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Review Article
64 (
); 102-108

Effect of exercise on glycaemic control and pregnancy outcomes in women with gestational diabetes mellitus: A review

Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
Corresponding author: Mona Hmoud AlSheikh, Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Building 30, King Fahd University Hospital, AlKhobar-36277, Saudi Arabia.
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: AlSheikh MH. Effect of exercise on glycaemic control and pregnancy outcomes in women with gestational diabetes mellitus: A review. Indian J Physiol Pharmacol 2020:64(2):102-8.


The prevalence of gestational diabetes mellitus (GDM) is increasing and is known for its adverse effects on maternal and neonatal health. Physical exercise during pregnancy has been demonstrated to be useful for women without diabetes. However, it is unclear whether exercise can improve glycaemic control, and thereby prevents the unwanted effects of GDM. This review examines the evidence from recent literature, in which various exercise interventions were used to improve glycaemic control and the pregnancy outcomes of women with GDM. For this purpose, literature was searched through Medline, PubMed, Web of Science, Cochrane Library, and Scopus, and relevant studies published between 2009 and 2019 were retrieved. In total, 11 studies met the inclusion criteria and were reviewed. The findings collated consistently suggest that exercise in women with GDM is not only safe but also is strongly recommended, providing there are no other complications. Exercise for 15–30 min in low to moderate intensity improves glycaemic control and reduces maternal or neonatal complications. However, despite its reported benefits, it is advisable to perform exercises under supervision. In addition, certain intense exercises should be avoided as they can create complications for the mother and/or the foetus.


Gestational diabetes
glycaemic control
Pregnancy Outcomes


During pregnancy, a significant number of women suffer from gestational or pre-existing type 1 or type 2 diabetes.[1-3] Of these three types, gestational diabetes mellitus (GDM) is the most common, with a worldwide prevalence rate of 16.4%, and is constantly on the rise.[4] GDM is defined as ‘carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy.’[5] The recent World Health Organization report[6] suggests that the diagnosis of GDM should be considered positive if the pregnant women have either a plasma glucose level between 5.1 and 6.9 mmol/L under fasting conditions, or more than 10.0 mmol/L 1 h after 75 g glucose intake, or between 8.5 and 11.0 mmol/L 2 h after glucose intake.

Pregnancies with GDM are usually high risk and the condition can trigger many adverse outcomes for the mother as well as the neonate.[7] Some of the most common are pre-eclampsia, perineal trauma, pregnancy-induced hypertension, and increased chances of caesarean section.[8-10] In addition, it is expected that almost half of the mothers with GDM will eventually develop diabetes mellitus type 2 later in their lives.[11] Further, possible neonatal complications include macrosomia, shoulder dystocia, birth trauma, hypoglycaemia, hyperbilirubinemia, polycythaemia, respiratory distress syndrome, and jaundice.[12,13] Despite its severe repercussions, GDM is preventable, and if detected at an early stage, it can be reversed through appropriate interventions, and consequently, the majority of the associated risks can be avoided.[14-16]

The management of GDM varies depending upon the resources available. In daily practice, physicians use various medical and non-medical (or combination of both) interventions to treat GDM. The most common medical interventions include oral hypoglycaemic drugs and insulin therapy.[17] Although insulin therapy is the preferred pharmacological treatment modality, it has its own challenges.[18] For this reason, non-pharmacological intervention should be recommended as the first- line treatment option. This involves adopting lifestyle modifications such as diet control and exercise.[19] Women with GDM are usually advised to first try controlling their glucose levels through diet control alone or in combination with physical exercise.[20] The literature suggests that over 75% of GDM cases achieve glycaemic control with lifestyle modifications alone.[15,21]

Exercise is defined as ‘physical activities consisting of planned and repetitive body movements to improve physical fitness.’[22] Physical exercise is considered essential to maintain a healthy lifestyle during pregnancy.[23] Most gynecological and obstetrical guidelines recommend 25–30 min of mild to moderate exercise per day during pregnancy.[24,25]

Exercises which are considered safe and acceptable during an uncomplicated pregnancy are: Walking, running or jogging, swimming, stationary cycling, low-intensity aerobics, modified Pilates, yoga, resistance training, and stretching exercises.[24] Exercise in cases of uncomplicated pregnancies has been known to be beneficial and may have long- term positive effects on maternal health.[26] The potential benefits include reduced stress and depression, improved cardiorespiratory fitness, reduced likelihood of urinary incontinence and lumbar pain, less gestational weight gain, better glycaemic control, and minimal risk of diabetes during pregnancy.[26-28] However, these reported that the benefits of exercise might not be generalizable to pregnant women with GDM.

Although it is well known that exercise is beneficial during an uncomplicated pregnancy, certain challenges exist that might restrict women from exercising. The known barriers are fatigue, nausea, inactivity prior to pregnancy, and/or restricted mechanical movements at a later stage of pregnancy.[29] In addition, the support of a qualified physical trainer may not be readily available at all antenatal centres, and the attending physician may recommend exercises that are neither based on evidence nor on standard guidelines.[30,31] In women with diabetes, it is usually recommended to take certain precautions because of the differences in physiology and possible interaction with anti- diabetic drugs taken during pregnancy. This complicated and sensitive condition demands the application of evidence- based exercise guidelines to improve maternal and neonatal health outcomes.[32]

To realize the optimal benefits of exercise without any complications or risks, it is essential to understand which type of exercise should be used, and with what regularity, duration, and intensity.[32,33] Several interventional studies have sought to clarify the impact of exercise on GDM and its effects on pregnancy outcomes. However, due to the disparity in reported results, there is currently no consensus on recommendations for the type, duration, and intensity of the known exercises. Therefore, this review aims to consolidate the evidence in the literature concerning the various exercise interventions used so far by women with GDM and their possible effects on glycaemic control and pregnancy outcomes.


To achieve the objectives of this study, a literature search was performed using Medline, PubMed, Web of Science, Cochrane Library, and Scopus. All the peer-reviewed articles published in the past 10 years (2009–2019) were retrieved and their abstracts screened. Abstracts were screened by using the following inclusion criteria: (1) The study should be randomized controlled trials (RCTs) involving human female subjects with GDM in both exercise and control group (CG), (2) the trial should be aiming to assess the impact of different exercise interventions, (3) the study should report any maternal or newborn outcome, (4) the article should be written in English, and (5) the article should be published in a peer-reviewed journal and within the decided timeframe (2009–2019). This timeline was selected because the objective of this review study was to give a literature update on what has been reported in the past decade while exploring the effect of exercise on glycaemic control and pregnancy outcomes. Those articles in which other medical or non-medical interventions were studied in combination with physical exercise were excluded from the study. Furthermore, excluded were studies which were not randomized. Papers written in languages other than English were also excluded from the study. The keywords used when exploring the literature included ‘non- pharmacological strategies,’ ‘non-medical strategies,’ ‘non- medical treatment,’ ‘pregnancy,’ ‘gestational diabetes,’ ‘GDM,’ ‘exercise,’ ‘glycaemic control,’ ‘pregnancy outcomes,’ ‘maternal outcomes,’ and ‘neonatal outcomes.’


A total of 11 studies were identified, all of which met the inclusion criteria for this review [Table 1].[34-44] In all the extracted articles, standard antenatal care was given to all the patients in the intervention group, in addition to performing different physical exercises; whereas, only standard antenatal care was given to the CG during the trial.

Table 1:: Summary of studies evaluating the effect of exercise on gestational diabetes mellitus and pregnancy outcomes.
Author and year of study Sample size Study objectives Components of exercise interventions
Type Duration
(in minutes)
Frequency Intensity Total period (in weeks) Summary of findings
Bambicini et al.[34] 17 (EG=11, CG=06) glycaemic control Combination of aerobics and resistance 60 NA** Moderate NA** No significant difference was observed in glycaemic levels between the EG and CG up to 1 h of exercise session
et al.[35]
428 (EG=210, CG=218) Pregnancy outcomes Combination of aerobics and resistance 50 Thrice/week Moderate 25–28 With respect to the gestational period, average birth weight, and average Apgar score, no significant difference was found between the exercise and CGs. A significantly lower rate of macrosomic babies and less chances of caesarean section were observed in the EG as compared to the CG
Bo et al.[36] 200 (EG=99, CG=101) Glycaemic control, pregnancy outcomes Brisk walk 20 Daily Light 10-12 A significant reduction in maternal postprandial glucose, CRP, HbA1c, and triglycerides was recorded. Furthermore, the occurrence and severity of maternal/neonatal complications were less in EG than CG
Cordero et al.[37] 257 (EG=101, CG=156) Glycaemic control Combination of aerobics and stretching 50–60 Twice/week Moderate to heavy 16–20 A reduction in the prevalence of GDM was recorded in the EG as compared to the CG. Furthermore, a significant improvement in glucose tolerance test was recorded in EG as compared to the CG
de Barros et al.[38] 64 (EG=32, CG=32) Glycaemic control Resistance training 30 Thrice/week Moderate to heavy 6–16 A significant reduction in insulin requirement was observed in EG as compared to the CG. The amount of time spent within the targeted glucose range was significantly higher in EG as compared to the CG
et al.[39]
40 (EG=20, CG=20) Pregnancy outcomes Aerobics 20-30 Daily Moderate 6 With respect to maternal weight gain and maternal/neonatal outcomes, no significant difference was observed between the two groups. However, an attitudinal and motivational improvement toward exercise and wellbeing was observed in EG, as compared to the CG
et al.[40]
06 (EG=02, CG=04) Glycaemic control Aerobics 50 Thrice/week Light to moderate 10 A decrease in mean HbA1c and HOMA was observed in EG as compared to the CG. Furthermore, the EG delivered lighter and smaller babies as compared to the CG
et al.[41]
65 (EG=40, CG=15) Glycaemic control Aerobics 70 Twice/week Moderate 16 The face-to-face EG showed significantly higher motivational determinants than both the CG and the home group. The face-to-face group also spent more exercise time and pedometer steps/day than the home group. Moreover, the face-to-face group started insulin later in gestational period than the home and CGs
et al.[42]
08 (EG=N/A, CG=N/A) Glycaemic control Walking (postprandial treadmill) 30 Daily Moderate 0.30* A greater postprandial glucose control was observed in EG as compared to the CG of women with GDM
et al.[43]
38 (EG=18, CG=20) Glycaemic control, pregnancy outcomes Combination of aerobics, resistance, and stretching 50 Twice/week Light to moderate 6 Significantly lower postprandial glucose levels were recorded in EG than the CG. No significant difference was recorded in fasting glucose levels between both groups. The neonatal body mass index was significantly higher in the EG
et al.[44]
18 (EG=09, CG=09) Glycaemic control Combination of aerobics, resistance, and stretching 50 Twice/week Light to moderate 6 A significant drop in glucose levels was recorded in EG as compared to CG. No harmful effects were recorded in women withGDM who used a combination of aerobic and resistance exercise during their gestational period
The exercise intervention was only for 2 days. **Not available (required information is not explicitly given in the article, hence, not available). EG: Exercise group, CG: Control group, GDM: Gestational diabetes mellitus

Types of interventions

Interventions included aerobics,[39-41] resistance training,[38] walking,[36,42] a combination of aerobics and resistance,[34,35] a combination of aerobics and stretching,[37] and a combination of aerobics, resistance, and stretching.[43,44] In these studies, the duration of the exercises varied from 20 to 70 min. The intensity was from light to heavy intensity and the total period of the intervention varied from 0.3 to 28 weeks. The frequency of the exercise sessions varied from daily to thrice weekly. The duration, intensity, and frequency of the interventions used in each study are given in [Table 1].

Purpose of interventions

Of these 11 clinical trials, seven[34,37,38,40-42,44] studied the effect of exercise on glycaemic control, two[35,39] studied pregnancy outcomes, and two[36,43] studied both glycaemic control and pregnancy outcomes.

Effect on glycaemic control

Nine of the 11 RCTs included evaluated the effect of exercise on glycaemic control in women with GDM. Ramos et al.[40] reported a significant decrease in mean HbA1c and HOMA levels in their exercise group (EG), when compared to CG. Bo et al.,[36] Coe et al.,[42] Cordero et al.,[37] Kokic et al.,[43] and Kokic et al.[44] noticed a significant reduction in glucose levels in their EG, whereas Bambicini et al.[34] observed no change in glucose levels between the two groups. In another clinical trial, Downs et al.[41] found their EG started insulin at a much later stage of pregnancy than the home and CGs. Similarly, de Barros et al.[38] reported a decrease in insulin demand in the EG, as compared to their CG. Furthermore, the EG had a longer gestational period within the targeted glucose range, as compared to the CG.

Effect on maternal and neonatal outcomes

Four of 11 of the included RCTs studied the effects of exercise on maternal and neonatal outcomes, either exclusively or alongside glycaemic measures. In one study, Barakat et al.[35] was unable to find a significant impact of exercise on the gestational period, average birth weight, and average Apgar score when comparing the EG with the CG. However, a significantly lower rate of macrosomic babies and a reduced probability of caesarean section were observed in the EG, as compared to the CG. In another study, Kokic et al.[43] found that the neonatal body mass index was significantly higher in EG than the CG. Although slightly delayed labour was observed in the CG, this difference was not statistically significant. Another non-significant finding was that more CG cases went through labour induction than EG cases. Furthermore, no significant differences were found between the two groups in terms of neonatal length, Apgar score, and ponderal index. In another study, Bo et al.[36] observed a reduced occurrence rate and severity in terms of maternal and neonatal complications in the EG than the CG. However, the nature of these complications has not been explicitly mentioned in the study. On the other hand, Halse et al.[39] compared the two groups with respect to mode, onset, or duration of labour, gestational period, chances of preterm birth, and Apgar scores. Surprisingly, the researchers did not experience any differences in the outcomes of both groups. In addition, none of these studies observed maternal complications such as duration and the induction of labour, rates of pre-eclampsia, or maternal mortality. With respect to neonatal outcomes, none of the studies observed neonatal morbidity or mortality, preterm births, or neonatal hypoglycaemia.


GDM is a metabolic problem with known negative effects on maternal and neonatal health. In this review, the researcher aimed to consolidate the literature reporting the effect of exercise on glycaemic control and pregnancy outcomes. The findings suggest that exercise is safe for women with GDM and that it may offer almost similar fitness benefits to suffering individuals as it does to those without diabetes. Furthermore, exercising women with GDM acquire better glucose control than non-exercising women. It can also be derived from the findings in the literature that an exercise intervention during pregnancy can surely help to avoid or at least delay the necessity for insulin.[38,42] Studies also suggest exercise alone can reverse GDM and reduce the chances of developing diabetes mellitus type 2 in the long term.[11,32]

While the current literature offers reassurance that exercising women with GDM might not experience hypoglycaemia, the possibility of its occurrence cannot be ignored as it is seriously harmful to both the mother and the foetus. Therefore, women with GDM should seek the professional support of a certified trainer, or at least avoid exercising without supervision.[45] In addition, workout measuring devices (ActiGraph and Omron) with known reliability and validity for use in pregnancy can be worn to keep physical activities in check.[46] Nowadays, many commercial companies offer wearable activity trackers and smart watches, which can help to monitor calorie consumption. These smart watches are also known as a source of motivation and commitment to exercise goals.[47]

After critically analysing the reported interventional studies, it can be concluded that an exercise of 15–30 min in low to moderate intensity is ideal in women with GDM. This is in line with the Canadian guidelines for physical activity throughout pregnancy,[48] and the recommendations of the American Diabetes Association.[49] GDM is typically diagnosed between 24 and 28 weeks of gestation, which offers an exercise window of 12–16 weeks duration. Between different types of exercises, it is up to the patient to choose according to her preference and practical options. However, certain high risk or high-intensity exercises raise safety concerns, and therefore these should be avoided, that is, skiing, road cycling, surfing, football, hockey, boxing, hot yoga, scuba diving, sky diving, and non-modified Pilates.[24]

It should be noted that the available evidence on which these recommendations have been based is limited. Moreover, few studies have evaluated the effect of exercise on pregnancy outcomes, which further restricts our understanding of the topic under discussion. Future researchers should convene longitudinal clinical trials at various gestational time points as a way to investigate in detail the effects of different exercise interventions on pregnancy outcomes. Another interesting factor would be to investigate the impact of emerging technologies, such as fitness trackers and smart watches, when monitoring glycaemic control among exercising women with GDM.

Certain limitations of this review need to be reported. In this study, the literature from the past 10 years has been reviewed and trials reported before 2009 have been excluded from the study. This review focuses on the effect of exercise in pregnant women with gestational diabetes only and does not include type 1 and 2 diabetes. A further limitation is that studies reporting the effect of exercise interventions only were included in the study. Trials involving mixed interventions (diet control and exercise), with or without pharmacological support, were not included in the study. Although all the reviewed articles were RCTs, assessment of the risk of bias was not performed, as it went beyond the objectives of this review.


For women with GDM, exercise is beneficial as a means of achieving better glycaemic control, thereby improving maternal and neonatal outcomes. It is recommended that pregnant women should exercise for 15–30 min from GDM diagnosis until the end of the gestational period. Patients can choose the type of exercise intervention they prefer, considering factors such as comfort, available resources, and providing the exercise chosen is of light to moderate intensity.

Declaration of patient consent

Patient’s consent not required as patients identity is not disclosed or compromised.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


  1. , , , , , , et al. Diabetes and pregnancy: National trends over a 15 year period. Diabetologia. 2018;61:1081-8.
    [CrossRef] [PubMed] [Google Scholar]
  2. , , , , . Trends in prevalence of diabetes among delivery hospitalizations, United States 1993-2009. Matern Child Health J. 2015;19:635-42.
    [CrossRef] [PubMed] [Google Scholar]
  3. , , , , , . Trends in incidence of diabetes in pregnancy and serious perinatal outcomes: A large, population-based study in Ontario, Canada 1996-2010. Diabetes Care. 2014;37:1590-6.
    [CrossRef] [PubMed] [Google Scholar]
  4. , , , , . Global estimates of the prevalence of hyperglycaemia in pregnancy. Diabetes Res Clin Pract. 2014;103:176-85.
    [CrossRef] [PubMed] [Google Scholar]
  5. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications: Report of a WHO Consultation. . Part 1, Diagnosis and Classification of Diabetes Mellitus. Geneva: World Health Organization; Available from: [Last accessed on 2019 Sep 21]
    [Google Scholar]
  6. Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy. . Geneva: World Health Organization; Available from: [Last accessed on 2019 Sep 22]
    [Google Scholar]
  7. , , , , . Adverse pregnancy outcomes using the international association of the diabetes and pregnancy study groups criteria: Glycemic thresholds and associated risks. Obstet Gynecol. 2015;126:67-73.
    [CrossRef] [PubMed] [Google Scholar]
  8. , , , , , , et al. Improving the effectiveness of lifestyle interventions for gestational diabetes prevention: A meta-analysis and meta-regression. BJOG. 2019;126:311-20.
    [CrossRef] [PubMed] [Google Scholar]
  9. , , , , , . The temporal trend of vascular function in women with gestational diabetes. Vasc Med. 2017;22:96-102.
    [CrossRef] [PubMed] [Google Scholar]
  10. , , , , , , et al. Effect of birth weight on adverse obstetric outcomes in vaginal birth after cesarean delivery. Obstet Gynecol. 2010;115:338-45.
    [CrossRef] [PubMed] [Google Scholar]
  11. , , . Exercise for pregnant women with gestational diabetes for improving maternal and fetal outcomes. Cochrane Database Syst Rev. 2017;6:CD012202.
    [CrossRef] [Google Scholar]
  12. . Gestational diabetes mellitus: Maternal and perinatal outcomes in 220 Saudi women. Oman Med J. 2012;27:140.
    [CrossRef] [PubMed] [Google Scholar]
  13. , , . Non-medical strategies to improve pregnancy outcomes of women with gestational diabetes mellitus: A literature review. Sultan Qaboos Univ Med J. 2019;19:4.
    [CrossRef] [PubMed] [Google Scholar]
  14. , , . Gestational diabetes in India: Science and society. Indian J Endocrinol Metab. 2015;19:701-4.
    [CrossRef] [PubMed] [Google Scholar]
  15. , , , , , , et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009;361:1339-48.
    [CrossRef] [PubMed] [Google Scholar]
  16. , , , , , . Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005;352:2477-86.
    [CrossRef] [PubMed] [Google Scholar]
  17. , , , , . Could metformin manage gestational diabetes mellitus instead of insulin? Int J Reprod Med. 2016;2016:1-8.
    [CrossRef] [PubMed] [Google Scholar]
  18. , , , , , . Benefits and risks of oral diabetes agents compared with insulin in women with gestational diabetes: A systematic review. Obstet Gynecol. 2009;113:193-205.
    [CrossRef] [PubMed] [Google Scholar]
  19. , , , , . Knowledge of pregnant women about gestational diabetes mellitus. J Nurs UFPE Line. 2012;6:1648-54.
    [Google Scholar]
  20. . Diagnosis and treatment of gestational diabetes. Nurse Prescr. 2013;11:14-20.
    [CrossRef] [Google Scholar]
  21. , , , , , , et al. Differences in pregnancy outcomes and characteristics between insulin-and diet-treated women with gestational diabetes. BMC Pregnancy Childbirth. 2015;15:271.
    [CrossRef] [PubMed] [Google Scholar]
  22. , , , . American College of Sports Medicine: ACSM’s Guidelines for Exercise Testing and Prescription Philadelphia, PA: Lippincott Williams & Wilkins; .
    [Google Scholar]
  23. , , , , , , et al. Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: A systematic review and meta-analysis. Br J Sports Med. 2018;52:1367-75.
    [CrossRef] [PubMed] [Google Scholar]
  24. . 650: Physical activity and exercise during pregnancy and the postpartum period. Obstet Gynecol. 2015;126:e135-42.
    [CrossRef] [PubMed] [Google Scholar]
  25. , , , , , , et al. Benefits of physical activity during pregnancy and postpartum: An umbrella review. Med Sci Sport Exerc. 2019;51:1292-302.
    [CrossRef] [PubMed] [Google Scholar]
  26. , , . Physical exercise during pregnancy: A systematic review. Curr Opin Obstet Gynecol. 2012;24:387-94.
    [CrossRef] [PubMed] [Google Scholar]
  27. , , , , , , et al. Effectiveness of exercise interventions in the prevention of excessive gestational weight gain and postpartum weight retention: A systematic review and meta-analysis. Br J Sports Med. 2018;52:1347-56.
    [CrossRef] [PubMed] [Google Scholar]
  28. , , , , , , 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;18:440.
    [CrossRef] [PubMed] [Google Scholar]
  29. , , , . Perceived barriers to leisure-time physical activity during pregnancy: A literature review of quantitative and qualitative evidence. J Sci Med Sport. 2017;20:17-25.
    [CrossRef] [PubMed] [Google Scholar]
  30. , , , , , . Exercise during pregnancy: Obstetricians’ beliefs and recommendations compared to American congress of obstetricians and gynecologists’ 2015 guidelines. Cureus. 2018;10:e3204.
    [CrossRef] [Google Scholar]
  31. , , , , . A qualitative study of women’s perceptions of provider advice about diet and physical activity during pregnancy. Patient Educ Couns. 2013;91:372-7.
    [CrossRef] [PubMed] [Google Scholar]
  32. , . Exercise in pregnant women with diabetes. Curr Diab Rep. 2019;19:80.
    [CrossRef] [PubMed] [Google Scholar]
  33. , . Fetal and maternal metabolic responses to exercise during pregnancy. Early Hum Dev. 2016;94:33-41.
    [CrossRef] [PubMed] [Google Scholar]
  34. , , , , , . Effects of aerobic and resistance exercises on glycemic levels of patients with gestational diabetes: Pilot study. Int J Gynecol Obstet. 2012;119:S603.
    [CrossRef] [Google Scholar]
  35. , , , , . Exercise during pregnancy and gestational diabetes-related adverse effects: A randomised controlled trial. Br J Sports Med. 2013;47:630-6.
    [CrossRef] [PubMed] [Google Scholar]
  36. , , , , , , et al. Simple lifestyle recommendations and the outcomes of gestational diabetes. A 2×2 factorial randomized trial. Diabetes Obes Metab. 2014;16:1032-5.
    [CrossRef] [PubMed] [Google Scholar]
  37. , , , , . Exercise is associated with a reduction in gestational diabetes mellitus. Med Sci Sports Exerc. 2015;47:1328-33.
    [CrossRef] [PubMed] [Google Scholar]
  38. , , , , . Resistance exercise and glycemic control in women with gestational diabetes mellitus. Am J Obstet Gynecol. 2010;203:1-6.
    [CrossRef] [PubMed] [Google Scholar]
  39. , , , , . Home-based exercise improves fitness and exercise attitude and intention in women with GDM. Med Sci Sports Exerc. 2015;47:1698-704.
    [CrossRef] [PubMed] [Google Scholar]
  40. , , , , , , et al. Effect of aerobic training in pregnant women diagnosed with gestational diabetes: A preliminary report. Pregnancy Hypertens Int J Women’s Cardiovasc Health. 2015;5:105.
    [CrossRef] [Google Scholar]
  41. , , , , . Randomized face-to-face vs. Home exercise interventions in pregnant women with gestational diabetes. Psychol Sport Exerc. 2017;30:73-81.
    [CrossRef] [PubMed] [Google Scholar]
  42. , , , , , , et al. Postprandial walking reduces glucose levels in women with gestational diabetes mellitus. Appl Physiol Nutr Metab. 2018;43:531-4.
    [CrossRef] [PubMed] [Google Scholar]
  43. , , , , , . Combination of a structured aerobic and resistance exercise improves glycaemic control in pregnant women diagnosed with gestational diabetes mellitus. A randomised controlled trial. Women Birth. 2018;31:232-8.
    [CrossRef] [PubMed] [Google Scholar]
  44. , , , , . Acute responses to structured aerobic and resistance exercise in women with gestational diabetes mellitus. Scand J Med Sci Sport. 2018;28:1793-800.
    [CrossRef] [PubMed] [Google Scholar]
  45. , , , , , , et al. Glucose responses to acute and chronic exercise during pregnancy: A systematic review and meta-analysis. Br J Sports Med. 2018;52:1357-66.
    [CrossRef] [PubMed] [Google Scholar]
  46. , , , , . Physical activity device reliability and validity during pregnancy and postpartum. Med Sci Sport Exerc. 2018;50:617-23.
    [CrossRef] [PubMed] [Google Scholar]
  47. , , , . Consumer-based wearable activity trackers increase physical activity participation: Systematic review and meta-analysis. JMIR Mhealth Uhealth. 2019;7:11819.
    [CrossRef] [PubMed] [Google Scholar]
  48. , , , , , , et al. 2019 Canadian guideline for physical activity throughout pregnancy. Br J Sports Med. 2018;52:1339-46.
    [CrossRef] [PubMed] [Google Scholar]
  49. , , , , , , et al. Physical activity/exercise and diabetes: A position statement of the American diabetes association. Diabetes Care. 2016;39:2065-79.
    [CrossRef] [PubMed] [Google Scholar]
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