sedentary time (ST). We assessed whether PA and ST are longitudinally associated with the glucose-insulin axis in obese pregnant women.Subjects/methodsIn this secondary analysis of the DALI (vitamin D And Lifestyle Intervention for gestational diabetes mellitus prevention) study, pregnant women, <20 weeks gestation, with a pre-pregnancy body mass index (BMI) ≥ 29 kg/m2, without GDM on entry were included. Time spent in moderate-to-vigorous PA (MVPA) and ST were measured objectively with accelerometers at <20 weeks, 24–28 weeks and 35–37 weeks of gestation. Fasting glucose (mmol/l) and insulin (mU/l), insulin resistance (HOMA-IR) and first-phase and second-phase insulin release (Stumvoll first and second phase) were assessed at the same time. Linear mixed regression models were used to calculate between-participant differences and within-participant changes over time. Analyses were adjusted for gestational age, randomisation, pre-pregnancy BMI, education and age. MVPA, Insulin, HOMA-IR and Stumvoll first and second phase were log-transformed for analyses due to skewness.Results232 women were included in the analysis. Concerning differences between participants, more ST was associated with higher fasting glucose (Estimate: 0.008; 95% CI: 0.002, 0.014), fasting insulin (0.011; 0.002, 0.019), HOMA-IR (0.012; 0.004, 0.021) and Stumvoll first and second phase (0.008; 0.001, 0.014 and 0.007; 0.001, 0.014). Participants with more MVPA had lower Stumvoll first and second phase (−0.137; −0.210, −0.064 and −0.133; −0.202, −0.063). Concerning changes over time, an increase in ST during gestation was associated with elevated Stumvoll first and second phase (0.006; 0.000, 0.011).ConclusionsAs the glucose-insulin axis is more strongly associated with ST than MVPA in our obese population, pregnant women could be advised to reduce ST in addition to increasing MVPA. Moreover, our findings suggest that behaviour change interventions aiming at GDM risk reduction should start in early or pre-pregnancy.
Highlights
Supplementary information The online version of this article contains supplementary material, which is available to authorized users.Extended author information available on the last page of the article.Gestational diabetes mellitus (GDM), one of the most common pregnancy complications, occurs in about 6.1% (1.8–31.0%) of all pregnancies in Europe [1], with numbers growing steadily due to the continuous rise of obesity among pregnant women [2]
Of the original 740 women participating in the RCTs, 232 had sufficient accelerometer measurements to be included in this secondary analysis
In this study we have shown that overweight and obese pregnant women with less sedentary time have more favourable glucose and insulin levels, insulin sensitivity and insulin secretion compared to women with more sedentary time
Summary
Extended author information available on the last page of the article. Caesarean section rates on the short term [3], and offspring obesity and development of type 2 diabetes in the mother on the long term [4]. Pre-conceptional obesity is the most important modifiable risk factor for developing GDM [5]. This factor cannot be addressed in prenatal care, as most women first get in contact with a health care professional when already pregnant. Other modifiable risk factors during pregnancy, such as physical activity and their association with GDM, need to be considered
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