BACKGROUND: Obesity and being overweight are becoming epidemic, and indeed, the proportion of such women of reproductive age has increased in recent times. Being overweight or obese prior to pregnancy is a risk factor for gestational diabetes mellitus, and increases the risk of adverse pregnancy outcome for both mothers and their offspring. Furthermore, the combination of gestational diabetes mellitus with obesity/overweight status may increase the risk of adverse pregnancy outcome attributable to either factor alone. Regular exercise has the potential to reduce the risk of developing gestational diabetes mellitus and can be used during pregnancy; however, its efficacy remain controversial. At present, most exercise training interventions are implemented on Caucasian women and in the second trimester, and there is a paucity of studies focusing on overweight/obese pregnant women. OBJECTIVE: We sought to test the efficacy of regular exercise in early pregnancy to prevent gestational diabetes mellitus in Chinese overweight/obese pregnant women. STUDY DESIGN: This was a prospective randomized clinical trial in which nonsmoking women age > 18 years with a singleton pregnancy who met the criteria for overweight/obese status (body mass index 24 to 28 kg/m2) and had an uncomplicated pregnancy at < 12 weeks of gestation were randomly allocated to either exercise or a control group. Patients did not have contraindications to physical activity. Patients allocated to the exercise group were assigned to exercise 3 times per week (at least 30 min/session with a rating of perceived exertion between 12 to 14) via a cycling program begun within 3 days of randomization until 37 weeks of gestation. Those in the control group continued their usual daily activities. Both groups received standard prenatal care, albeit without special dietary recommendations. The primary outcome was incidence of gestational diabetes mellitus. RESULTS: From December 2014 through July 2016, 300 singleton women at 10 weeks' gestational age and with a mean prepregnancy body mass index of 26.78 +/- 2.75 kg/m2 were recruited. They were randomized into an exercise group (n = 150) or a control group (n = 150). In all, 39 (26.0%) and 38 (25.3%) participants were obese in each group, respectively. Women randomized to the exercise group had a significantly lower incidence of gestational diabetes mellitus (22.0% versus 40.6%; p < 0.001). These women also had significantly less gestational weight gain by 25 gestational weeks (4.08 +/- 3.02 versus 5.92 +/- 2.58 kg; p < 0.001) and at the end of pregnancy (8.38 +/- 3.65 versus 10.47 +/- 3.33 kg; p < 0.001), and reduced insulin resistance levels (2.92 +/- 1.27 versus 3.38 +/- 2.00; p = 0.033) at 25 gestational weeks. Other secondary outcomes, including gestational weight gain between 25 to 36 gestational weeks (4.55 +/- 2.06 versus 4.59 +/- 2.31 kg; p = 0.9), insulin resistance levels at 36 gestational weeks (3.56 +/- 1.89 versus 4.07 +/- 2.33; p = 0.1), hypertensive disorders of pregnancy (17.0% versus 19.3%; odds ratio, 0.854; 95% confidence interval 0.434 to 2.683; p = 0.6), cesarean delivery (except for scar uterus) (29.5% versus 32.5%; odds ratio, 0.869; 95% confidence interval 0.494 to 1.529; p = 0.6), mean gestational age at birth (39.02 +/- 1.29 versus 38.89 +/- 1.37 weeks' gestation; p = 0.5); preterm birth (2.7% versus 4.4%, odds ratio, 0.600; 95% confidence interval 0.140 to 2.573; p = 0.5), macrosomia (defined as birthweight > 4,000 g) (6.3% versus 9.6%; odds ratio 0.624; 95% confidence interval 0.233 to 1.673; p = 0.3), and large-for-gestational-age infants (14.3% versus 22.8%; odds ratio, 0.564; 95% confidence interval 0.284 to 1.121; p = 0.1) were also lower in the exercise group compared to the control group, but without significant difference. However, infants born to women following the exercise intervention had a significantly lower birthweight compared with those born to women allocated to the control group (3,345.27 +/- 397.07 versus 3,457.46 +/- 446.00 g; p = 0.049). CONCLUSION: Cycling exercise initiated early in pregnancy and performed at least 30 minutes, 3 times per week, is associated with a significant reduction in the frequency of gestational diabetes mellitus in overweight/obese pregnant women. And this effect is very relevant to that exercise at the beginning of pregnancy decreases the gestational weight gain before the mid-second trimester. Furthermore, there was no evidence that the exercise prescribed in this study increased the risk of preterm birth or reduced the mean gestational age at birth.
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