Regular physical activity has been shown to prevent the development of metabolic disorders. Meta-analyses show that physical activity performed pre-pregnancy (1-3) or during pregnancy (especially in early pregnancy) in normal-weight women is associated a reduced risk of developing diabetes of pregnancy (3-9).  This evidence appears consistent for both physical activity interventions alone and combined physical activity and dietary interventions as part of a lifestyle package.  One large meta-analysis of 47 randomised controlled trials showed that physical activity interventions conferred a risk reduction of 0.70 (95%CI 0.59-0.84) (4).  Meta-analyses have also shown that physical activity performed in overweight or obese women (who have a greater risk of diabetes of pregnancy), is associated with reduced blood glucose levels and a reduced risk of developing diabetes of pregnancy (10,11).   

Quality of evidence

High 

Strength of recommendation 

Strong

Conclusion 

There is consistent high-quality evidence that physical activity pre-pregnancy or during pregnancy reduces the risk of developing gestational diabetes mellitus in normal weight and overweight or obese women.  This can be part of a lifestyle package including dietary changes as well. 

 References

 1. Davenport, M.H., et al., Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis, in Br J Sports Med. 2018, Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.: England. p. 1367-1375. 

2. Davenport, M.H., et al., Glucose responses to acute and chronic exercise during pregnancy: a systematic review and meta-analysis, in Br J Sports Med. 2018, Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.: England. p. 1357-1366. 

3. Mijatovic-Vukas, J., et al., Associations of Diet and Physical Activity with Risk for Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis. Nutrients, 2018. 10(6). 

4. Song, C., et al., Lifestyle intervention can reduce the risk of gestational diabetes: a meta-analysis of randomized controlled trials. Obes Rev, 2016. 17(10): p. 960-9. 

5. Guo, X.Y., et al., Improving the effectiveness of lifestyle interventions for gestational diabetes prevention: a meta-analysis and meta-regression. BJOG, 2019. 126(3): p. 311-320. 

6. Yu, Y., et al., Effect of exercise during pregnancy to prevent gestational diabetes mellitus: a systematic review and meta-analysis. J Matern Fetal Neonatal Med, 2018. 31(12): p. 1632-1637. 

7. Ming, W.K., et al., The effect of exercise during pregnancy on gestational diabetes mellitus in normal-weight women: a systematic review and meta-analysis. BMC Pregnancy Childbirth, 2018. 18(1): p. 440. 

8. Zheng, J., H. Wang, and M. Ren, Influence of exercise intervention on gestational diabetes mellitus: a systematic review and meta-analysis, in J Endocrinol Invest. 2017: Italy. p. 1027-1033. 

9. Aune, D., et al., Physical activity and the risk of gestational diabetes mellitus: a systematic review and dose-response meta-analysis of epidemiological studies. Eur J Epidemiol, 2016. 31(10): p. 967-997. 

10. Bennett, C.J., et al., Interventions designed to reduce excessive gestational weight gain can reduce the incidence of gestational diabetes mellitus: A systematic review and meta-analysis of randomised controlled trials, in Diabetes Res Clin Pract. 2018, 2018 Elsevier B.V: Ireland. p. 69-79. 

11. Cremona, A., et al., Effect of exercise modality on markers of insulin sensitivity and blood glucose control in pregnancies complicated with gestational diabetes mellitus: a systematic review. Obes Sci Pract, 2018. 4(5): p. 455-467.