Review of general suggestions on physical activity to prevent and treat gestational and pre-existing diabetes during pregnancy and in postpartum

There is evidence that Physical Activity (PA) during pregnancy has many potential positive effects on the mother: reduced risk of excessive weight gain, gestational diabetes (GDM), preeclampsia, varicose veins, deep vein thrombosis, and lower back pain. PA also reduces the duration of labor and complications at childbirth, fatigue, stress, anxiety and depression, leading to an improved sense of wellbeing. Other potential benefits for the fetus are improvement of placental function with increased amniotic fluid, flow and volume of the placenta, foetal vascular function, placental villous tissue, speed of foetal growth, neuronal development and reduced percentage of foetal fat. Physicians should advise female patients how to safely perform PA during pregnancy and in the postpartum period. Providing a woman with an adequate prescription of exercise training can encourage her to take part in safe and effective activities throughout pregnancy, in the absence of contraindications .For women at high risk of GDM, initiating an exercise-training program during the preconception phase may be of importance. Risk factors include overweight, obesity, previous GDM, prior macrosomia, age above 35 years, positive family history for diabetes, polycystic ovary syndrome (PCOS), and high-risk ethnicity.The prevalence of GDM is 4.7% - 13.7% [8] Diagnostic criteria for GDM are according to IADPSG (International Association of Diabetes and Pregnancy Study Groups) criteria and Italian National guidelines and should be tested between 24th and 28th gestational weeks. A single positive test is enough for the diagnosis using a 2-hour 75-g OGTT: Fasting Plasma Glucose is ≥92 mg/dL (≥ 5.1 mmol/l), 1-h glucose value ≥180 mg/dL (≥10 mmol/l) and 2-h glucose value ≥153 mg/dL (≥ 8.5 mmol/l), furthermore in high risk women, testing may be carried out before 24-28 gestational weeks. [9]Once gestational diabetes mellitus is diagnosed, either aerobic or resistance training can improve insulin action and glycaemic control [10]. However, to the best of our knowledge, there are no clear guidelines or clear clinical recommendations. We review the literature and make suggestions regarding areas of prevention of GDM in the general female population,treatment of GDM in gestation and prescription of exercise in pregnancy, with specific attention to type, intensity and volume.