Physical activity in gestational diabetes
Women with gestational diabetes mellitus want clear and practical messages from credible sources about physical activity during pregnancy. Anne Harrison highlights her qualitative study.
What is gestational diabetes?
Gestational diabetes mellitus (GDM) is defined as glucose intolerance of variable severity that occurs in pregnancy. GDM is diagnosed through routine pregnancy oral glucose tolerance testing, and usual management comprises diet therapy, self-monitoring of blood glucose levels and insulin as required. Physical activity is recommended for pregnant women with GDM to assist with glycaemic control.
Which women get gestational diabetes? GDM is a common complication of pregnancy. Risk factors for developing GDM include, specific race/ethnic backgrounds (Southern and East Asian, Pacific-Islander, Aboriginal and Torres Strait Islander, African-American, Hispanic and Middle Eastern), being overweight and having a history of GDM.
What are the implications for the mother and the baby?
The risks associated with GDM include maternal hypertension and pre-eclampsia, birth trauma from macrosomia for the baby, and the longer-term risk of developing type 2 diabetes in both the mother and baby.
Is it safe for these women to be physically active during their pregnancy?
Physical activity has substantial benefits and minimal risks for pregnant women including those diagnosed with GDM. Benefits include a reduced risk of excessive weight gain, premature birth, low back pain, anxiety and depressive symptoms, and improved physical fitness, sleep, and health perception. For women diagnosed with GDM, physical activity also assists glycaemic control, which is critical for reducing adverse maternal and neonatal complications associated with poorly controlled GDM. And when performed at a moderate intensity on most days of the week, it is a safe and effective adjunctive intervention to GDM management.
If it is not only safe but beneficial, do these women all participate in physical activity?
Despite known benefits more than 60 per cent of women with GDM do not participate in physical activity as recommended. Our study found that women diagnosed with GDM believed physical activity during pregnancy was beneficial and important, but the diagnosis of GDM triggered concerns about the safety of physical activity. Inconsistency in information, uncertainty about what type and how much physical activity was safe, and the lack of confidence in sources such as the internet were barriers hindering the women’s participation in physical activity. These factors appeared to create a disconnection between the women’s attitude and their action.
How did your study aim to address the mismatch between the evidence and what women with GDM do?
As data was limited on this topic, it was important to talk to women with GDM to better understand their attitudes to physical activity during pregnancy, the reasons why they do not engage in physical activity and enablers that could be utilised. This information was needed to enable development of GDM-specific physical activity interventions that are relevant, realistic and acceptable for women with GDM; and thereby help to facilitate behaviour change and participation in physical activity in this specific group.
The findings from this study aim to help clinicians by enabling them to direct their efforts into focusing on overcoming barriers to physical activity by harnessing what women with GDM identified as enablers, for example, improving messaging to facilitate a shift from intention to action, to improve participation in physical activity for pregnant women with GDM. Physiotherapists are well qualified to translate the evidence and clinical guidelines into clear and simple messaging about physical activity recommendations to facilitate more effective transfer of information from guidelines into practice.
What themes arose in the women’s responses?
Our study found that women with GDM wanted clear and simple messaging about physical activity. The women described needing physical activity messages that were easy to understand and explicit about what and how much they needed to participate in, specifically during their GDM pregnancy, and delivered by a credible source such as a health professional. The health of the baby was a strong motivating factor so they wanted information that explained why physical activity was relevant and important to GDM pregnancy outcomes. They talked about needing information that provided flexible, convenient, practical options to be physically active that could be tailored to meet their individual needs and fit in with their busy lifestyles.
Did the study address physical activity after the pregnancy is over?
This study focused on physical activity during a GDM pregnancy but the knowledge (that for these women their baby’s health was their strong overriding motivator) could be harnessed by clinicians in both pregnancy and postnatally. Women may be motivated to stay physically active for their own health and wellbeing in the longer-term if messaging also emphasises the importance of staying active and healthy to look after their baby throughout its childhood and adolescence.
Anne Harrison, APAM, has over 30 years’ clinical experience, including 20 years of health management experience. She is currently manager of physiotherapy services at Werribee Mercy Hospital, Mercy Hospitals Victoria Ltd and a doctoral candidate at La Trobe University.
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