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Prepregnancy Fitness and Risk of Gestational Diabetes: A Longitudinal Analysis

WHITAKER, KARA M.1; INGRAM, KATHERINE H.2; APPIAH, DUKE3; NICHOLSON, WANDA K.4; BENNETT, WENDY L.5; LEWIS, CORA E.6; REIS, JARED P.7; SCHREINER, PAMELA J.8; GUNDERSON, ERICA P.9

Medicine & Science in Sports & Exercise: August 2018 - Volume 50 - Issue 8 - p 1613–1619
doi: 10.1249/MSS.0000000000001600
Epidemiology

Purpose This study aimed to assess the associations of prepregnancy cardiorespiratory fitness, moderate- to vigorous-intensity physical activity (MVPA), and time spent watching television with subsequent development of gestational diabetes mellitus (GDM).

Methods Participants were 1333 women enrolled in the Coronary Artery Risk Development in Young Adults study who did not have diabetes either at baseline (1985–86) or before births occurring after baseline. Baseline fitness was estimated using a graded symptom-limited maximal exercise treadmill test and expressed in MET units. Baseline MVPA (exercise units per day) was measured using the Coronary Artery Risk Development in Young Adults physical activity history questionnaire, and television viewing (h·d−1) was assessed by self-report in 1990–1991. Logistic regression analysis was used to derive odds ratios and 95% confidence intervals, adjusting for time from baseline to delivery and baseline study center, age, race, education, parity, family history of diabetes, smoking, alcohol, saturated fat intake, waist circumference, homeostasis model assessment of insulin resistance, and HDL cholesterol.

Results Over 25 yr of follow-up, 164 women developed GDM. The odds of developing GDM were 21% lower for each 1 SD increment in baseline level of fitness (2.3 METs, odds ratio = 0.79, 95% confidence interval = 0.65–0.96). Prepregnancy MVPA and television viewing were not statistically associated with the development of GDM.

Conclusion Study findings indicate that objectively assessed prepregnancy fitness, but not self-reported MVPA or television time, is associated with GDM. Clinicians should counsel women on the benefits of improving fitness in the preconception period, particularly among women at greater risk for GDM.

1Department of Health and Human Physiology, University of Iowa, Iowa City, IA;

2Department of Exercise Science and Sport Management, Kennesaw State University, Kennesaw, GA;

3Department of Public Health, Texas Tech University Health Sciences Center, Abilene, TX;

4Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC;

5Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD;

6Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL;

7Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD;

8Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN; and

9Division of Research, Kaiser Permanente Northern California, Oakland, CA

Address for correspondence: Kara M. Whitaker, Ph.D., M.P.H., E112 Field House, Iowa City, IA; E-mail: kara-whitaker@uiowa.edu.

Submitted for publication November 2017.

Accepted for publication March 2018.

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© 2018 American College of Sports Medicine