Physical activity patterns and gestational diabetes outcomes - The wings project.
OBJECTIVE
To compare physical activity (PA) patterns in pregnant woman with and without gestational diabetes (GDM) and to assess the effects of an exercise intervention on change in PA patterns, blood glucose levels and pregnancy outcomes in GDM women.


METHODS
For the first objective, PA patterns were studied in 795 pregnant women with and without GDM. For the second objective, the Women in India with Gestational Diabetes Strategy-Model of Care (WINGS-MOC) intervention were evaluated in 151 women out of 189 with GDM. PA was assessed using a validated questionnaire and a pedometer. Changes in PA patterns, glycemic parameters and neonatal outcomes were evaluated.


RESULTS
Overall, only 10% of pregnant women performed recommended levels of PA. Women with GDM were significantly more sedentary compared to those without GDM (86.2 vs. 61.2%, p<0.001). After the MOC was implemented in women with GDM, there was a significant improvement in PA and a decrease in sedentary behaviour amongst women (before MOC, moderate activity: 15.2%, sedentary: 84.8% vs. after MOC-moderate: 26.5%, sedentary: 73.5%; p<0.001), and an increase in their daily step count from 2206/day to 2476/day (p<0.001). Fasting 1 and 2-h postprandial glucose values significantly decreased (p<0.001 for all). Sedentary behaviour was associated with a fourfold higher risk (p=0.02), and recreational walking with 70% decreased risk, of adverse neonatal outcomes (p=0.04) after adjusting for potential confounders.


CONCLUSIONS
PA levels are inadequate amongst this group of pregnant women studied i.e. those with and without GDM. However, a low-cost, culturally appropriate MOC can bring about significant improvements in PA in women with GDM. These changes are associated with improved glycemic control and reduction in adverse neonatal outcomes.
Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Gopalapuram, Chennai, India. Electronic address: dranjana@drmohans.com.
Ranjit Mohan
RM
Anjana
Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Gopalapuram, Chennai, India.
Vasudevan
V
Sudha
Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Gopalapuram, Chennai, India.
Nagarajan
N
Lakshmipriya
Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Gopalapuram, Chennai, India.
Chandrasekaran
C
Anitha
Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Gopalapuram, Chennai, India.
Ranjit
R
Unnikrishnan
Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Gopalapuram, Chennai, India.
Balaji
B
Bhavadharini
Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Gopalapuram, Chennai, India.
Manni Mohanraj
MM
Mahalakshmi
Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Gopalapuram, Chennai, India.
Kumar
K
Maheswari
Department of Policy and Programme, International Diabetes Federation, Brussels, Belgium.
Arivudainambi
A
Kayal
SeethapathyClinic and Hospital, Chennai, India.
Uma
U
Ram
Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Gopalapuram, Chennai, India.
Harish
H
Ranjani
Department of Policy and Programme, International Diabetes Federation, Brussels, Belgium.
Lyudmil
L
Ninov
Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Gopalapuram, Chennai, India.
Mohan
M
Deepa
Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Gopalapuram, Chennai, India.
Rajendra
R
Pradeepa
Department of Pharmacy Practice Personnel, Colleges of Pharmacy, Purdue University, West Lafayette, Indiana, USA.
Sonak D
SD
Pastakia
Department of Policy and Programme, International Diabetes Federation, Brussels, Belgium.
Belma
B
Malanda
Department of Policy and Programme, International Diabetes Federation, Brussels, Belgium.
Anne
A
Belton
Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Gopalapuram, Chennai, India.
Viswanathan
V
Mohan
D000328:Adult; D044466:Asian People / Q000706:statistics & numerical data; D001786:Blood Glucose / Q000502:physiology; D016640:Diabetes, Gestational / Q000097:blood / Q000503:physiopathology*; D015444:Exercise / Q000502:physiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000502:physiology; D006801:Humans; D007194:India; D008019:Life Style; D011247:Pregnancy; D011256:Pregnancy Outcome; D055815:Young Adult
D001786:Blood Glucose; D006442:Glycated Hemoglobin
Asian Indians; Exercise; GDM; Lifestyle intervention; Physical activity; Type 2 diabetes