Pregnant Women With Gestational Diabetes: Gap Identification

Introduction

Gestational diabetes is a health condition that affects approximately 10% of women during pregnancy. The researchers distinguish two main types of gestational diabetes: A1 and A2 classes. Women with A1 gestational diabetes can manage their high sugar levels through exercise and custom-made diet schedules. When it comes to A2, it is necessary to take specific medications such as insulin (Bane, 2015). After pregnancy, gestational diabetes goes away, but complications may develop further.

The baby’s health can be impacted severely, which is an incentive for proper intervention. The mother is exposed to an increased risk of type 2 diabetes later if she had the aforementioned problem during pregnancy. Recommendations from scholarly articles confirm the idea that aerobic exercises may be helpful to prevent obesity, thereby avoiding type 2 diabetes (Bane, 2015). As a research tool, a PICO question will be utilized. The question is as follows: in pregnant women with gestational diabetes (P), can aerobic exercises (I) prevent the incidence of type 2 diabetes (O) within two years of postpartum (T)?

Literature Review

Weight Reduction Through Exercises

In their research, Moon, Kwak, and Jang (2017) dwelled on the role of glucose intolerance in pregnant women and the underlying influence of gestational diabetes on the prevalence of type 2 diabetes in postpartum females. With a 700% increase in the risk for the development of postpartum diabetes, women with gestational diabetes are required to complete specific exercises, in particular, aerobics and resistance training (Bane, 2015).

Different dietary patterns, family history, maternal age, pre-pregnancy BMI, and breastfeeding preferences were addressed as some of the factors that impact the risk for type 2 diabetes (Di Cianni et al., 2018). From the genetic studies on the subject, it became clear that type 2 diabetes had common genetic variations with gestational diabetes. However, the authors did not provide primary data and conducted a literature review, thereby summarizing the findings (Di Cianni et al., 2018). As a result, this study may be seen as a background for intervention but not as a guide to work.

Benefits of Lifestyle Interventions

The article written by Moon et al. (2017) took on the topics of modifiable risks and lifestyle interventions that could reduce the incidence of type 2 diabetes. As the researchers also stated, the risk for postpartum diabetes could be adequately mitigated with the help of physical exercise and lifestyle interventions (Moon et al., 2017). Ruchat et al. (2018) shared a similar outlook, with the only difference being that the latter noted the effectiveness of exercises and health management programs.

There was also an idea that prenatal exercises could significantly contribute to reducing diabetes-related risks. In similar research projects that raise the issue of clinical interventions, some gaps may be identified, which relate to small samples and a reduced value of study validity, for instance, in the article by Li et al. (2015). In particular, the authors include both males and females in their research, while paying little attention to postpartum (Li et al., 2015). Therefore, these gaps are the reason to pay attention to moderate intensity exercises as one of the most effective tools in working with postpartum women that face an increased risk of type 2 diabetes.

Similarly, Elliott-Sale, Barnett, and Sale (2015) took on the topic of exercise in postpartum women. They argued that three training sessions per week might be enough to help mothers evade or at least reduce the risk of getting type 2 diabetes. They also mentioned that found only a limited number of studies that supported their findings, which confirms that the topic of exercise in postpartum women yet has to be researched more profoundly. As Wang, Guelfi, and Yang (2016) suggested, those exercise sets should include resistance-based drills and not only the aerobic ones, as it would assist women in following up the childbirth process.

This study was consistent and included recommendations from reputable health agencies. Through a review of available information and interaction with healthcare organizations, the researchers identified the symptoms of type 2 diabetes during postpartum and explained the significance of alternating exercises to prevent overload (Wang et al., 2016). Therefore, one can conclude that the results achieved for postpartum women may be considered valid. This leaves exercise to be arguably the best method to mitigate excessive weight, increased blood sugar, and predisposition to type 2 diabetes.

Mitigation of Type 2 Diabetes through Exercise

According to Endres et al. (2015), exercises for postpartum women with a history of gestational diabetes highlight the value of a mix of strengthening, aerobic, and toning exercises. The evidence from existing literature shows that researchers adequately prevent bias in their research projects, with one of the critical recommendations being to control postpartum weight by any means (Bane, 2015). The efficacy of exercises has been outlined as a decisive factor during postpartum.

Nevertheless, it was also mentioned by Li et al. (2015) and Wang et al. (2016) that the duration and intensity of training should be considered when interacting with postpartum women. Another important conclusion was that long-term phenotypic transformation would require study participants to follow the exercise plan relentlessly and make sure that all study requirements are respected as well (Endres et al., 2015). These findings could be used to communicate the need for exercise among high-risk populations.

Another critical article on the topic of type 2 diabetes in postpartum women was written by Tawfik (2016), who discussed a new intervention for high-risk women. This was a randomized controlled trial, and corresponding correlations were obtained in a statistical ratio. The author stated that pre-pregnancy BMI had a crucial impact on the development of associated conditions, including diabetes (Tawfik, 2016).

Most importantly, the researcher mentioned that the family history of type 2 diabetes could be devastating for postpartum women since their exposure to adverse outcomes would proliferate almost exponentially (Tawfik, 2016). The effectiveness of lifestyle interventions was not supported by extensive evidence, but the premises for further investigation on knowledge-based interventions were highlighted. Tawfik (2016), similarly to Ruchat et al. (2018), stated that postpartum women would require a lengthy follow-up schedule to make sure that lifestyle modifications were positive.

Diabetes-Related Risks and Their Association with Aerobic Exercises

In the article by Bertz, Sparud-Lundin, and Winkvist (2015), the authors discussed the impact of weight loss on the postpartum treatment of diabetes-related risks. In addition to exercises and the treatment context, the researchers also pointed out the considerable role that care providers played in the promotion and installment of exercise programs among postpartum women (Bertz et al., 2015). However, despite a systematic review being chosen as a study methodology, small sample size was provided, which was a limitation.

A similar model of approaching type 2 diabetes was mentioned by Wang et al. (2016), and in their review, the authors focused solely on treatment obstacles and enablers. The weight-loss treatment was found to be most effective when it was applied together with physical exercises, which included aerobic and resistance-based variations. The category of aerobic exercises was considered effective only in the case when weight loss treatment had been accurately aligned against the renewed dietary pattern and lifestyle trends.

The article by Li et al. (2015), on the other hand, pointed out the importance of predicting specific outcomes in postpartum women and engaging this target population to demonstrate their willpower through physical exercise, in particular, aerobics. The support from care providers and family members should be carefully introduced into the program as well. This practice would generate a greater understanding of one’s emotions, behaviors, and cognition (Elliott-Sale et al., 2015).

Nonetheless, the researchers concluded that the barriers to a renewed lifestyle could only be overcome with the help of external actors who would support postpartum women and help them navigate through required aerobic exercises and dietary changes (Moon et al., 2017). Overall, the issue of type 2 diabetes-related risks may be outlined as multidimensional in postpartum women due to the prevalence of unhealthy lifestyles that lead to obesity.

A Summary of Evidence

First, gestational diabetes is a significant health issue that causes many problems and requires interventions to eliminate its premises, in particular, corresponding physical exercises. The challenge with the evidence that was obtained within the framework of the current literature review is that it may be hard to translate factual data into practice effectively. Prevention measures, such as aerobic exercises, should be started as early as possible to make sure that postpartum women are protected from the impact of type 2 diabetes.

The idea is that both care providers and postpartum women should realize the importance of maintaining a healthy lifestyle and creating premises for improved everyday habits. Currently, there is no universal approach to how aerobics could be used to prevent type 2 diabetes in women who were diagnosed with gestational diabetes. Nonetheless, raising awareness of the benefits of aerobic exercises among postpartum women could significantly reduce the prevalence of type 2 diabetes, as the existing evidence clearly shows that the benefits of this approach are real.

Conclusion

Implications for Nursing Practice

The current literature review shows that pregnancy presents a severe risk for women who are predisposed to obesity, since, as Bane (2015) argued, the threat of weight gain after giving birth increased by 60%. The most prevalent risk factors for type 2 diabetes in women who had already given birth were identified. These drivers were the race, including African American women being the most exposed population, high BMI before the pregnancy, the lack of postpartum exercises, and the absence of breastfeeding (Bane, 2015; Ruchat et al., 2018). Female prenatal obesity was considered one of the prerequisites for weight gain in the postpartum period and, in particular, the development of type 2 diabetes.

Despite the limited success of the studied articles, the current review shows that weight in postpartum women should be modified with the help of physical activity (Endres et al., 2015). During postpartum, women should focus on dietary patterns as well, as it would help them evade obesity by one or two years postpartum. The excessive weight that had been gained during pregnancy would be mitigated easier in those women that had not been overweight before the pregnancy. Therefore, aerobic exercises could be considered a crucial contributor to a woman’s ability to get through the postpartum period without getting type 2 diabetes as a follow-up to its gestational variation.

Recommendations for Future Practice and Research

Based on the information collected throughout the literature review, it was found that health care providers could seriously benefit from the recommendations that were provided by the Institute of Medicine. As Bertz et al. (2015) argued, this board discussed weight gain with pregnant women and offered follow-up activities represented by physical exercises and diets. Every pregnant client would gain more insight into the process of monitoring weight gain, which also means that type 2 diabetes would be mediated by nutrition counseling and exercise plans.

Within the framework of future research projects, investigators should review the benefit of breastfeeding and moderate exercises, as the literature showed that a moderate exercise program would significantly reduce the prevalence of type 2 diabetes in postpartum women (Di Cianni et al., 2018). The essential variables that should be taken into consideration are the age when the woman gets pregnant, her race, weight gain prevalence during pregnancy, and the BMI before pregnancy.

All health consequences of obesity are to be perceived as critical health issues on a nationwide scale, which makes the need for synergistic interventions rather urgent. The underlying mechanisms of preventing type 2 diabetes may be seen as the essential gap that has yet to be addressed within future research projects. However, as a gap, one can remark little information about specific exercise types, for instance, water gymnastics, and only Ruchat et al. (2018) barely discuss this topic, although this practice correlates with postpartum obesity.

Another challenge that has to be approached by nurses is the ability to maintain specific behaviors in postpartum women that have to move with precision to reduce excessive weight and condense the impact of an inflated BMI on their future health. Lifestyle changes should be promoted among postpartum women who had gestational diabetes because the relationship between one’s physical shape and the prevalence of type 2 diabetes became evident from the literature review.

References

Bane, S. M. (2015). Postpartum exercise and lactation. Clinical Obstetrics and Gynecology, 58(4), 885-892.

Bertz, F., Sparud-Lundin, C., & Winkvist, A. (2015). Transformative Lifestyle Change: Key to sustainable weight loss among women in a post-partum diet and exercise intervention. Maternal & Child Nutrition, 11(4), 631-645.

Di Cianni, G., Lacaria, E., Lencioni, C., & Resi, V. (2018). Preventing type 2 diabetes and cardiovascular disease in women with gestational diabetes – The evidence and potential strategies. Diabetes Research and Clinical Practice, 145, 184-192.

Elliott-Sale, K. J., Barnett, C. T., & Sale, C. (2015). Exercise interventions for weight management during pregnancy and up to 1 year postpartum among normal weight, overweight and obese women: A systematic review and meta-analysis. British Journal of Sports Medicine, 49(20), 1336-1342.

Endres, L. K., Straub, H., McKinney, C., Plunkett, B., Minkovitz, C. S., Schetter, C. D.,… Shalowitz, M. U. (2015). Postpartum weight retention risk factors and relationship to obesity at one year. Obstetrics and Gynecology, 125(1), 144-152.

Li, Y., Ley, S. H., Tobias, D. K., Chiuve, S. E., VanderWeele, T. J., Rich-Edwards, J. W.,… Qi, L. (2015). Birth weight and later life adherence to unhealthy lifestyles in predicting type 2 diabetes: Prospective cohort study. BMJ, 351, 1-9.

Moon, J. H., Kwak, S. H., & Jang, H. C. (2017). Prevention of type 2 diabetes mellitus in women with previous gestational diabetes mellitus. The Korean Journal of Internal Medicine, 32(1), 26-42.

Ruchat, S. M., Mottola, M. F., Skow, R. J., Nagpal, T. S., Meah, V. L., James, M.,… Nuspl, M. (2018). Effectiveness of exercise interventions in the prevention of excessive gestational weight gain and postpartum weight retention: A systematic review and meta-analysis. British Journal of Sports Medicine, 52(21), 1347-1356.

Tawfik, M. Y. (2017). The impact of health education intervention for prevention and early detection of type 2 diabetes in women with gestational diabetes. Journal of Community Health, 42(3), 500-510.

Wang, C., Guelfi, K. J., & Yang, H. X. (2016). Exercise and its role in gestational diabetes mellitus. Chronic Diseases and Translational Medicine, 2(4), 208-214.