The effect of exercise on the prevention of gestational diabetes in obese and overweight pregnant women: A systematic review and meta-analysis

Background: Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy and its prevalence worldwide is increasing along with enhancing type two of diabetes. Contrary results have been found in some review articles that examine the effect of exercise activities on preventing GDM, regardless of obesity. Therefore, the aim of this study was to systematically review the articles on the effect of exercise activities on the prevention of GDM in obese and overweight pregnant women. Methods: In this systematic review, data on gestational diabetes related to the effect of exercise on the prevention of gestational diabetes in obese and overweight pregnant women using appropriate keywords in the MEDLINE database, Cochrane Library, Web of Science, PubMed, Scopus, Proquest, and their Synonym in Magiran SID databases were searched by applying a time limit from 2008 /1/1 to 2018/5/30. The methodological quality of the trials was assessed according to the Cochrane handbook. Data analysis was performed using Review Manager Software version 5.3. In order to investigate the effect of sports activities on the incidence of gestational diabetes, the risk ratio, and for quantitative indices, the standardized mean difference with 95% confidence interval for each study was calculated. The Higgins index (I2) and chi-square test (Chi2) were used to examine the heterogeneity of the studies. The significance level for the heterogeneity evaluation of the studies was considered due to the low power of the Chi-square test of 90%. Results: Out of 5,107 papers identified, 7 papers with 1441 participants entered the study after applying the entry and exit criteria (intervention group 727, control group 714). In the intervention group, 143 (19.66%, 95% confidence intervals: 76.83 to 22.74) and in the control group, 196 (27.45%, 95% confidence intervals: 20.24 to 30.88%), pregnant women had diabetes. The risk ratio of gestational diabetes was 0.76 (95% confidence interval: 0.56 to 1.03). In studies that the time for the intervention was three times a week or less, effect of intervention was significant in reducing the incidence of diabetes (0.59, with 95% confidence interval: 0.46 to 0.76). However, in studies with repeat of intervention was more than three times a week, the effect of intervention between two intervention and control groups was not significantly (1.03, 95% CI: 0.78 to 1.35 .) Conclusion: the exercise activities, alone, in obese or overweight pregnant women did not have a significant effect on the overall incidence of GDM, but considering the relative risk ratio, the incidence of GDM was 24% lower in the intervention group than control group. This difference is considerable in the two groups. As the systematic review literatures both represent the information gap on the research subject and pave the way for further studies so it seems that there is a need for more randomized controlled trials so that we can make a complete conclusion on the type, intensity and duration of exercise in preventing GDM

کلیدواژه ها:

Gestational diabetes mellitus ، exercise ، obese and overweight ، pregnancy ، prevention