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Exercise as it relates to Disease/Mums and bubs: the benefits of physical activity during pregnancy and the prevalence of gestational diabetes

The following text was written by student u3032917 for the purpose of an assignment. This page is an analysis of a journal article "Physical Activity, Obesity, and Diabetes in Pregnancy" by Dye et al. (1997).[1]

Background to the ResearchEdit

Gestational diabetes (GDM) is a disorder of glucose utilisation affecting pregnant women [1], affecting 5%-10% of Australian women[2]. Women who have been diagnosed with GDM are at risk of: - preeclampsia - infection - post partum haemorrhage - macrosomia Traditionally GDM has been managed through diet and insulin management; however, more recently the use of physical activity has been argued as the more appropriate type of therapy for management of GDM.[1]. This research paper suggests that exercise may play a role in preventing GDM during pregnancy.

Where is the research from?Edit

The study was funded by the State of New York and was conducted by Dr Timothy Dye and others, at the State University of New York, Syracuse. Dr Timothy Dye has written numerous publications dating from 1997-2017, focussed on applied public health. His recent work has been focussed on pregnancy and infancy.[3]

Dr Dye has led teams around the world including countries such as; Lebanon, Turkey, China, South Africa, Ethiopia, Burkina Faso, Tanzania, Nigeria, Tibet, India, Kashmir, Ladakh, Indonesia, Malaysia, Thailand, Costa Rica, Dominican Republic, Grenada, Petite Martinique, Kenya, Antarctica, Northern Ireland, and the United Kingdom.[3]

What kind of research was this?Edit

According to Detsky 1992, this research occupies a poor rating in the level of hierarchy of evidence.[4] The research is an analysis using information obtained from medical records and self reporting interviews. The research team used contingency tables and chi square statistics to analyse bivariate differences.

The use of self reporting in relation to 'amount of exercise' could skew the data and questions the validity of the results. BMI measures may not have been the most appropriate measurement to use, as the measure does not account for body composition of individuals.[5]

Research MethodEdit

  • 12, 799 women from the New York State were involved in face-to-face interviews regarding their exercise status. This interview data was used in correlation with BMI, and Glucose test results obtained from medical records.
  • GDM Status was obtained through medical records after the pregnancy was completed. BMI was calculated using pregnancy weight and height from medical records after the pregnancy was completed.
  • The methodology was a cost effective product; however, it was a poor approach to obtain any significant findings. The use of interviews left much room for memory and self reporting bias to skew the data. Other research in this field has used observational data and a more supervised approach with directed exercise interventions.[6]

Table 1 - Advantages/Disadvantages of the research analysis

Advantages Disadvantages
Use of medical records

- easy to attain

- economical way to attain data

Data may be incorrect due to input error
Self Report of Exercise frequency

- Interview technique used to create report with subjects - Information data obtained for 96% of participants

Time consuming and high self-reporting bias
Small sample size

- allows for a more targeted approach

Weakens statistical strength

Doesn't address gap in the literature

ResultsEdit

  • Prevalence in the test population was 2.9%.
  • Women with a BMI of 33 or higher has similar rates of GDM regardless of whether they exercised or not; however, exercise did appear to significantly reduce the rate of their GDM?
  • The study found that overall exercise was not associated with a reduction in GDM. They did however find that exercise reduced GDM in women with BMI's 33 and above (odds ratio = 1.9, 95 percent confidence interval 1.2-3.1).

ConclusionsEdit

The study was very basic and did not account for the exercise activity levels prior to pregnancy, which in recent studies has had a significant impact on GDM prevalence during pregnancy. [7] The studies major data collection regarding exercise frequency was based on self-reporting interviews which significantly reduces the validity of the research, by heavily introducing bias to skew the data. Recent research has used a more controlled platform to secure valid information regarding exercise, by using supervised exercise sessions.[6] These studies created categories of research to indicate what exercise has greater prevalence rates for GDM, such as aerobic exercise or resistance based exercise, which was missing from the research paper by Dye and others. It would have been useful information for the paper to include this in their findings. This research found no significant correlation between exercise and a reduction in GDM, however, much of the recent research has proven that exercise does reduce GDM, and obesity with pregnant women.

Practical adviceEdit

This research skims the surface on BMI levels having an impact on GDM and health risks associated for pregnant women; however, does not publish any results that provide raw data on the health risks associated with obesity and low activity levels on the mother and child during exercise and later in life. Health professionals should encourage (and provide relevant information) women to exercise prior to/during/post pregnancy as recent research indicates this has positive effects on the mother and child. Women should consult their doctor before commencing exercise and approach a health and fitness professional to assist them with their exercise regime.

Further InformationEdit

Before commencing any physical activity pregnant women should consult their general practitioner (GP).


Find out more about GDM from Diabetes Australia: https://www.diabetesaustralia.com.au/gestational-diabetes

For further information regarding exercise during pregnancy click on the following link: https://www.essa.org.au/epd/pregnancy-and-exercise-for-optimal-outcomes/

For information on Physical activity guidelines please click on the following link: http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines

ReferencesEdit

Add in the references using this code

  1. a b c Dye, T., Knox, K., Artal, R., Aubry, R., & Wojtowycz, M. (1997). Physical Activity, Obesity, and Diabetes in Pregnancy. American Journal of Epidemiology, 146(11), 961-965.
  2. Diabetes Australia,. (2016). Gestational Diabetes. Ndss.com.au. Retrieved 19 September 2016, from https://www.ndss.com.au/gestational-diabetes
  3. a b University of Rochester,. (2017). Dr Timothy D. Dye. urmc.rochester.edu. Retrieved 22 September 2017, from https://www.urmc.rochester.edu/people/22139573-timothy-d-dye/researchers
  4. Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbe KA. Incorporating variations in the quality of individual randomized trials into meta-analysis. J Clin Epidemiol. 1992;45:255–65.
  5. Nuttal, F. Body Mass Index: Obesity, BMI, and Health: A Critical Review. Nutrition Today. 2015;50(3):117-128.
  6. a b Coredero, Y., Mottola, M., Vargas, J., Blanco, M., and Barakat, R. Exercise is associated with a reduction in Gestational Diabetes Mellitus. American College of Sports Medicine. 2015;47(7):1328-1333.
  7. Zhang, C., Solomon, C., Manson, J., & Hu, F. (2006). A Prospective Study of Pregravid Physical Activity and Sedentary Behaviors in Relation to the Risk for Gestational Diabetes Mellitus. Journal Of The American Medical Association, 166(5), 543-548.