Pregnancy is a time of great joy and excitement, but for six to seven percent of all pregnant women in the U.S., pregnancy-related diabetes can cause worry and complication. The vast majority (90%) of women who deal with diabetes during pregnancy are those with gestational diabetes, or diabetes that results from the condition of being pregnant. The remainder are women who have a diagnosis of diabetes (type 1 or type 2) prior to pregnancy.

The cause for concern stems from that fact that diabetes, or lack of insulin and blood glucose regulation, can be harmful to the mother and the unborn child. In utero, a high blood glucose environment stimulates increased insulin production in the fetus and placenta, which stimulates fetal growth and can lead to larger than usual birth weight (macrosomia). Further complications for the baby directly after birth can include difficulty breathing, jaundice, hypoglycemia and nerve palsy due to birth trauma.

For the mom, unregulated gestational diabetes can result in trauma due to larger birth weight, longer active labor times, perineal tearing and increased risk of post-partum hemorrhage and C-section.

Who’s at Risk for Gestational Diabetes?

Women who are at higher risk for developing diabetes during pregnancy include those who have:

• advanced maternal age (> 35 years)
• polycystic ovarian syndrome
• family history of diabetes
• ethnic backgrounds – especially Hispanic, African American, Native American and Pacific Islander women

Some women, however, experience gestational diabetes without any of these risk factors. Also, with the increase in obesity and sedentary lifestyle, the prevalence is increasing globally in women of reproductive age.

How is it Treated?

Good glucose control is the best way to treat gestational diabetes and reduce maternal, fetal and neonatal complications. By carefully modifying and monitoring diet, pregnant women can control glucose levels without use of oral medications or insulin. However, exercise is an often overlooked but effective tool in glucose control during pregnancy which may prevent, reduce or delay the need for insulin.

Research in the 1990’s showed that women who exercised during pregnancy had babies with a significant lower birth weight than those who had decreased their physical activity during pregnancy. In another study of women with gestational diabetes, women who followed a regime of diet and exercise had a significantly lower fasting blood glucose than women who practiced diet alone. Those who exercised also showed a reduced dependence on insulin.

Other Benefits of Exercise during Pregnancy

Moms-to-be don’t need to have a diagnosis of gestational diabetes to benefit from exercise during pregnancy. In addition to helping regulate blood glucose levels, exercise is associated with plenty of other benefits for the pregnant woman, including:

• decreased lower back pain
• improved cardiovascular functions such as fitness, blood pressure and decreased swelling of ankles and legs
• fewer problems with constipation
• reduced prevalence of preeclampsia (pregnancy-related high blood pressure)
• improved mood and psychological wellbeing

Maternal exercise also benefits the baby. Maternal exercise is associated with greater placental volume and vascular function as well as increased amniotic fluid. Babies tend to have a higher tolerance to labor, lower birth weights, and an increased gestational ages (i.e., lower risk of preterm birth and lower body fat percentage.

We recommend that all pregnant women, especially those with diabetes during pregnancy, engage in physical activity during pregnancy, unless your obstetrician advises against it. Moderate intensity aerobic and strength training along with recreational physical activity (walking, gardening, tennis, etc.) is best.

Talk with your obstetrician for more information about gestational diabetes or for suggestions about ways to exercise during pregnancy, or visit our Roper St. Francis health library.

By Dr. Richard Adams, Maternal Fetal Medicine specialist