GD and Exercise

by KMom

Copyright 1999 KMom@Vireday.Com. All rights reserved.


DISCLAIMER: The information on this website is not intended and should not be construed as medical advice. Consult your health provider.

 

CONTENTS

 

Why Exercise?

Exercise is often recommended as another therapy for blood glucose (bG) control in conjunction with dietary therapy and other measures. Exercise tends to improve glucose uptake and lessen insulin resistance, permitting your body to improve the use of its own energy. It can potentially be a very valuable addition to your treatment protocols, though some people will see more improvement with exercise than others will.

What Research Shows

Most research shows that ongoing, regular mild exercise is beneficial to most gd mothers (although not all studies agree). Bung et al. (1991) found that 17 women who participated in supervised exercise 3x a week (and a 'nonsedentary' lifestyle outside of that time) were able to completely avoid using insulin despite pre-treatment persistent fasting hyperglycemia on dietary treatment alone. Their eventual outcomes were almost exactly the same as the comparable group placed on insulin, except that they did not need insulin and delivered slightly later.

So utilizing exercise may enable some women to avoid needing insulin. Since women on insulin are automatically subjected to more intervention like early induction, extensive testing, and a generally lower threshold for surgical intervention, this could be very important! Women in the exercise components of this study were able to match the level of blood glucose control of the insulin-treated groups WITHOUT the use of insulin, and thus would not be as subject to the intervention protocols for them. For women who are seeking to avoid as many interventions as possible, this is an important discovery.

A few studies have not shown as dramatic an improvement in gd women who exercise. Lesser et al. (1996) did not find that 30 minutes of stationary cycling improved 'postprandial glycemic excursion', however this study looked at only the results of ONE single bout of exercise, not an overall pattern of exercise. It's quite possible that it is not the impact of one session of exercise but rather the cumulative improvement in metabolism, insulin sensitivity, and glucose uptake from regular exercise over a longer period of time that improves glucose metabolism.

Avery et al. (1997) did not find that even regular exercise improved blood glucose control, however. In this study, 33 women with gd were randomly assigned to an exercise or no-exercise group. The exercise group was asked to exercise 2x a week with supervision, and 2x a week without supervision, while the no-exercise group was asked to simply maintain its current level of activity. No improvement in blood sugar or insulin need was seen, bringing into question whether exercise is all that valuable. However, it is notable that the exercise group was able to consume significantly more carbohydrates to achieve the same bG levels as the no-exercise group, whose carb intake declined significantly. This suggests that perhaps the exercise group really did experience an improvement in bG levels, since they had equal bG levels yet consumed more carbs than the no-exercise group. Also notable was that there were no complications in the group that exercised, which suggests that reasonable exercise intervention appears safe.

Jovanovic-Peterson et al. (1989), on the other hand, found significant differences between women with gd who exercised and those who did not. After 6 weeks of training, the exercise group's fasting levels averaged 70 mg/dl, whereas the non-exercise group's fasting levels averaged about 88 mg/dl. Their response to a 50g glucose challenge test at the end of the exercise protocol was also significantly different; the exercise group's 1 hour results averaged 106 mg/dl, while the non-exercise group's results averaged 188 mg/dl---quite a significant difference! So while a few studies have challenged whether exercise is really useful, more studies have shown that it DOES help, and in some cases, eliminates the need for insulin.

Researchers should continue to study the issue, since there is not an extensive amount of research into this question and more study is needed before making any permanent conclusions. However, the promising results of a few studies and the lack of harm found in them suggests that exercise therapy should be more widely considered and utilitized in the meantime. Not all gd moms who exercise will be able to avoid needing insulin, mind, but it is a therapy that is all-too-often underutilized by gd providers, and gd moms should probably look carefully into incorporating more exercise if possible.

For most gd women, daily walking or swimming is the most appropriate exercise, but it's important to do it regularly, since skipping more than a day or two lessens the effect. Those who have no contraindication against exercise should strongly consider adding it to their daily treatment regimen; it could make a real difference in your treatment!

Other Benefits of Exercise

Some gd moms may benefit more from exercise therapy than others, in particular. Dye et al. (1997) showed the most benefits in preventing gd occurred for middle-class obese women who had been previously sedentary. They found that although exercise was not as preventive for women who were not obese, women who had a Body Mass Index of 33 or higher and did NOT exercise were twice as likely to develop gd as those of that size who did exercise. Although this study looked at the effect of exercise in PREVENTING gd in the first place (not its effect on treating it once it occurs), it is likely that exercise is particularly beneficial to obese women who have been mostly sedentary. Therefore, it is likely that exercise should be strongly considered by larger women with gd, in particular, though conclusive research on this point has not been done thus far.

Although little official study has been done on the preventative effects of exercise on gd recurrence in subsequent pregnancy, there is anecdotal evidence that careful attention to food intake and exercise before and during the next pregnancy may help gd from recurring. A number of women online have written to Kmom and noted that they were able to prevent the gd from recurring by being very proactive with diet and exercise; some studies also support this (see the section on GD: Planning a Subsequent Pregnancy).

Furthermore, many resources on diabetes note that regular exercise can help prevent or delay the onset of type II diabetes in people with risk factors. Some books estimate that regular exercise can lower your risk for diabetes by up to 40%! So don't stop exercising after your gd pregnancy is done.

Exercise Specifics and Cautions

Talk with your provider about the appropriate use of exercise for YOU; most women are able to walk about 30 minutes per day without a problem. Timing your walk for right after breakfast is often recommended, since many gd mothers experience their highest numbers of the day in the morning due to an extra-strong hormonal surge that happens in the morning. However, each mother must find the plan that works best for her (Kmom finds an evening walk most beneficial and convenient; she does not usually have troubles with her morning numbers so this works out well).

Walking is the exercise most often recommended for pregnant women, but swimming is also an excellent choice for pregnancy. Low-impact water aerobics or recreational dancing can be very helpful to women in pregnancy, and yoga designed for pregnant women is also generally considered a good choice. Talk to your provider about the appropriateness of YOUR preferred activities.

For a few women, exercise is contraindicated, such as women with bleeding in pregnancy, pre-term labor, hypertension, etc. Some sources list obesity as a contraindication for exercise, but this is probably only a concern for those with very extreme obesity. Ask your doctor if you are unsure.

For those who cannot participate in regular exercise, sometimes exercise of only the upper body is helpful. Researchers such as Javanovic-Peterson have done several studies on using upper-arm exercise only, and have found that while lower-body exercise did tend to cause uterine contractions in some women, upper-body (arm ergometer) exercise did not. Their 1989 study (cited above) found that women who participated in 20-minute upper arm exercise sessions 3x a week for 6 weeks had significantly lower fasting results and 1-hour glucose challenge results than women who did not exercise. In some cases, it obviated insulin treatment for some women. So if possible, you may want to consider upper-arm exercise instead, if your provider approves. However, be sure to always clear it with your provider beforehand.

Occasionally, some gd women cannot participate in exercise at all. Women who are experiencing high levels of ketones that do not respond to other measures of control have occasionally found that a new-found exercise program causes ketones that cannot be resolved any other way. In this rare instance, exercise should probably be cut back or cut out to see if this brings the ketones under control. If it does not, keep searching for the cause, since ketones are a significant potential concern (see the gd section on Ketones). If cutting out exercise does get rid of the ketones, then try easing back into exercise again, but very slowly and cautiously.

Check the timing of your exercise so that it does not fall after a period of time with no food. This could potentially cause ketones in women who are more susceptible to ketones. Be sure to eat a source of carbohydrate and protein shortly before exercising, which might help if you are experiencing ketones later in the day. If you are experiencing ketones early in the morning, try a snack in the middle of the night, and be sure to avoid exercising in the evening; try a short walk in the morning instead. Try to pinpoint when the ketones are occurring and why; change your eating and exercise patterns to see if that will help. Try a milder form of exercise or a shorter duration--upper arm exercise may be just the compromise you need. For some women, this will allow them to ease back into exercising again, at least minimally, but for others in very unusual cases, exercise may need to be discontinued until after the pregnancy ends. Again, consult your provider for specific guidance.

For the majority of gd women, however, exercise is not contraindicated and often proves quite beneficial. It may help lower your blood glucose results, and it certainly helps you improve your endurance, which is important during the hard work of labor. For some women, it may even elimate the need for insulin, and in the next pregnancy, may help reduce the recurrence of gd completely. Exercise is very useful in gd, and just generally feels good. However, there are a few things to remember about starting an exercise program.

 

Guidelines for Exercise

The biggest rule about exercising during pregnancy is always to consult your provider. The vast majority of pregnant women can and should exercise, and that includes gd moms too. However, each situation has to be considered on its own merit, and no overall guidelines can ever hope to address all the possible variations and concerns that need to be considered in any individual's situation. Please be sure to consult your provider before and during any exercise program.

Generally speaking, the most important items to keep in mind while exercising are:

The Basics of Exercising in Pregnancy

Of course, you should already be doing basic pregnancy exercises such as pelvic tilts, kegels, squatting, etc. several times daily (see pregnancy exercise books such as Elizabeth Noble's Essential Exercise for Pregnancy) . These are very important for preparing your body for labor, getting the baby into the most optimal position for delivery, easing backaches, etc. Do not neglect these just because you might be doing other pregnancy exercises too! However, these activities should not be your only source of activity during your pregnancy either.

Obviously, some activities are more suited for pregnancy than others. Many providers advise avoiding racquet sports, volleyball, and basketball, since these activities involve lots of twists, turns, jumping, and sudden stops and starts, all of which can be hard on joints and ligaments, which are already stressed somewhat in pregnancy by hormones, etc. Other activities that involve real risk of falling, such as water skiiing or snow skiing, are probably out during pregnancy too. Some doctors feel that jogging is fine in pregnancy while others do not; consult your provider for his/her recommendations on it. Aerobics can be done, but with caution---low-impact classes or those designed especially for pregnant women are more appropriate; water aerobics can also be an excellent alternative. Special prenatal yoga classes are especially good in pregnancy, as they help you prepare both physically and mentally for labor; Tai Chi may also be very suitable, though other martial arts are generally out.

Often, the best activities for pregnancy are simple walking and/or swimming, since these are not very strenuous yet provide an excellent workout, and they are very easy on the joints and back. Walking should be the the most common exercise in pregnancy; it is excellently suited for the needs of pregnancy and is convenient and free! You should strongly consider a daily walk as part of your pregnancy routine if your provider approves. Swimming is also an excellent exercise for pregnancy, since the buoyancy of the water can ease stress on the joints; this is a particularly good activity for large pregnant women. You can alternate walking and swimming, instead of devoting yourself to any one activity exclusively. On days when the weather outside is forbidding for walking or you are not able to get to a pool, brisk walking or dancing around your house, going up and down the stairs of your house, doing brisk housework chores, or simply doing some upper-arm exercise as described above can be beneficial and is certainly better than doing nothing! Vacuuming and even sex have been known to lower blood sugar appreciably! So many activities can be helpful for lowering blood sugar--and some can even be fun! Use your imagination. :-D

Fatigue is an important signal from your body that you should listen to, but of course you have to make situational judgments. Pregnancy is a time of a lot of fatigue, and if you waited to exercise until you were never tired, you'd probably never move an inch during the entire pregnancy! Oftentimes, you may feel borderline about whether you should exercise on a certain day, and the first half-mile of that walk you might just drag through, but once you get going you start feeling much better and much more energized. Most women find that they feel better after exercising if they just persist through the inertia at the beginning.

However, you do still have to listen carefully to your body. Sometimes, you don't feel better after exercising or you really are just too tired that day. So while you should not let a little bit of the 'blahs' keep you from getting out and walking or swimming, you do need to respect the messages of your body if it tells you that you really need to take a break that day, or find a less strenuous form of exercise. Sometimes you can delay the exercise till after you've had a nap, eaten a little energy-boosting food (like half a banana and some peanut butter), or stretched out the kinks a bit. Sometimes you can substitute a less-demanding form of exercise instead, like a mild saunter instead of a brisk walk, or some upper-arm exercise instead of going for a swim, etc. But you may find that there are some days when you just need to cancel or delay your exercise, depending on how you feel. That's ok too.

The concern over keeping your core body temperature fairly low is generally the same that prevents you from using the hot tub while pregnant. In animal studies, raising the mother's temperature temperature too high caused problems for the baby, so generally caution is advised about becoming too hot through either outside sources of heat or through exercise. This is more of a precaution; don't worry about getting a little warm during exercise or if it's hot outside in your area. However, it is probably sensible to avoid overheating too. Just use your judgment, and if you are unsure about anything, ask your provider.

Most pregnancy guidelines consider it very important not to raise your heart rate too high, or for too extended a period of time. The guidelines given by most pregnancy manuals and gd guides specify that your pulse should not go above 140 beats per minute, and should not stay elevated for longer than 20 minutes at a time. However, the guides also always stress the importance of checking with your provider for guidelines that are specific for your situation. You can certainly walk for longer than 20 minutes at a time; just try not to be working at peak heartrate capacity during more than 20 minutes of that time. Aerobics, which are a bit more strenuous, should be carefully monitored so that you do not exceed the heart rate guidelines nor the time length guidelines. Generally speaking, you should be able to converse comfortably while exercising; if you find it hard to talk while you are exercising, you are probably working too hard for pregnancy levels---slow it down. Basically, just use common sense and ask your provider to clarify any questions.

Contractions and Other Concerns

Some women start exercise without a problem but then start experiencing fatigue, breathlessness, or contractions during the exercise. What then? This is another situation where individual judgment and some guidance from your provider is important. For some women, it might mean that they need to stop exercising altogether that day and sometimes for good, for some it means only that they need to slow down, and for others it may simply mean taking a brief break during the exercise and then restarting at a milder pace later on. You have to judge what it means for your situation.

Many pregnant women do experience some amount of breathlessness during pregnancy, sometimes with exercise and sometimes even without. There are several possible causes to this--of course you should explore the possibilities with your provider, just to be sure! Most people expect some degree of breathlessness late in pregnancy, when baby is crowding your insides and making it difficult for your lungs to fully expand to their normal capacity. This is pretty common; just take it easy and let your breath be your guide. Respect the limitations your body is communicating.

There are other possible causes to breathlessness in pregnancy too, though. One of the more serious possibilities is pregnancy-induced asthma, so while breathlessness is very common and in all likelihood nothing to worry about, you certainly should take up the concern with your doctor. If you are having trouble catching your breath, remember, then the amount of oxygen getting to your baby is less too. So don't be shy about taking it easy during the breathlessness and then discussing it with your provider whenever you feel it appropriate.

Another possible cause for breathlessness in pregnancy is hormones. Even very early in pregnancy, the interaction of all the hormones in your body can cause you to feel a bit breathless, even with only very mild exercise or none at all. This can be very disconcerting! Again, you should always consult your provider over any concern like this, but do be aware there are a lot of women whose pregnancies are perfectly normal who feel this and it turns out to be no big deal. Err on the side of caution, but don't overreact either.

What about contractions during exercise? This is tricky, since true contractions during exercise are a sign you should stop---you don't want to trigger pre-term labor! Since pre-term labor is one possible consequence of a few cases of gd, it's something to be extra-aware of in the gd mom, but remember that statistically it is not one of the more common complications of gd. Other things that can cause 'true' contractions before term include a Urinary Tract Infection (UTI) that has gone up into the kidneys (and gd moms are a bit more prone to UTIs), or dehydration. Often, the doctor's office will advise you to lie on your left side and drink several glasses of water to see if they contractions will go away, since dehydration is a very common cause of pre-term labor. So be sure to keep yourself well-hydrated before and during your exercise!

However, many women experience so-called "Braxton-Hicks" contractions instead of true contractions, and it's not always easy to tell the difference, especially for first-time moms! As always, consult your provider for guidelines, but generally speaking, Braxton Hicks contractions are not painful. Usually they are felt as mild "squeezing" or "tightening" sensations, often accompanied by a bit of breathlessness, and your belly gets hard. They are most often felt as a squeezing at the top of the uterus instead at the bottom or in the back, though a few women feel them on the side. A "pulling" sensation is common in some women, as the ligaments supporting the uterus stretch and adjust; this can happen with Braxton-Hicks contractions or without them.

Just because the sensations you feel when exercising might be Braxton-Hicks doesn't mean that you shouldn't take them seriously. If you are feeling contractions of any type during your exercise, you should immediately stop and rest a bit. If the contractions continue without easing up, you should stop your exercise and contact your provider. If the contractions were mostly just tightening and not painful, and if they ease up within a few minutes, take a couple minutes more to rest, and then ease back into your exercise slowly. Stop as often as you need to, and go easy that day. If you get a lot of them or if they are constantly recurring, then it's time to stop exercising for that day, and contact your provider when you get a chance. The main thing is to trust your own judgment and intuition, and if in doubt, clarify with your provider.

Braxton-Hicks contractions really are fairly common when exercising, though some women experience them more strongly than others. It is sometimes very difficult to know whether what you are feeling is just a normal Braxton-Hicks sensation or something of more concern. The general rule is if in doubt, contact your provider for further clarification, but don't panic. Some women, like Kmom, experience lots of Braxton-Hicks contractions during exercise, but can rest and restart without problems in a few minutes; other women experience too many recurrent BH contractions--or those that do not respond to rest--and should not exercise. Once again, consult your provider for guidelines.

Watch for Hypoglycemia

Generally speaking, hypoglycemia (low blood sugar) is one concern you should be very careful of when you have gd. This doesn't mean you can't or shouldn't exercise, just that you need to be careful that your blood sugar doesn't drop too low as a result of exercising, particularly if you are using insulin or tends towards reactive hypoglycemia (sudden sharp drops in blood sugar--see below).

Some resources recommend that you check your blood sugar before and after exercise religiously. Other resources feel that you don't need to be quite that cautious, but that you should check if you have any doubt, or if you are using insulin. You should generally make a note in your blood sugar log that you have exercised that day, when, and how long. You should also be careful to drink plenty of water, wear comfortable shoes and clothes, rest as needed, etc.

You don't want to start exercising when it's been a long time since you've eaten. Exercise can significantly lower your blood sugar, so if you start out at a normal or slightly low level, your levels can really drop, which is also not good for the baby. Furthermore, if energy is not readily available in the form of blood glucose, your body will turn to other sources for energy, such as fat stores. This sounds great on the surface, but when fat is burned as a source of energy, it releases a by-product called ketones, which is not good for the baby. So you don't want to start exercise without an energy source to utilize during the exercise.

When is the best time to exercise? 'Shortly after eating' is what most resources say. You don't want to start so soon that you don't allow your body any time to process the food and impede digestion, but you don't want to wait so long that you don't have much energy resource and so get hypoglycemic, and you also want the exercise to help improve your blood sugar after the meal. Generally speaking, about a half hour after eating is probably fine, but do consult your provider for their specific recommendation.

If it's been a while since your last meal, that doesn't mean you can't exercise, but it does mean you should be cautious. If possible, it's probably sensible to have a small snack shortly before you start your exercise. One carbohydrate serving of some kind, or one carb plus one protein is usually adequate before most exercise. For example, crackers and cheese, half a banana with some nuts, or a piece of bread with some peanut butter, etc. can be a good choice. If exercise hasn't been part of your pregnancy before, you probably should take your blood sugar before and afterwards a few times as a precaution and guide to snacking, but after you get the hang of it, you may not need to test every time.

Women who are on insulin, however, generally need to test before and after exercise, according to most sources. If you are on insulin, it is also vitally important that you always take a snack or quick source of energy on your person during the exercise. It is very easy for blood sugar to drop too low from a combination of the exercise and the insulin; it's extremely important for you to have something handy you can eat during or after the exercise if you start to notice symptoms of hypoglycemia. Milk, raisins, half a banana, orange juice, or special glucose tablets you can get at a pharmacy are excellent ways to quickly raise blood sugar if you start to experience hypoglycemic symptoms. Some of these are more portable than others, but raisins, juice boxes, or glucose tablets are usually easily transportable and not too bulky. This is VERY important to have with you at all times if you are on insulin, but even women who do not need insulin should consider carrying some form of quick energy if possible, just in case, especially if they tend towards reactive hypoglycemia (a quick spike of blood sugar followed by a strong surge of insulin, causing a subsequent precipitous drop in blood sugar).

Symptoms of hypoglycemia include shakiness, dizziness, sweating, grumpiness, hunger, headache, sudden moodiness, behavior changes (like crying or irritability for no apparent reason), pale skin color, clumsy or jerky movements, difficulty paying attention, confusion, fast heartbeat, ringing in the ears or tingling sensations around the mouth. If you notice any of these symptoms, test your blood sugar immediately if you have access to your meter. If you are not near your meter, go ahead and treat it if you are experiencing definite symptoms. Most sources agree that it's better to have a little too much blood sugar than to develop an insulin reaction.

If you are able to test and the results are low, treat with one serving of the above foods, and then test again. If you are still low 15 minutes later, have another serving of the food. This will almost always take care of the problem. Different sources define 'low' differently; anything below 60-70 mg/dl should certainly be treated, and some sources feel that levels above this, depending on the circumstance, should probably be treated too. Be sure to consult your provider for their specific recommendations.

Although low blood sugar is not good for either you or the baby and should be avoided, it's important to realize that gestational diabetes is NOT the same as type 1 diabetes, where insulin reactions and hypoglycemia can be life-threatening. The etiology of the two are distinctly different, and while hypoglycemia is not desirable in gestational diabetes and should be treated, it is not nearly as serious. It should be taken seriously at any time of course, but it is not likely to cause death or serious problems, so don't panic if it happens. Reassure your family and those around you that it's different from the low blood sugar episodes that are associated with other types of diabetes.

If you are on insulin, you must consult carefully with your provider before you start any exercise program. Scheduling your exercise carefully may be especially important for women with insulin-dependent gd, and your providers will want to track your exercise, food intake, and bG results carefully. Be sure to keep excellent notes for yourself, and take them with you to any appointments with your providers. They can guide you more carefully as to their requirements for blood glucose specifics.

 

References

Exercise and GD

Jovanovic-Peterson, L et al. Randomized Trial of Diet Versus Diet Plus Cardiovascular Conditioning on Glucose Levels in Gestational Diabetes. American Journal of Obstetrics and Gynecology. August 1989. 161(2):415-9.

19 women with gd (extremely small sample) were randomized into either a diet-only or a diet plus exercise group. Exercising women did 20 minutes of exercise 3x a week for 6 weeks; an arm ergometer was used to maintain their heart rates in the training range. Week 1 glycemic parameters were the same for both groups; the results began to diverge significantly at week 4. At the end of 6 weeks, however, the diet plus exercise group has much better numbers than the diet-only group (70 mg/dl fasting vs. 88 fasting; 106 vs. 187 on a 50g challenge test; and 4.2% vs. 4.7% glycohemoglobin test results). "We conclude that arm ergometer training is feasible in women with gestational diabetes mellitus and results in lower glycosylated hemoglobin, fasting, and 1-hour plasma glucose concentrations than diet alone. Arm Ergometer training may provide a useful treatment option for women with gestational diabetes mellitus and may obviate insulin treatment."

Jovanovic-Peterson, L and Peterson CM. Is Exercise Safe or Useful for Gestational Diabetic Women? Diabetes. December 1991. 40(Supplement 2):179-81.

Presumably a follow-up to the above study, with very similar results. The main difference was that this study examined the effect of exercise on contractions in the women; upper-extremity (arm-only) exercise did not produce any uterine contractions, but lower-extremity exercise tended to produce contractions. For women who find they have a great deal of contractions with walking or who are in danger of pre-term labor (i.e., women with twins or a history of pre-term labor), this finding that upper-extremity exercise is effective at improving glycemic levels while not producing contractions is important. Kmom has also tested upper-extremity exercise ('lifting' cans as dumbbells) and found that it does lower her blood sugar, though not quite as well as walking or other exercise. This study (and others like it) confirms that exercise options are available even to those who don't seem to be able to do regular exercise. (Of course, however, providers should be consulted first.)

Dye, TD et al. Exercise Cuts Rate of Diabetes in Pregnancy in Obese Women. American Journal of Epidemiology. December 1997. Summarized from a press release from Doctor's Guide to Medical and Other News, at www.pslgroup.com/dg/4a5ce.htm.

This study looked at the effect of exercise during pregnancy on the rate of the development of glucose intolerance. Little effect was found for women of average size or those somewhat 'overweight'. However, in women who were significantly obese (Body Mass Index of 33 or more; the usual recommendation for women is a BMI of <25), exercise had a definite preventive effect. Women with BMIs of 33+ who did not exercise were twice as likely to develop gd as their counterparts who did exercise. Curiously, the amount and frequency of exercise showed little difference in benefit; the important factor was the presence of absence of exercise.

Artal, R. Exercise: An Alternative Therapy for Gestational Diabetes. The Physician and Sportsmedicine. March 1996. 24(3):54-6.

A primer on things for doctors to consider when considering an exercise program for a woman with gd. Contains many cautions and caveats since some experts have expressed doubts at the lack of information confirming lack of harm to the fetus from maternal exercise (too bad they are not so demanding about proof of lack of harm from aggressive insulin treatments and early induction!). Notes that in a recent uncontrolled study, a small sample of patients with high fasting levels were placed on a mild exercise program. Only one needed insulin; the rest (who would have needed insulin without the program) were able to avoid it. None had any problems.

Bung, P et al. Exercise in Gestational Diabetes: An Optional Therapeutic Approach? Diabetes. December 1991. 40(Supplement 2):182-185.

41 Hispanic, previously sedentary gd patients with abnormal fasting levels who failed a diet therapy trial of 1 week were randomized to either diet+exercise or diet+insulin programs. The exercise group did 45 minutes of exercise 3x per week in a lab with medical supervision. [10 minutes of rest and monitoring preceded each exercise session; the 45 minute session was divided into 3 periods of 15 minutes each interspersed with two 5-minute rest periods for fetal monitoring. In addition, the patients were instructed to conduct a 'nonsedentary' lifestyle outside the lab time so they probably had more exercise than just 3x per week. The exercise consisted of using recumbent exercise bikes, which the researchers felt more appropriate for obese, previously sedentary women instead of weight-bearing exercise.] 17 patients in each group finished the study. No differences were seen between the groups in terms of blood sugar determinations, complication rates, or fetal health (remember that the exercise group did not have insulin; they achieved the same bG results as the insulin group WITHOUT insulin). The exercise group delivered slightly later on average (38.9 weeks vs. 38.2 weeks), perhaps because of differences in physician management. "The exercise program prescribed...in this study obviated insulin therapy for all the subjects who complied...Exercise training results in sustained insulin sensitivity and improves glucose tolerance...in the absence of either medical or obstetrical complications, exercise prescription can be an optional or adjunct therpay for gestational diabetes."

 

General Resources for GD, Exercise, etc.

Noble, Elizabeth. Essential Exercises for the Childbearing Year. Fourth Edition. Harwich, Massachusetts: New Life Images, 1995.

Book detailing optimal exercises before, during, and after pregnancy. A valuable resource.

Jovanovic-Peterson, Lois, M.D. with Morton B. Stone. Managing Your Gestational Diabetes. Minneapolis: Chronimed Publishing, 1994. To order, write P.O. Box 59032, Minneapolis, MN 55459-9686, or call 1-800-848-2793.

A good introduction to gd issues by one of the leading researchers in the field, who also happens to be diabetic (Type I) and a mother herself. Be aware her treatment guidelines in this book are quite conservative and not all providers use the same guidelines. Her writings also contain some patronizing and fat-phobic statements (fat people "live to eat rather than eat to live"). But she is an excellent introduction to the conservative approach to gd. She happens to be a very prolific writer in the field, so she tends to dominate the available published material on gd. Many more articles and books are available under her name.

Gestational Diabetes: What to Expect, The American Diabetes Association, Inc. Alexandria, Virginia: American Diabetes Association, 1992. To order, write to the ADA, 1970 Chain Bridge Road, McLean, VA 22109-0592, or call 1-800-232-3472.

The standard intro to the subject, written by the leading authorities on diabetes. A good, easy-to-read summary for those not desiring a great deal of detail. It is, of course, the standard medical approach to gd and does not contain any discussion of the controversies involved in gd. Definitely read this text as one of your first introductions to gd, while also keeping in mind that alternative views do exist.

 

 

 

 

 

 


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