The effectiveness of exercise in preventing gestational Diabetes Mellitus

Abstract

Overview of the topic: Gestational Diabetes Mellitus (GDM) is a metabolic disorder that occurs during pregnancy and most often around the third trimester of pregnancy (American Diabetes Association, 2013). GDM increases the risk of pregnancy related complications and also of developing Type 2 diabetes both in the mother and the offspring (World Health Organization, 2016). There are several predisposing factors, such as being inactive, which increase the risk of developing GDM. In this dissertation, the effect of physical exercise to prevent GDM development will be studied. The research question: Does physical exercise prevent Gestational Diabetes Mellitus (GDM)? PEO elements: The population (P) studied was pre-pregnant and pregnant females. The Exposure (E) observed was performing physical exercise. The final desired outcome was preventing Gestational Diabetes Mellitus. Method: The key elements of the PEO question were used as key terms to generate alternative terms. These terms were combined using the Boolean Operators. Limiters were applied to narrow down the search results. The Combined terms were searched in two databases; EBSCO and PubMed. The PRISMA 2009 checklist was used to exclude irrelevant articles. The inclusion/exclusion criteria were applied in order to assess the eligibility of the articles (Table 2.4). The Critical Appraisal Skills Programme (CASP) tool was used to critically appraise the literature. Results: A total of eight key studies were identified. These included three meta-analysis, three randomised control trials and two prospective cohort studies. All meta-analysis conducted in the area found significant reduction of risk to develop GDM amongst those who exercised. These results were achieved upon pooling the evidence. However these findings were not consistent amongst the other key studies, most of which failed to find significant differences between groups. Conclusion: A definite conclusion cannot be presented however it can be said that the evidence gathered pointed to the likelihood of benefits being reaped from carrying out exercise around the time of pregnancy to reduce GDM. However, more research is needed in the area to answer the PEO question. Implications and recommendations: Increasing the level of physical activity amongst the general Maltese population would decrease the risk of developing any metabolic syndromes such as GDM. Promoting physical exercise amongst pregnant woman is needed in Malta, particularly amongst high risk groups. A screening tool to identify these groups should be developed. Management needs to provide guidelines for practice and more research, using larger samples, is required to provide better understanding of the role of exercise in preventing GDM