Exercise for pregnant women with gestational diabetes for improving maternal and fetal outcomes

Background Gestational diabetes mellitus (GDM) is associated with both short‐ and long‐term complications for the mother and her baby. Exercise interventions may be useful in helping with glycaemic control and improve maternal and infant outcomes. The original review on Exercise for diabetic pregnant women has been split into two new review titles reflecting the role of exercise for pregnant women with gestational diabetes and for pregnant women with pre‐existing diabetes. Exercise for pregnant women with gestational diabetes for improving maternal and fetal outcomes (this review) Exercise for pregnant women with pre‐existing diabetes for improving maternal and fetal outcomes Objectives To evaluate the effects of exercise interventions for improving maternal and fetal outcomes in women with GDM. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (27 August 2016), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (18th August 2016), and reference lists of retrieved studies. Selection criteria We included randomised controlled trials (RCTs) comparing an exercise intervention with standard care or another intervention in pregnant women diagnosed with gestational diabetes. Quasi‐randomised and cross‐over studies, and studies including women with pre‐existing type 1 or type 2 diabetes were not eligible for inclusion. Data collection and analysis All selection of studies, assessment of trial quality and data extraction was conducted independently by two review authors. Data were checked for accuracy. Main results We included 11 randomised trials, involving 638 women. The overall risk of bias was judged to be unclear due to lack of methodological detail in the included studies. For the mother, there was no clear evidence of a difference between women in the exercise group and those in the control group for the risk of pre‐eclampsia as the measure of hypertensive disorders of pregnancy (risk ratio (RR) 0.31, 95% confidence interval (CI) 0.01 to 7.09; two RCTs, 48 women; low‐quality evidence), birth by caesarean section (RR 0.86, 95% CI 0.63 to 1.16; five RCTs, 316 women; I2 = 0%; moderate‐quality evidence), the risk of induction of labour (RR 1.38, 95% CI 0.71 to 2.68; one RCT, 40 women; low‐quality evidence) or maternal body mass index at follow‐up (postnatal weight retention or return to pre‐pregnancy weight) (mean difference (MD) 0.11 kg/m2, 95% CI ‐1.04 to 1.26; three RCTs, 254 women; I2 =