Advanced maternal age, overweight and obese positively correlate to the abnormal plasma glucose among gestational diabetes mellitus women even with physical exercise > 90 min/day: a prospective cohort study in Shanghai – Nature

sdgtalks sdgtalks
Jul 1, 2025 - 22:00
0 0
Advanced maternal age, overweight and obese positively correlate to the abnormal plasma glucose among gestational diabetes mellitus women even with physical exercise > 90 min/day: a prospective cohort study in Shanghai – Nature

Advanced maternal age, overweight and obese positively correlate to the abnormal plasma glucose among gestational diabetes mellitus women even with physical exercise > 90 min/day: a prospective cohort study in Shanghai – Nature” /> <h2>Report on Physical Exercise and Abnormal Plasma Glucose in Gestational Diabetes Mellitus Women: Emphasis on Sustainable Development Goals</h2> <h3>Abstract</h3> <p>Physical exercise is a recognized intervention for controlling gestational plasma glucose (PG) and mitigating adverse pregnancy outcomes, aligning with the Sustainable Development Goal (SDG) 3: Good Health and Well-being. This prospective cohort study conducted in Shanghai, China, investigated the relationship between physical exercise duration and abnormal plasma glucose (APG) during the third trimester among women diagnosed with gestational diabetes mellitus (GDM). Using group-based trajectory modeling (GBTM) and restricted cubic spline (RCS) analysis, the study identified distinct APG trajectories and dose-response relationships with exercise time. Findings indicate that physical exercise exceeding 60 minutes per day effectively reduces APG risk; however, women with advanced maternal age and overweight/obesity require additional interventions beyond physical exercise. These insights contribute to SDG 3 by informing targeted health strategies for maternal and neonatal well-being. <h2>Introduction</h2> <p>Gestational diabetes mellitus (GDM) is a prevalent metabolic disorder during pregnancy, adversely affecting maternal and neonatal health and contributing to long-term complications. This condition poses challenges to achieving SDG 3 by increasing healthcare burdens and impacting quality of life. Physical exercise has been shown to improve glycemic control and reduce adverse outcomes, yet specific guidelines for exercise duration in GDM women, particularly in China, remain limited. This study addresses this gap by exploring the association between physical exercise time and APG, employing advanced statistical modeling to inform personalized exercise recommendations. <h2>Methods</h2> <h3>Study Population</h3> <p>A prospective cohort of 1,448 GDM women aged 18–45 years was recruited from Songjiang Maternal and Children’s Healthcare Hospital in Shanghai between 2020 and 2024. Inclusion criteria ensured a representative sample to support SDG 3 through evidence-based maternal health interventions. Ethical approval was obtained, and informed consent was secured. <h3>Data Collection</h3> <ul> <li>Demographic and obstetric data were extracted from electronic health records.</li> <li>Physical exercise frequency and duration during late gestation were collected via face-to-face interviews.</li> <li>Data integrity and participant privacy were maintained rigorously.</li> </ul> <h3>Definitions and Measurements</h3> <ul> <li>GDM diagnosis followed International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria.</li> <li>APG was defined as fasting plasma glucose ≥ 5.10 mmol/L or 2-hour plasma glucose ≥ 8.5 mmol/L post-breakfast.</li> <li>Physical exercise time was categorized into five groups from less than 30 minutes to 120 minutes or more per day.</li> <li>Body Mass Index (BMI) and maternal age groups were classified to assess risk factors.</li> </ul> <h3>Statistical Analysis</h3> <p>GBTM identified distinct APG trajectories, while logistic regression and RCS curves modeled associations between exercise time and APG risk. Statistical significance was set at p < 0.05. These methods support SDG 3 by enabling precise health risk stratification and intervention planning. <h2>Results</h2> <h3>Participant Characteristics</h3> <ul> <li>Mean age: 31.22 years; 46.75% primipara, 53.25% multipara.</li> <li>Education: 61.40% had college-level or higher education.</li> <li>BMI distribution: 4.63% underweight, 59.25% normal weight, 36.12% overweight/obese.</li> <li>Median daily physical exercise: 55 minutes.</li> <li>Approximately 25% experienced adverse pregnancy outcomes (APO).</li> </ul> <h3>APG Trajectories</h3> <p>Two distinct APG trajectory groups were identified: <ol> <li>Low APG group (67.27%)</li> <li>High APG group (32.73%)</li> </ol> <p>Women in the high APG group were more likely to be of advanced maternal age and overweight/obese, highlighting key risk factors aligned with SDG 3 targets. <h3>Factors Associated with High APG and Adverse Pregnancy Outcomes</h3> <ul> <li>Advanced maternal age (36–45 years) and overweight/obesity significantly increased APG risk.</li> <li>Increased physical exercise time was associated with reduced APG risk, particularly beyond 60 minutes per day.</li> <li>Primiparous women had higher risk of adverse pregnancy outcomes.</li> </ul> <h3>Physical Exercise and APG Relationship</h3> <p>Restricted cubic spline analysis revealed: <ul> <li>APG percentage decreased sharply with physical exercise under 60 minutes/day.</li> <li>For women aged ≤35 years and those with normal weight, APG risk decreased continuously with exercise time.</li> <li>Women with advanced maternal age or overweight/obesity required at least 60 minutes/day of exercise to maintain APG below 45%, but exercise beyond 90 minutes/day showed diminished returns, indicating the need for complementary interventions.</li> </ul> <h2>Discussion</h2> <p>This study underscores the importance of tailored physical exercise interventions in managing GDM, contributing to SDG 3 by promoting maternal and neonatal health. Advanced maternal age and overweight/obesity exacerbate APG risk due to physiological factors such as increased insulin resistance and chronic inflammation. Physical exercise enhances insulin sensitivity and glucose metabolism, yet cultural factors in China favor low-intensity activities, potentially limiting effectiveness. Therefore, integrating physical exercise with additional measures such as dietary management and medical treatment is essential for high-risk groups. <h3>Implications for Sustainable Development Goals</h3> <ul> <li><b>SDG 3 (Good Health and Well-being):</b> The study supports improved maternal health through evidence-based exercise guidelines, reducing complications from GDM.</li> <li><b>SDG 4 (Quality Education):</b> Education level influences health behaviors; promoting awareness about exercise benefits is critical.</li> <li><b>SDG 10 (Reduced Inequalities):</b> Addressing disparities in health outcomes among different demographic groups enhances equity in maternal care.</li> </ul> <h3>Strengths and Limitations</h3> <ul> <li>Strengths include a large prospective cohort, real-world clinical data, and advanced modeling techniques.</li> <li>Limitations involve geographic restriction to Shanghai, potential recall bias in exercise reporting, and lack of detailed dietary data.</li> <li>Future research should incorporate multi-center designs and objective exercise monitoring to enhance generalizability and accuracy.</li> </ul> <h2>Conclusions</h2> <p>Physical exercise exceeding 60 minutes daily effectively reduces abnormal plasma glucose risk among women with gestational diabetes mellitus, supporting SDG 3 objectives. However, for women with advanced maternal age and overweight/obesity, exercise alone may be insufficient even beyond 90 minutes per day, necessitating integrated intervention strategies to optimize maternal and neonatal health outcomes. <h2>1. Sustainable Development Goals (SDGs) Addressed in the Article</h2> <ol> <li><strong>SDG 3: Good Health and Well-being</strong> <ul> <li>The article focuses on gestational diabetes mellitus (GDM), its management through physical exercise, and its impact on maternal and neonatal health outcomes.</li> <li>It addresses reducing maternal mortality and improving neonatal health by controlling abnormal plasma glucose levels during pregnancy.</li> </ul> </li> <li><strong>SDG 2: Zero Hunger</strong> <ul> <li>Though not directly focused on nutrition, the article mentions the importance of balanced diet and nutrition interventions alongside physical exercise for GDM management.</li> </ul> </li> <li><strong>SDG 10: Reduced Inequalities</strong> <ul> <li>The study highlights the need for tailored physical exercise interventions for different groups of GDM women, including those with advanced maternal age and overweight/obese status, addressing health inequalities.</li> </ul> </li> </ol> <h2>2. Specific Targets Under the Identified SDGs</h2> <ol> <li><strong>SDG 3: Good Health and Well-being</strong> <ul> <li><strong>Target 3.1:</strong> Reduce the global maternal mortality ratio.</li> <li><strong>Target 3.2:</strong> End preventable deaths of newborns and children under 5 years of age.</li> <li><strong>Target 3.4:</strong> Reduce by one third premature mortality from non-communicable diseases through prevention and treatment, including diabetes.</li> <li><strong>Target 3.8:</strong> Achieve universal health coverage, including access to quality essential health-care services and medicines.</li> </ul> </li> <li><strong>SDG 2: Zero Hunger</strong> <ul> <li><strong>Target 2.2:</strong> End all forms of malnutrition, including addressing nutritional needs during pregnancy.</li> </ul> </li> <li><strong>SDG 10: Reduced Inequalities</strong> <ul> <li><strong>Target 10.2:</strong> Empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, or other status.</li> </ul> </li> </ol> <h2>3. Indicators Mentioned or Implied in the Article to Measure Progress</h2> <ol> <li><strong>Indicator for SDG 3:</strong> <ul> <li>Prevalence of gestational diabetes mellitus (GDM) among pregnant women.</li> <li>Percentage of abnormal plasma glucose (APG) occurrences during pregnancy (fasting plasma glucose ≥ 5.10 mmol/L or 2-hour plasma glucose ≥ 8.5 mmol/L).</li> <li>Incidence of adverse pregnancy outcomes (premature rupture of membranes, macrosomia, premature infants, low birth weight, postpartum hemorrhage, polyhydramnios, puerperal infection, neonatal asphyxia, forceps delivery).</li> <li>Physical exercise duration (minutes per day) among GDM women as a behavioral indicator linked to glycemic control.</li> <li>Odds ratios (OR) for risk factors such as advanced maternal age and overweight/obesity in relation to APG and adverse pregnancy outcomes.</li> </ul> </li> <li><strong>Indicator for SDG 2:</strong> <ul> <li>Proportion of GDM women following balanced diet recommendations (42.40% reported balanced diet with doctors’ suggestion).</li> </ul> </li> <li><strong>Indicator for SDG 10:</strong> <ul> <li>Stratification of GDM women by age groups, BMI categories, and pregnancy outcomes to assess disparities in glycemic control and intervention effectiveness.</li> </ul> </li> </ol> <h2>4. Table of SDGs, Targets, and Indicators</h2> <table border= SDGs Targets Indicators SDG 3: Good Health and Well-being

  • 3.1: Reduce maternal mortality ratio
  • 3.2: End preventable newborn and under-5 deaths
  • 3.4: Reduce premature mortality from non-communicable diseases including diabetes
  • 3.8: Achieve universal health coverage
  • Prevalence of GDM among pregnant women
  • Percentage of abnormal plasma glucose (APG) occurrences
  • Incidence of adverse pregnancy outcomes (e.g., macrosomia, premature infants)
  • Physical exercise duration (min/day) among GDM women
  • Odds ratios for risk factors (advanced maternal age, overweight/obesity)
SDG 2: Zero Hunger
  • 2.2: End all forms of malnutrition, including during pregnancy
  • Proportion of GDM women following balanced diet recommendations
SDG 10: Reduced Inequalities
  • 10.2: Promote social, economic, and political inclusion of all
  • Stratification of GDM women by age, BMI, and pregnancy outcomes to assess disparities

Source: nature.com