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Published in: BMC Pregnancy and Childbirth 1/2018

Open Access 01-12-2018 | Research article

Exercise training during pregnancy reduces circulating insulin levels in overweight/obese women postpartum: secondary analysis of a randomised controlled trial (the ETIP trial)

Authors: Kirsti K. Garnæs, Siv Mørkved, Kjell Å. Salvesen, Øyvind Salvesen, Trine Moholdt

Published in: BMC Pregnancy and Childbirth | Issue 1/2018

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Abstract

Background

The primary aim was to investigate if supervised exercise training during pregnancy could reduce postpartum weight retention (PPWR) three months after delivery in overweight and obese women. We also measured circulating markers of cardiometabolic health, body composition, blood pressure, and physical activity level.

Methods

This was a secondary analysis of a randomised controlled trial in which 91 women with BMI ≥ 28 kg/mwere allocated 1:1 to an exercise program or a control group. Women in the exercise group were prescribed three weekly, supervised sessions of 35 min of moderate intensity walking/running followed by 25 min of resistance training. The control group received standard maternal care. Assessments were undertaken in early pregnancy, late pregnancy, and three months postpartum. PPWR was defined as postpartum body weight minus early pregnancy weight.

Results

Seventy women participated three months after delivery, and PPWR was −0.8 kg in the exercise group (n = 36) and −1.6 in the control group (n = 34) (95% CI, −1.83, 3.84, p = 0.54). Women in the exercise group had significantly lower circulating insulin concentration; 106.3 pmol/l compared to the control group; 141.4 pmol/l (95% CI, −62.78, −7.15, p = 0.01), and showed a tendency towards lower homeostatic measurement of insulin resistance (HOMA2-IR) (3.5 vs. 5.0, 95% CI, −2.89, 0.01, p = 0.05). No women in the exercise group compared to three women in the control group were diagnosed with type 2 diabetes postpartum (p = 0.19). Of the women in the exercise group, 46.4% reported of exercising regularly, compared to 25.0% in the control group (p = 0.16).

Conclusions

Offering supervised exercise training during pregnancy among overweight/obese women did not affect PPWR three months after delivery, but reduced circulating insulin levels. This was probably due to a higher proportion of women being active postpartum in the exercise group.

Trial registration

ClinicalTrials.​gov (NCT01243554), registration date: September 6, 2010.
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Literature
1.
go back to reference Brunner S, Stecher L, Ziebarth S, et al. Excessive gestational weight gain prior to glucose screening and the risk of gestational diabetes: a meta-analysis. Diabetologia. 2015;58(10):2229–37.CrossRefPubMed Brunner S, Stecher L, Ziebarth S, et al. Excessive gestational weight gain prior to glucose screening and the risk of gestational diabetes: a meta-analysis. Diabetologia. 2015;58(10):2229–37.CrossRefPubMed
2.
go back to reference Lutsiv O, Math J, Beyene J, McDonald SD. The effects of morbid obesity on maternal and neonatal health outcomes: a systematic review and meta-analyses. Obes Rev. 2015;16(7):531–46.CrossRefPubMed Lutsiv O, Math J, Beyene J, McDonald SD. The effects of morbid obesity on maternal and neonatal health outcomes: a systematic review and meta-analyses. Obes Rev. 2015;16(7):531–46.CrossRefPubMed
3.
go back to reference Oken E, Kleinman KP, Belfort MB, Hammitt JK, Gillman MW. Associations of gestational weight gain with short- and longer-term maternal and child health outcomes. Am J Epidemiol. 2009;170(2):173–80.CrossRefPubMedPubMedCentral Oken E, Kleinman KP, Belfort MB, Hammitt JK, Gillman MW. Associations of gestational weight gain with short- and longer-term maternal and child health outcomes. Am J Epidemiol. 2009;170(2):173–80.CrossRefPubMedPubMedCentral
4.
5.
go back to reference Weiss JL, Malone FD, Emig D, et al. Obesity, obstetric complications and cesarean delivery rate--a population-based screening study. Am J Obstet Gynecol. 2004;190(4):1091–7.CrossRefPubMed Weiss JL, Malone FD, Emig D, et al. Obesity, obstetric complications and cesarean delivery rate--a population-based screening study. Am J Obstet Gynecol. 2004;190(4):1091–7.CrossRefPubMed
6.
go back to reference Gaudet L, Ferraro ZM, Wen SW, Walker M. Maternal obesity and occurrence of fetal macrosomia: a systematic review and meta-analysis. Biomed Res Int. 2014;2014:640291.CrossRefPubMedPubMedCentral Gaudet L, Ferraro ZM, Wen SW, Walker M. Maternal obesity and occurrence of fetal macrosomia: a systematic review and meta-analysis. Biomed Res Int. 2014;2014:640291.CrossRefPubMedPubMedCentral
7.
go back to reference Schmitt NM, Nicholson WK, Schmitt J. The association of pregnancy and the development of obesity - results of a systematic review and meta-analysis on the natural history of postpartum weight retention. Int J Obes. 2007;31(11):1642–51.CrossRef Schmitt NM, Nicholson WK, Schmitt J. The association of pregnancy and the development of obesity - results of a systematic review and meta-analysis on the natural history of postpartum weight retention. Int J Obes. 2007;31(11):1642–51.CrossRef
8.
go back to reference Gavard JA, Artal R. Effect of exercise on pregnancy outcome. Clin Obstet Gynecol. 2008;51(2):467–80.CrossRefPubMed Gavard JA, Artal R. Effect of exercise on pregnancy outcome. Clin Obstet Gynecol. 2008;51(2):467–80.CrossRefPubMed
10.
go back to reference Nehring I, Schmoll S, Beyerlein A, Hauner H, von Kries R. Gestational weight gain and long-term postpartum weight retention: a meta-analysis. Am J Clin Nutr. 2011;94(5):1225–31.CrossRefPubMed Nehring I, Schmoll S, Beyerlein A, Hauner H, von Kries R. Gestational weight gain and long-term postpartum weight retention: a meta-analysis. Am J Clin Nutr. 2011;94(5):1225–31.CrossRefPubMed
11.
go back to reference Siega-Riz AM, Viswanathan M, Moos MK, et al. A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retention. Am J Obstet Gynecol. 2009;201(4):339 e331–14.CrossRef Siega-Riz AM, Viswanathan M, Moos MK, et al. A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retention. Am J Obstet Gynecol. 2009;201(4):339 e331–14.CrossRef
13.
go back to reference Cedergren M. Effects of gestational weight gain and body mass index on obstetric outcome in Sweden. Int J Gynaecol Obstet. 2006;93(3):269–74.CrossRefPubMed Cedergren M. Effects of gestational weight gain and body mass index on obstetric outcome in Sweden. Int J Gynaecol Obstet. 2006;93(3):269–74.CrossRefPubMed
14.
go back to reference Ronnberg A, Hanson U, Ostlund I, Nilsson K. Effects on postpartum weight retention after antenatal lifestyle intervention - a secondary analysis of a randomized controlled trial. Acta Obstet Gynecol Scand. 2016;95(9):999-1007. Ronnberg A, Hanson U, Ostlund I, Nilsson K. Effects on postpartum weight retention after antenatal lifestyle intervention - a secondary analysis of a randomized controlled trial. Acta Obstet Gynecol Scand. 2016;95(9):999-1007.
15.
go back to reference Geiss LS, Wang J, Cheng YJ, et al. Prevalence and incidence trends for diagnosed diabetes among adults aged 20 to 79 years, United States, 1980-2012. JAMA. 2014;312(12):1218–26.CrossRefPubMed Geiss LS, Wang J, Cheng YJ, et al. Prevalence and incidence trends for diagnosed diabetes among adults aged 20 to 79 years, United States, 1980-2012. JAMA. 2014;312(12):1218–26.CrossRefPubMed
16.
go back to reference Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight-gain as a risk factor for clinical diabetes-mellitus in women. Ann Intern Med. 1995;122(7):481–6.CrossRefPubMed Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight-gain as a risk factor for clinical diabetes-mellitus in women. Ann Intern Med. 1995;122(7):481–6.CrossRefPubMed
17.
go back to reference Catalano PM, Shankar K. Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. BMJ. 2017;356:j1.CrossRefPubMed Catalano PM, Shankar K. Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. BMJ. 2017;356:j1.CrossRefPubMed
18.
go back to reference Choi J, Fukuoka Y, Lee JH. The effects of physical activity and physical activity plus diet interventions on body weight in overweight or obese women who are pregnant or in postpartum: a systematic review and meta-analysis of randomized controlled trials. Prev Med. 2013;56(6):351–64.CrossRefPubMedPubMedCentral Choi J, Fukuoka Y, Lee JH. The effects of physical activity and physical activity plus diet interventions on body weight in overweight or obese women who are pregnant or in postpartum: a systematic review and meta-analysis of randomized controlled trials. Prev Med. 2013;56(6):351–64.CrossRefPubMedPubMedCentral
19.
go back to reference Berger AA, Peragallo-Urrutia R, Nicholson WK. Systematic review of the effect of individual and combined nutrition and exercise interventions on weight, adiposity and metabolic outcomes after delivery: evidence for developing behavioral guidelines for post-partum weight control. BMC Pregnancy Childbirth. 2014;14:319.CrossRefPubMedPubMedCentral Berger AA, Peragallo-Urrutia R, Nicholson WK. Systematic review of the effect of individual and combined nutrition and exercise interventions on weight, adiposity and metabolic outcomes after delivery: evidence for developing behavioral guidelines for post-partum weight control. BMC Pregnancy Childbirth. 2014;14:319.CrossRefPubMedPubMedCentral
20.
go back to reference Ostbye T, Krause KM, Lovelady CA, et al. Active mothers postpartum: a randomized controlled weight-loss intervention trial. Am J Prev Med. 2009;37(3):173–80.CrossRefPubMedPubMedCentral Ostbye T, Krause KM, Lovelady CA, et al. Active mothers postpartum: a randomized controlled weight-loss intervention trial. Am J Prev Med. 2009;37(3):173–80.CrossRefPubMedPubMedCentral
21.
go back to reference Nascimento SL, Pudwell J, Surita FG, Adamo KB, Smith GN. The effect of physical exercise strategies on weight loss in postpartum women: a systematic review and meta-analysis. Int J Obes. 2014;38(5):626–35.CrossRef Nascimento SL, Pudwell J, Surita FG, Adamo KB, Smith GN. The effect of physical exercise strategies on weight loss in postpartum women: a systematic review and meta-analysis. Int J Obes. 2014;38(5):626–35.CrossRef
22.
go back to reference Garnaes KK, Morkved S, Salvesen O, Moholdt T. Exercise training and weight gain in obese pregnant women: a randomized controlled trial (ETIP trial). PLoS Med. 2016;13(7):e1002079.CrossRefPubMedPubMedCentral Garnaes KK, Morkved S, Salvesen O, Moholdt T. Exercise training and weight gain in obese pregnant women: a randomized controlled trial (ETIP trial). PLoS Med. 2016;13(7):e1002079.CrossRefPubMedPubMedCentral
23.
go back to reference Moholdt TT, Salvesen K, Ingul CB, Vik T, Oken E, Morkved S. Exercise training in pregnancy for obese women (ETIP): study protocol for a randomised controlled trial. Trials. 2011;12:154.CrossRefPubMedPubMedCentral Moholdt TT, Salvesen K, Ingul CB, Vik T, Oken E, Morkved S. Exercise training in pregnancy for obese women (ETIP): study protocol for a randomised controlled trial. Trials. 2011;12:154.CrossRefPubMedPubMedCentral
24.
go back to reference Exercise during pregnancy and the postpartum period. Clin Obstet Gynecol. 2003;46(2):496–9. Exercise during pregnancy and the postpartum period. Clin Obstet Gynecol. 2003;46(2):496–9.
25.
go back to reference ACOG Committee Opinion No. 650. Physical activity and exercise during pregnancy and the postpartum period. Obstet Gynecol. 2015;126(6):e135–42.CrossRef ACOG Committee Opinion No. 650. Physical activity and exercise during pregnancy and the postpartum period. Obstet Gynecol. 2015;126(6):e135–42.CrossRef
26.
go back to reference ACOG Committee opinion. Number 267, January 2002: exercise during pregnancy and the postpartum period. Obstet Gynecol. 2002;99(1):171–3.CrossRef ACOG Committee opinion. Number 267, January 2002: exercise during pregnancy and the postpartum period. Obstet Gynecol. 2002;99(1):171–3.CrossRef
27.
28.
go back to reference Rasmussen KM, Abrams B, Bodnar LM, Butte NF, Catalano PM, Maria S-RA. Recommendations for weight gain during pregnancy in the context of the obesity epidemic. Obstet Gynecol. 2010;116(5):1191–5.CrossRefPubMedPubMedCentral Rasmussen KM, Abrams B, Bodnar LM, Butte NF, Catalano PM, Maria S-RA. Recommendations for weight gain during pregnancy in the context of the obesity epidemic. Obstet Gynecol. 2010;116(5):1191–5.CrossRefPubMedPubMedCentral
30.
go back to reference Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412–9.CrossRefPubMed Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412–9.CrossRefPubMed
31.
go back to reference Gore SA, Brown DM, West DS. The role of postpartum weight retention in obesity among women: a review of the evidence. Ann Behav Med. 2003;26(2):149–59.CrossRefPubMed Gore SA, Brown DM, West DS. The role of postpartum weight retention in obesity among women: a review of the evidence. Ann Behav Med. 2003;26(2):149–59.CrossRefPubMed
32.
go back to reference Phelan S, Phipps MG, Abrams B, et al. Does behavioral intervention in pregnancy reduce postpartum weight retention? Twelve-month outcomes of the fit for delivery randomized trial. Am J Clin Nutr. 2014;99(2):302–11.CrossRefPubMed Phelan S, Phipps MG, Abrams B, et al. Does behavioral intervention in pregnancy reduce postpartum weight retention? Twelve-month outcomes of the fit for delivery randomized trial. Am J Clin Nutr. 2014;99(2):302–11.CrossRefPubMed
33.
go back to reference Price BB, Amini SB, Kappeler K. Exercise in pregnancy: effect on fitness and obstetric outcomes-a randomized trial. Med Sci Sports Exerc. 2012;44(12):2263–9.CrossRefPubMed Price BB, Amini SB, Kappeler K. Exercise in pregnancy: effect on fitness and obstetric outcomes-a randomized trial. Med Sci Sports Exerc. 2012;44(12):2263–9.CrossRefPubMed
34.
go back to reference Asci O, Rathfisch G. Effect of lifestyle interventions of pregnant women on their dietary habits, lifestyle behaviors, and weight gain: a randomized controlled trial. J Health Popul Nutr. 2016;35:7.CrossRefPubMedPubMedCentral Asci O, Rathfisch G. Effect of lifestyle interventions of pregnant women on their dietary habits, lifestyle behaviors, and weight gain: a randomized controlled trial. J Health Popul Nutr. 2016;35:7.CrossRefPubMedPubMedCentral
35.
go back to reference Sagedal LR, Sanda B, Overby NC, et al. The effect of prenatal lifestyle intervention on weight retention 12 months postpartum: results of the Norwegian fit for delivery randomised controlled trial. BJOG. 2016;124(1):111-121. doi:10.1111/1471-0528.13863. Sagedal LR, Sanda B, Overby NC, et al. The effect of prenatal lifestyle intervention on weight retention 12 months postpartum: results of the Norwegian fit for delivery randomised controlled trial. BJOG. 2016;124(1):111-121. doi:10.​1111/​1471-0528.​13863.
36.
go back to reference Vinter CA, Jensen DM, Ovesen P, et al. Postpartum weight retention and breastfeeding among obese women from the randomized controlled lifestyle in pregnancy (LiP) trial. Acta Obstet Gynecol Scand. 2014;93(8):794–801.CrossRefPubMed Vinter CA, Jensen DM, Ovesen P, et al. Postpartum weight retention and breastfeeding among obese women from the randomized controlled lifestyle in pregnancy (LiP) trial. Acta Obstet Gynecol Scand. 2014;93(8):794–801.CrossRefPubMed
37.
go back to reference Ronnberg A, Hanson U, Ostlund I, Nilsson K. Effects on postpartum weight retention after antenatal lifestyle intervention - a secondary analysis of a randomized controlled trial. Acta Obstet Gynecol Scand. 2016;95(9):999–1007.CrossRefPubMed Ronnberg A, Hanson U, Ostlund I, Nilsson K. Effects on postpartum weight retention after antenatal lifestyle intervention - a secondary analysis of a randomized controlled trial. Acta Obstet Gynecol Scand. 2016;95(9):999–1007.CrossRefPubMed
38.
go back to reference Leuridan L, Wens J, Devlieger R, Verhaeghe J, Mathieu C, Benhalima K. Glucose intolerance in early postpartum in women with gestational diabetes: who is at increased risk? Prim Care Diabetes. 2015;9(4):244–52.CrossRefPubMed Leuridan L, Wens J, Devlieger R, Verhaeghe J, Mathieu C, Benhalima K. Glucose intolerance in early postpartum in women with gestational diabetes: who is at increased risk? Prim Care Diabetes. 2015;9(4):244–52.CrossRefPubMed
39.
go back to reference Buchanan TA, Xiang A, Kjos SL, Watanabe R. What is gestational diabetes? Diabetes Care. 2007;30(Suppl 2):S105–11.CrossRefPubMed Buchanan TA, Xiang A, Kjos SL, Watanabe R. What is gestational diabetes? Diabetes Care. 2007;30(Suppl 2):S105–11.CrossRefPubMed
41.
go back to reference Ramakrishnan A, Lee LJ, Mitchell LE, Agopian AJ. Maternal hypertension during pregnancy and the risk of congenital heart defects in offspring: a systematic review and meta-analysis. Pediatr Cardiol. 2015;36(7):1442–51.CrossRefPubMedPubMedCentral Ramakrishnan A, Lee LJ, Mitchell LE, Agopian AJ. Maternal hypertension during pregnancy and the risk of congenital heart defects in offspring: a systematic review and meta-analysis. Pediatr Cardiol. 2015;36(7):1442–51.CrossRefPubMedPubMedCentral
42.
go back to reference Gaudet L, Wen SW, Walker M. The combined effect of maternal obesity and fetal macrosomia on pregnancy outcomes. J Obstet Gynaecol Can. 2014;36(9):776–84.CrossRefPubMed Gaudet L, Wen SW, Walker M. The combined effect of maternal obesity and fetal macrosomia on pregnancy outcomes. J Obstet Gynaecol Can. 2014;36(9):776–84.CrossRefPubMed
43.
go back to reference Marchi J, Berg M, Dencker A, Olander EK, Begley C. Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews. Obes Rev. 2015;16(8):621–38.CrossRefPubMed Marchi J, Berg M, Dencker A, Olander EK, Begley C. Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews. Obes Rev. 2015;16(8):621–38.CrossRefPubMed
44.
go back to reference Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2002;136(7):493–503.CrossRefPubMed Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2002;136(7):493–503.CrossRefPubMed
45.
go back to reference Schwingshackl L, Dias S, Hoffmann G. Impact of long-term lifestyle programmes on weight loss and cardiovascular risk factors in overweight/obese participants: a systematic review and network meta-analysis. Syst Rev. 2014;3:130.CrossRefPubMedPubMedCentral Schwingshackl L, Dias S, Hoffmann G. Impact of long-term lifestyle programmes on weight loss and cardiovascular risk factors in overweight/obese participants: a systematic review and network meta-analysis. Syst Rev. 2014;3:130.CrossRefPubMedPubMedCentral
46.
go back to reference American College of O, Gynecologists. Exercise during pregnancy and the postpartum period. Clin Obstet Gynecol. 2003;46(2):496–9.CrossRef American College of O, Gynecologists. Exercise during pregnancy and the postpartum period. Clin Obstet Gynecol. 2003;46(2):496–9.CrossRef
47.
go back to reference Sui Z, Moran LJ, Dodd JM. Physical activity levels during pregnancy and gestational weight gain among women who are overweight or obese. Health Promot J Austr. 2013;24(3):206–13.CrossRefPubMed Sui Z, Moran LJ, Dodd JM. Physical activity levels during pregnancy and gestational weight gain among women who are overweight or obese. Health Promot J Austr. 2013;24(3):206–13.CrossRefPubMed
48.
go back to reference Straub H, Simon C, Plunkett BA, et al. Evidence for a complex relationship among weight retention, Cortisol and breastfeeding in postpartum women. Matern Child Health J. 2016;20(7):1375–83.CrossRefPubMedPubMedCentral Straub H, Simon C, Plunkett BA, et al. Evidence for a complex relationship among weight retention, Cortisol and breastfeeding in postpartum women. Matern Child Health J. 2016;20(7):1375–83.CrossRefPubMedPubMedCentral
49.
go back to reference Avery ND, Wolfe LA, Amara CE, Davies GA, McGrath MJ. Effects of human pregnancy on cardiac autonomic function above and below the ventilatory threshold. J Appl Physiol (1985). 2001;90(1):321–8.CrossRef Avery ND, Wolfe LA, Amara CE, Davies GA, McGrath MJ. Effects of human pregnancy on cardiac autonomic function above and below the ventilatory threshold. J Appl Physiol (1985). 2001;90(1):321–8.CrossRef
50.
go back to reference Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care. 2002;25(10):1862–8.CrossRefPubMed Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care. 2002;25(10):1862–8.CrossRefPubMed
Metadata
Title
Exercise training during pregnancy reduces circulating insulin levels in overweight/obese women postpartum: secondary analysis of a randomised controlled trial (the ETIP trial)
Authors
Kirsti K. Garnæs
Siv Mørkved
Kjell Å. Salvesen
Øyvind Salvesen
Trine Moholdt
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2018
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-017-1653-5

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