Exercise During the First Trimester of Pregnancy and the Risks of Abnormal Screening and Gestational Diabetes Mellitus
Research Design and Methods: Data come from PETALS, a prospectively followed pregnancy cohort (n= 2,246, 79% minorities) receiving care at Kaiser Permanente Northern California. A Pregnancy Physical Activity Questionnaire was used to assess exercise. Glucose testing results for screening and diagnostic tests were obtained from electronic health records. Inverse probability of treatment weighting and Targeted Maximum Likelihood with data-adaptive estimation (machine learning) of propensity scores and outcome regressions were used to obtain causal risk differences adjusted for potential confounders, including prepregnancy BMI, exercise before pregnancy, and gestational weight gain. Exercise was dichotomized at: 1) the cohort’s 75th percentile for moderate to vigorous intensity exercise (≥ 13.2 MET hours per week, approximately ≥ 264 minutes per week of moderate exercise), 2) current recommendations (≥ 7.5 MET hours per week, or ≥ 150 minutes per week of moderate exercise), and 3) any vigorous exercise.
Results: Overall, 24.3% and 6.5% had abnormal screening and GDM, respectively. Exercise meeting or exceeding the 75th percentile decreased the risks of abnormal screening and GDM, by 4.8 (95% CI 1.1, 8.5) and 2.1 (0.2, 4.1) fewer cases per 100, respectively, in adjusted analyses.
Conclusions: Exercise reduces the risks of abnormal screening and GDM but the amount needed to achieve these risk reductions is likely higher than current recommendations. Future interventions may consider promoting ≥ 38 minutes per day of moderate intensity exercise to prevent GDM.