Exercise and its role in gestational diabetes mellitus

Chen Wang, Kym Janese Guelfi, Hui-Xia Yang, Chen Wang, Kym Janese Guelfi, Hui-Xia Yang

Abstract

Gestational diabetes mellitus (GDM) refers to diabetes diagnosed in the second or third trimester of pregnancy that is not clearly either type 1 or type 2 diabetes. GDM is a common medical complication in pregnancy that has been rapidly increasing worldwide. GDM is associated with both short- and long-term health issues for both mothers and offspring. Consistent with type 2 diabetes, peripheral insulin resistance contributes to the hyperglycemia associated with GDM. Accordingly, it is important to identify strategies to reduce the insulin resistance associated with GDM. To date, observational studies have shown that exercise can be a non-invasive therapeutic option for preventing and managing GDM that can be readily applied to the antenatal population. However, the relevant mechanisms for these outcomes are yet to be fully elucidated. The present review aimed to explain the potential mechanisms of exercise from the perspective of reducing the insulin resistance, which is the root cause of GDM. Exercise recommendations and opinions of exercise during pregnancy are briefly summarized.

Keywords: Exercise; Gestational diabetes mellitus; Insulin resistance; Pregnancy.

References

    1. American Diabetes Association Standards of medical care in diabetes-2016: summary of revisions. Diabetes Care. 2016;39 Suppl 1:S4–S5.
    1. Colagiuri S., Falavigna M., Agarwal M.M. Strategies for implementing the WHO diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Diabetes Res Clin Pract. 2014;103:364–372.
    1. Zhu W.W., Yang H.X., Wei Y.M. Evaluation of the value of fasting plasma glucose in the first prenatal visit to diagnose gestational diabetes mellitus in China. Diabetes Care. 2013;36:586–590.
    1. Kaaja R., Rönnemaa T. Gestational diabetes: pathogenesis and consequences to mother and offspring. Rev Diabet Stud. 2008;5:194–202.
    1. Page K.A., Romero A., Buchanan T.A., Xiang A.H. Gestational diabetes mellitus, maternal obesity, and adiposity in offspring. J Pediatr. 2014;164:807–810.
    1. Bellamy L., Casas J.P., Hingorani A.D., Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009;373:1773–1779.
    1. Keshel T.E., Coker R.H. Exercise training and insulin resistance: a current review. J Obes Weight Loss Ther. 2015;5:S5-003.
    1. Dugan J.A. Exercise recommendations for patients with type 2 diabetes. JAAPA. 2016;29:13–18. quiz 1.
    1. Russo L.M., Nobles C., Ertel K.A., Chasan-Taber L., Whitcomb B.W. Physical activity interventions in pregnancy and risk of gestational diabetes mellitus: a systematic review and meta-analysis. Obstet Gynecol. 2015;125:576–582.
    1. Tobias D.K., Zhang C., van Dam R.M., Bowers K., Hu F.B. Physical activity before and during pregnancy and risk of gestational diabetes mellitus: a meta-analysis. Diabetes Care. 2011;34:223–229.
    1. Halse R.E., Wallman K.E., Newnham J.P., Guelfi K.J. Home-based exercise training improves capillary glucose profile in women with gestational diabetes. Med Sci Sports Exerc. 2014;46:1702–1709.
    1. Hod M., Kapur A., Sacks D.A. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: a pragmatic guide for diagnosis, management, and care. Int J Gynaecol Obstet. 2015;131 Suppl 3:S173–S211.
    1. Pessin J.E., Saltiel A.R. Signaling pathways in insulin action: molecular targets of insulin resistance. J Clin Invest. 2000;106:165–169.
    1. Nozaki S., Takeda T., Kitaura T., Takenaka N., Kataoka T., Satoh T. Akt2 regulates Rac1 activity in the insulin-dependent signaling pathway leading to GLUT4 translocation to the plasma membrane in skeletal muscle cells. Cell Signal. 2013;25:1361–1371.
    1. Jessen N., Sundelin E.I., Møller A.B. AMP kinase in exercise adaptation of skeletal muscle. Drug Discov Today. 2014;19:999–1002.
    1. Treebak J.T., Pehmøller C., Kristensen J.M. Acute exercise and physiological insulin induce distinct phosphorylation signatures on TBC1D1 and TBC1D4 proteins in human skeletal muscle. J Physiol. 2014;592:351–375.
    1. Benton C.R., Holloway G.P., Han X.X. Increased levels of peroxisome proliferator-activated receptor gamma, coactivator 1 alpha (PGC-1alpha) improve lipid utilisation, insulin signalling and glucose transport in skeletal muscle of lean and insulin-resistant obese Zucker rats. Diabetologia. 2010;53:2008–2019.
    1. Ma Z., Qi J., Meng S., Wen B., Zhang J. Swimming exercise training-induced left ventricular hypertrophy involves microRNAs and synergistic regulation of the PI3K/AKT/mTOR signaling pathway. Eur J Appl Physiol. 2013;113:2473–2486.
    1. de Barros M.C., Lopes M.A., Francisco R.P., Sapienza A.D., Zugaib M. Resistance exercise and glycemic control in women with gestational diabetes mellitus. Am J Obstet Gynecol. 2010;203:556.e1–556.e6.
    1. Davenport M.H., Mottola M.F., McManus R., Gratton R. A walking intervention improves capillary glucose control in women with gestational diabetes mellitus: a pilot study. Appl Physiol Nutr Metab. 2008;33:511–517.
    1. Golbidi S., Laher I. Potential mechanisms of exercise in gestational diabetes. J Nutr Metab. 2013;2013:285948.
    1. Cao H. Adipocytokines in obesity and metabolic disease. J Endocrinol. 2014;220:T47–T59.
    1. Cheng K.K., Lam K.S., Wang B., Xu A. Signaling mechanisms underlying the insulin-sensitizing effects of adiponectin. Best Pract Res Clin Endocrinol Metab. 2014;28:3–13.
    1. Doruk M., Uğur M., Oruç A.S., Demirel N., Yildiz Y. Serum adiponectin in gestational diabetes and its relation to pregnancy outcome. J Obstet Gynaecol. 2014;34:471–475.
    1. Lain K.Y., Daftary A.R., Ness R.B., Roberts J.M. First trimester adipocytokine concentrations and risk of developing gestational diabetes later in pregnancy. Clin Endocrinol (Oxf) 2008;69:407–411.
    1. Saunders T.J., Palombella A., McGuire K.A., Janiszewski P.M., Després J.P., Ross R. Acute exercise increases adiponectin levels in abdominally obese men. J Nutr Metab. 2012;2012:148729.
    1. Racil G., Ben Ounis O., Hammouda O. Effects of high vs. moderate exercise intensity during interval training on lipids and adiponectin levels in obese young females. Eur J Appl Physiol. 2013;113:2531–2540.
    1. Korkmazer E., Solak N. Correlation between inflammatory markers and insulin resistance in pregnancy. J Obstet Gynaecol. 2015;35:142–145.
    1. Nergiz S., Altınkaya Ö.S., Küçük M. Circulating galanin and IL-6 concentrations in gestational diabetes mellitus. Gynecol Endocrinol. 2014;30:236–240.
    1. Daniele G., Guardado Mendoza R., Winnier D. The inflammatory status score including IL-6, TNF-α, osteopontin, fractalkine, MCP-1 and adiponectin underlies whole-body insulin resistance and hyperglycemia in type 2 diabetes mellitus. Acta Diabetol. 2014;51:123–131.
    1. Uysal K.T., Wiesbrock S.M., Marino M.W., Hotamisligil G.S. Protection from obesity-induced insulin resistance in mice lacking TNF-alpha function. Nature. 1997;389:610–614.
    1. Hassiakos D., Eleftheriades M., Papastefanou I. Increased maternal serum interleukin-6 concentrations at 11 to 14 weeks of gestation in low risk pregnancies complicated with gestational diabetes mellitus: development of a prediction model. Horm Metab Res. 2016;48:35–41.
    1. Chen L., Chen R., Wang H., Liang F. Mechanisms linking inflammation to insulin resistance. Int J Endocrinol. 2015;2015:508409.
    1. Sarvas J.L., Khaper N., Lees S.J. The IL-6 paradox: context dependent interplay of SOCS3 and AMPK. J Diabetes Metab. 2013;Suppl 13
    1. Hayashino Y., Jackson J.L., Hirata T. Effects of exercise on C-reactive protein, inflammatory cytokine and adipokine in patients with type 2 diabetes: a meta-analysis of randomized controlled trials. Metabolism. 2014;63:431–440.
    1. Akbarpour M. The effect of aerobic training on serum adiponectin and leptin levels and inflammatory markers of coronary heart disease in obese men. Biol Sport. 2013;30:21–27.
    1. Pal M., Febbraio M.A., Whitham M. From cytokine to myokine: the emerging role of interleukin-6 in metabolic regulation. Immunol Cell Biol. 2014;92:331–339.
    1. Reihmane D., Dela F. Interleukin-6: possible biological roles during exercise. Eur J Sport Sci. 2014;14:242–250.
    1. Fernandez-Gonzalo R., De Paz J.A., Rodriguez-Miguelez P., Cuevas M.J., González-Gallego J. TLR4-mediated blunting of inflammatory responses to eccentric exercise in young women. Mediators Inflamm. 2014;2014:479395.
    1. Baynard T., Vieira-Potter V.J., Valentine R.J., Woods J.A. Exercise training effects on inflammatory gene expression in white adipose tissue of young mice. Mediators Inflamm. 2012;2012:767953.
    1. Wang Y., Cupul-Uicab L.A., Rogan W.J. Recreational exercise before and during pregnancy in relation to plasma C-reactive protein concentrations in pregnant women. J Phys Act Health. 2015;12:770–775.
    1. Ono M., Takebe N., Oda T. Association of coronary artery calcification with MDA-LDL-C/LDL-C and urinary 8-isoprostane in Japanese patients with type 2 diabetes. Intern Med. 2014;53:391–396.
    1. Golbidi S., Laher I. Antioxidant therapy in human endocrine disorders. Med Sci Monit. 2010;16:RA9–24.
    1. Grissa O., Atègbo J.M., Yessoufou A. Antioxidant status and circulating lipids are altered in human gestational diabetes and macrosomia. Transl Res. 2007;150:164–171.
    1. Karacay O., Sepici-Dincel A., Karcaaltincaba D. A quantitative evaluation of total antioxidant status and oxidative stress markers in preeclampsia and gestational diabetic patients in 24–36 weeks of gestation. Diabetes Res Clin Pract. 2010;89:231–238.
    1. Houstis N., Rosen E.D., Lander E.S. Reactive oxygen species have a causal role in multiple forms of insulin resistance. Nature. 2006;440:944–948.
    1. Kobe H., Nakai A., Koshino T., Araki T. Effect of regular maternal exercise on lipid peroxidation levels and antioxidant enzymatic activities before and after delivery. J Nippon Med Sch. 2002;69:542–548.
    1. Sankaralingam S., Jiang Y., Davidge S.T., Yeo S. Effect of exercise on vascular superoxide dismutase expression in high-risk pregnancy. Am J Perinatol. 2011;28:803–810.
    1. Wagey F.W. Pregnancy exercise increase enzymatic antioxidantin pregnant women. Bali Med J. 2012;1:36–39.
    1. Mendoza-Núñez V.M., Hernández-Monjaraz B., Santiago-Osorio E., Betancourt-Rule J.M., Ruiz-Ramos M. Tai Chi exercise increases SOD activity and total antioxidant status in saliva and is linked to an improvement of periodontal disease in the elderly. Oxid Med Cell Longev. 2014;2014:603853.
    1. Skrypnik D., Bogdański P., Madry E., Pupek-Musialik D., Walkowiak J. Effect of physical exercise on endothelial function, indicators of inflammation and oxidative stress. Pol Merkur Lekarski. 2014;36:117–121.
    1. Committee on Obstetric Practice ACOG committee opinion Exercise during pregnancy and the postpartum period. Number 267, January 2002. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 2002;77:79–81.
    1. American Diabetes Association Gestational diabetes mellitus. Diabetes Care. 2004;27 Suppl 1:S88–S90.
    1. Nascimento S.L., Surita F.G., Cecatti J.G. Physical exercise during pregnancy: a systematic review. Curr Opin Obstet Gynecol. 2012;24:387–394.
    1. Lee D.T., Ngai I.S., Ng M.M., Lok I.H., Yip A.S., Chung T.K. Antenatal taboos among Chinese women in Hong Kong. Midwifery. 2009;25:104–113.
    1. Mudd L.M., Owe K.M., Mottola M.F., Pivarnik J.M. Health benefits of physical activity during pregnancy: an international perspective. Med Sci Sports Exerc. 2013;45:268–277.
    1. Barakat R., Pelaez M., Cordero Y. Exercise during pregnancy protects against hypertension and macrosomia: randomized clinical trial. Am J Obstet Gynecol. 2016;214:649.e1–649.e8.
    1. Mourtakos S.P., Tambalis K.D., Panagiotakos D.B. Maternal lifestyle characteristics during pregnancy, and the risk of obesity in the offspring: a study of 5,125 children. BMC Pregnancy Childbirth. 2015;15:66.
    1. Share with women Exercise in pregnancy. J Midwifery Womens Health. 2014;59:473–474.
    1. Committee Opinion No 650 Summary: Physical Activity and Exercise during Pregnancy and the Postpartum Period. Obstet Gynecol. 2015;126:1326–1327.
    1. Evenson K.R., Barakat R., Brown W.J. Guidelines for physical activity during pregnancy: comparisons from around the world. Am J Lifestyle Med. 2014;8:102–121.

Source: PubMed

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