Gestational Diabetes Mellitus
What is it?
Gestational diabetes mellitus (GDM) is a form of diabetes that occurs during pregnancy. According to Diabetes Australia, GDM is the fastest growing type of diabetes in Australia, affecting between 12% and 14% of pregnant women.
GDM poses significant risks to the mother and baby, therefore good management is essential. First line treatment involves a healthy eating plan, physical activity and glucose monitoring. Some women may also require medication or insulin therapy to maintain healthy blood glucose levels.
What is the Physiotherapist’s role in the management of GDM?
Exercise is now accepted as an effective way to reduce peripheral insulin resistance. Exercise can increase the action of insulin in the body, allowing more glucose to be removed from the bloodstream and taken up by muscle and other tissues. A systematic review by Harrison et al (2016) found that exercise, as an adjunct to standard care, significantly improved both post-prandial (after a meal) and fasting blood glucose levels in pregnant women with GDM.
Once a mother is diagnosed with GDM, they may become concerned about how to exercise safely, or where to begin. They are more likely to become inactive, which puts them at greater risk of excessive weight gain and other pregnancy-related complications. An exercise program should begin in an environment where the mother can be monitored and reassured.
Although the effect of increased insulin sensitivity is mostly gone within 60 hours after exercise, exercise can affect glycaemic control for up to 5 days in some women. This has the potential for really positive impacts in a GDM pregnancy, however it also means that the mother may become at risk of hypoglycaemia (low blood glucose levels). In these circumstances, it is important to begin exercise under the guidance of a health care professional who can monitor blood sugar levels, and tailor the exercise program accordingly.
What do Women with GDM want to know?
A recent qualitative study by Harrison et al (2019) aimed to understand the perceived barriers to and enablers of physical activity during pregnancy in women with GDM. The study found that women want clear messages regarding:
- What type of physical activity is safe during a GDM pregnancy
- Why physical activity is important during a GDM pregnancy, and how it can improve outcomes for themselves and their babies
- Flexible, convenient and practical physical activity options
The women in this study said that they wanted information about physical activity during a GDM pregnancy to come from a credible source such as a health professional. Additionally, this study found that a new GDM diagnosis is a strong motivator to be more physically active.
How much Exercise is Needed?
It is recommended that women with GDM perform aerobic or resistance exercise at a moderate intensity, for 20-30mins, 3-4 times per week.
Ramsay Health Plus
At Ramsay Health Plus (our onsite Private Practice) we can assist pregnant women to achieve the recommended level of exercise to help manage their GDM. Through our Antenatal and Postnatal Physiotherapy program, each woman will receive a thorough assessment and tailored exercise plan.
We also have a dietician on site that can assist to achieve a healthy eating plan.
For Further information please follow the link Ramsay Health Plus webpage.
Bung P, Artal R, Khodiguian N and Kjos S 1991. Exercise in Gestational Diabetes: An Optional Therapeutic Approach? Diabetes, vol 40, 182 - 185
Diabetes Australia www.diabetesaustralia.com.au/gestational-diabetes
Harrison A, Shields N, Taylor N and Frawley H 2016. Exercise improves glycemic control in women diagnosed with gestational diabetes mellitus: a systematic review. Journal of Physiotherapy, vol 62, 188 – 196
Harrison A, Taylor N, Frawley H, Shields N 2019. Women with gestational diabetes mellitus want clear and practical messages from credible sources about physical activity during pregnancy: a qualitative study. Journal of Physiotherapy, vol 65, 37 – 42