More Physical Exercise is Beneficial to Glycemic Control in Late Pregnancy Among Women with Gestational Diabetes Mellitus: Findings Based on Trajectory Model in a Prospective Cohort in Shanghai

Xiuqi Zhang,1,2,* Yuning Ding,1,2,* Zhen Duan,3,* Ruiqi Cai,3 Xiangjin Gao,1 Rui Zhang,1 Ruiping Wang1– 4 1Clinical Research Center, Shanghai Skin Diseases Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China; 2School of Medicine, Tongji University, Shanghai, People’s Republic of China; 3School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 4Office of Public Health Management, Songjiang Maternal and Children’s Health-Care Hospital, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ruiping Wang, Clinical Research Center, Shanghai Skin Diseases Hospital, School of Medicine, Tongji University, 1278 Baode Road, Jing’an District, Shanghai, 200443, People’s Republic of China, Email [email protected]: Physical exercise effectively prevents the onset of gestational diabetes mellitus (GDM). However, the association between the daily physical exercise time (PET) and the overall trend in glycemic levels in late pregnancy among women with GDM is limited. This study aimed to explore this association using a group-based trajectory model (GBTM) among women with GDM.Patients and Methods: We constructed two types of models (A and B) by applying GBTM analysis based on a series of abnormal plasma glucose (PG) prevalence values calculated at each prenatal checkup in the GDM cohort. Women with GDM were classified into good plasma glucose control (PGC) and bad PGC groups based on each trajectory model. Logistic regression was used to explore the association between daily PET and prevalence of good PGC among women with GDM. In this study, P value less than 0.05 was set as the statistical significance.Results: Among 1122 GDM women, the average age was 26.9 years. The number of women with GDM in the good PGC group was 539 (48.0%) in Model A 644 (57.4%) in Model B. The median daily PET was longer in the good PGC group (70 min in both Models A and B) than in the poor PGC group (Model A, 65 min; Model B, 64 min). Logistic regression analysis indicated that GDM women with ≥ 120 min/day PET had a significantly higher PGC prevalence in late pregnancy (odds ratio (OR), 1.32 (95% confidence interval (CI): 1.12– 1.56) in Model A, and 1.24 (95% CI: 1.05– 1.46) in Model B, even after adjusting for potential confounders (age and BMI).Conclusion: Women with GDM need ≥ 120 min/day PET to achieve glycemic control, especially for those who are older and have BMI ≥ 24kg/m2.Keywords: physical exercise, gestational diabetes mellitus, trajectory model, abnormal plasma glucose prevalence