Effect of Exercise in Preventing Gestational Diabetes Mellitus in Racially Diverse Overweight Pregnant Women

Title: Effect of Exercise in Preventing Gestational Diabetes Mellitus in Racially Diverse Overweight Pregnant Women Authors: Barry Francis1, Ami Eho1, Bre McDonald1, Sadaf Dabeer, Ph.D.2, Juliana Meireles, Ph.D.2, Katherine H. Ingram, Ph.D.(mentor)2 Institution: 1Department of Molecular and Cellular Biology, 2Department of Exercise Science and Sport Management, Kennesaw State University Introduction: With the increase in unhealthy lifestyles in the Western world, obesity and other chronic diseases plague our current society. Gestational diabetes mellitus (GDM) remains a major complication affecting 7-10% of pregnancies. The fetus is affected by GDM which increases chances of having diabetes in their lifetime. Racial and ethnic minority populations especially American Indians and African Americans are at a higher risk of GDM. Some studies postulated that this might be due to the prevalence of obesity in these groups. Exercise has been shown to lower the risk for GDM in overweight pregnant women. Studies reviewed the necessity of exercise pre-pregnancy and during pregnancy, but the correct amount of exercise to see these effects in racially- diverse women remains to be determined. Purpose: The aim of this study is to conduct a systematic review which evaluates the specific exercise volume required to prevent GDM in women of different races who are also overweight. Methods: PubMed, Cochrane Library, EMBASE, and the Kennesaw State University library system will be searched to identify systematic reviews and randomized trials published until 2021. Key terms to be utilized include: pregnancy, GDM, at-risk, obesity, race, and exercise/physical activity. Using these terms but omitting “obesity,” the number of sources available on PubMed narrowed to 21 sources. Of these 21 sources, based on the criteria deemed necessary for the review, different races represented, at-risk women with GDM, and the volume of exercise deemed necessary, only five of those 21 articles matched the necessary guidelines. When key terms overweight, pregnant women, exercise, GDM were entered along with the Boolean operators with terms AND, OR in PubMed, excluding the focus on diet, 78 results were obtained. With the filters of English for language and human for species checked, 10 were deemed fit. Including the five sources from the search focusing on race and the 10 sources found from an obesity focus, 15 total sources were collected. Conclusion: The findings from this study will provide more information about specific exercise volume that should be recommended as part of prenatal care to pregnant women based on their racial differences in order to decrease the prevalence of GDM in these groups

Agreement Between 3 Physical Activity Monitors for Estimating Step Count

PURPOSE: The ActiGraph GT3X, ActiGraph GT9X, and ActivPAL 4 are accelerometry devices used to measure human physical activity for both research and clinical data. The accelerometer selection is important to yield the most accurate data. This study tests the association and agreement between estimated step counts measured by these accelerometry devices. METHODS: Two males and five females participated (Age: 19.6±3.0 years, BMI: 23.2±6.0 kg/m2). Three accelerometers were worn simultaneously for at least 19 hours. Two ActiGraphs (GT3X and GT9X) were worn on the waist and one ActivPAL monitor was affixed to the right thigh. Step count data from the 3 devices were compared using ANOVA test and were associated using Pearson correlation test. Agreement was determined by calculating the correlation between the difference in step count between 2 devices and the average of the step counts from the 2 devices. RESULTS: Average step count recorded from the GT3X (5644± 2410.3), GT9X (5229.2± 2088.1), and ActivPAL 4 (5836.4± 2641.6) appear to be similar (p=0.924). Strong correlations were found in step count between GT3X and GT9X (r= 0.978, p= 0.001), GT3X and ActivPAL 4 (r=0.995, p=0.001), and GT9X and ActivPAL 4 (r= 0.968, p=0.001). Step count data was in agreement between GT3X and GT9X (r= 0.479, p= 0.316), GT3X and ActivPAL 4 (r= -0.463, p= 0.355), GT9X and ActivPAL 4 (r= -0.568, p= 0.183) were also found. CONCLUSION: These findings suggest that for estimating step count, the three devices may be used interchangeably

Are prenatal exercise volume and level different between c-section and natural birth groups?

Title: Are prenatal exercise volume and level different between c-section and natural birth groups? Authors: Brianna Lee1, DJ Phillips1, Ami Eho2, Juliana Meireles, Ph.D.2, Sadaf Dabeer, Ph.D.3, Janeen Amason, Ph.D.1, Katherine Ingram, Ph.D.2 Institution: 1Wellstar School of Nursing, Kennesaw State University, Kennesaw, GA, USA 2Department of Exercise Science and Sports Management, Kennesaw State University, 3 Department of Endocrinology, Emory University, Atlanta, GA, USA Background: According to the World Health Organization (WHO), the ideal rate for c-section births is between 10% and 15% of births. However, the Centers for Disease Control and Prevention (CDC) reports there is a current rate of 31% for C-section births in the United States. The American College of Obstetricians and Gynecologists (ACOG) mentioned that based on observational studies, women who exercise during pregnancy have shown benefits such as decreased C-section births. Objective: The purpose of the study is to compare exercise volume and level between c-section and natural birth groups. Methods: Women who had given birth in the past two years were invited to participate in an online survey that asked for descriptive information (age and race) and mode of delivery. They provided information about the frequency of overall exercise and the frequency of engaging in high, moderate, and light intensity exercise. Exercise volume score was calculated using [(high intensity exercise frequency*3) + (moderate intensity exercise frequency*2) + (light intensity exercise frequency*1)]. Exercise level was calculated as Exercise volume score * Frequency of overall exercise. Comparisons were made using Mann Whitney U test. Results: Data from 232 women (33±4.61 years, 75% white) was used for analysis. Responses show that 163 women (70.3%) gave birth naturally while 69 women (29.7%) had c-section delivery. Natural delivery group (8.19±6.18) had a significantly higher exercise volume score (p=0.048) when compared to the c-section group (6.39±5.50). No statistical difference was found in exercise level (p=0.102) between mode of delivery groups (17.63±17.92 vs 12.72±14.41). Conclusion: Exercise level was similar between mode of delivery groups. However, women who gave birth naturally reported a higher volume of exercise than those who had a c-section. Health care providers should emphasize exercise intensity and frequency guidelines when discussing exercise with pregnant women

The Relationship Between Self-Reported Exercise Levels During Pregnancy and Labor Pains

Abstract Background: Physical activity is important to maintain overall health and wellness even during pregnancy. There are numerous benefits to exercise during pregnancy that include reduced back pain and lower risk of preeclampsia and gestational diabetes. Recent studies have shown an association between aerobic exercise and reduction in the intensity of labor pains. Purpose: The purpose of this study is to determine the association among level of exercise level and the intensity of pain during active labor. Methods: Women up to 2 years postpartum were invited to complete an online survey about the frequency of exercise (none, occasionally, a few times a week, or most days of the week) and intensity (high, moderate, and light). To calculate exercise level, we used the formula exercise level = [(high x 3) + (moderate x 2) +(light x 1)]*Frequency. Participants also answered how intense their active labor pains were using a scale of 1-10, with 10 being the worst. The Kolmogorov-Smirnov test was used to evaluate data distribution and Spearman’s test to verify the correlations. Results: A cohort of 160 women aged between 22 to 47 years (mean age 32±.36 years, BMI 29 ±0.47) suggested no correlation between exercise intensity during pregnancy and pain intensity during active labor (p\u3e0.05). In addition, the mean exercise level was 20.17, the maximum being 69. The labor pain mean was 7.5, with the maximum being 10. For high exercise intensity, half of the population reported none. For moderate exercise intensity, the majority reported sometimes. For light exercise intensity, the majority claimed they exercised 2-3 days of the week. Conclusion:There was no correlation between exercise levels during pregnancy and labor pains. However, ACOG recommends that women include exercise in a healthy pregnancy to ease discomfort. Therefore, further research is needed to determine the role of exercise in labor pains with previous studies showing a linkage between exercise and pain during labor

Clinical Importance of FNDC-5 and Selectin-E mRNA Expression Among Type 2 Diabetics with and without Obesity

Background: Type 2 diabetes mellitus (T2DM) is growing illnesses associated with metabolic dysregulation such as obesity affecting a large population become leading causes of death worldwide. Fibronectin type III domain-containing protein 5 (FNDC-5) and selectin-E were suggested to have effects on metabolism and diabetes, therefore present study aimed to evaluate the clinical importance of FNDC-5 and selectin-E among the T2DM patients with and without obesity. Methods: Study included cohort of 200 T2DM patients with and without obesity. We evaluated FNDC-5, selectin-E mRNA expression as well as vitamin-D, and vitamin-B12 levels in among the T2DM patients with and without obesity. Results: Study observed significant difference in biochemical parameters included in study. T2DM patients with obesity had significantly higher fasting blood glucose levels (p\u3c0.0001) and HbA1c (glycated hemoglobin) (p\u3c0.0001) compared to those T2DM patients without obesity. T2DM patients with obesity also had higher systolic blood pressure (p=0.001), LDL (low density lipoprotein) (p=0.02), TG (triglycerides) (p=0.02) and cholesterol (p=0.01) compared to T2DM patients without obesity. The mRNA expression of FNDC-5 (p\u3c0.0001) was lower in T2DM patients with obesity compared to T2DM patients without obesity. It was observed that the T2DM patients with vitamin-D deficiency had significantly lower FNDC-5 mRNA expression (p=0.03) when compared with those with sufficient vitamin-D level. T2DM patients with clinically normal vitamin-B12 level expressed 0.60 fold FNDC-5 mRNA expression while B12 deficient T2DM patients had 0.28 fold FNDC-5 mRNA expression (p=0.005). No as such significant association was was observed with selectin-E. A negative correlation of FNDC-5 mRNA expression with Post prandial glucose (mg/dl) (p=0.04) and TG (mg/dl) (p=0.02) was observed. Conclusion: FNDC-5 down regulation was observed with T2DM with obesity, vitamin-D and vitamin-B12 deficiency suggesting obesity, vitamin-D and vitamin-B12 deficiency could be the factor for FNDC-5 down-regulation leading to worseness or progression of disease. We suggest that FNDC-5 down-regulation could be used as an indicator for T2DM worseness and development of other associated complications

Agreement Between 2 Bioimpedance Devices for Estimating Body Composition in Pregnant Women

INTRODUCTION: Body composition is an important metric in pregnant women for assessing risk of metabolic disorders such as gestational diabetes mellitus. The InBody (IB) 720 and InBody 230 (InBody, Seoul, South Korea) are multi-frequency bioelectrical impedance analysis (BIA) devices used to estimate body composition. The IB720 is a research-grade device while the IB230 is a portable device. Previous studies have assessed the agreement of BIA devices in general population adults but not in pregnant women. The purpose of this investigation was to evaluate the reliability of the IB230 and IB720 to measure total body water (TBW), total lean mass (TLM), and total fat mass (TFM) in pregnant women. METHODS: Thirty-two pregnant women (27.0±7.8 years; BMI 31.8±4.5 kg/m2, 68.8% Caucasian) were evaluated using the IB720 and the IB230 at 19-21 weeks gestation. Total body water (TBW), total lean mass (TLM), and total fat mass (TFM) were estimated and compared using Pearson’s correlation coefficients. RESULTS: Average TBW was 34.8±5.1kg from IB720 and 34.9±5.41kg from IB230. Average TLM was 47.7±7.0kg from IB720 and 45.6±11.4kg from IB230. Average TFM was 34.7±15.2kg from IB720 and 34.6±14.7kg from IB230. Measures from IB720 and IB230 were strongly correlated for TBW, TLM, and TFM (r = 0.994, 0.663, 0.998, respectively, p\u3c0.01 for all (2-tailed)). CONCLUSION: The IB720 and IB230 produced similar measurements for TBW, TLM, and TFM. The data suggest that the portable and more accessible IB230 was in agreement with the IB720 and can be used to estimate body composition in pregnant women

The association between Age, BMI, and Gestational Weight Gain with HOMA-IR during pregnancy

Introduction: The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) is used to determine insulin resistance in individuals. During pregnancy, several variables may be related to HOMA-IR, including age, gestational weight gain (GWG), and body mass index (BMI), which classifies an individual\u27s weight as healthy or unhealthy. The objective of this research is to test the relationships of age, GWG at 20-weeks, and BMI at 20-weeks with log HOMA-IR. Methods: Twenty-six women (27.8±4.2 years; 74.1% white) completed this study between 2015 and 2016. HOMA-IR was measured using fasting plasma insulin and blood glucose (fasting insulin[microU/L] x fasting glucose [nmol/L]/22.5). The Pearson Correlation test was used to determine correlations between the variables. Results: Mean GWG at 20-weeks was 5.3kg±5.1 (range -5.4 kg to 15.9 kg). BMI at 20-weeks ranged from 19.7 kg/m2 to 43.5 kg/m2, with an average of 29.6444 kg/m2, ±5.99733. There was a correlation between (r=0.614, p=0.001) HOMA-IR and BMI at 20-weeks. There was no correlation between HOMA-IR and age (r=0.044, p=0.83), nor between HOMA-IR and GWG at 20-weeks (r=0.173, p=0.39). Conclusion: Our study showed there was no correlation between age and HOMA-IR, nor between GWG at 20-weeks and HOMA-IR; however, a correlation between BMI at 20-weeks and HOMA-IR was found. These findings may allow practitioners to understand how HOMA-IR relates to female body fat and thus monitor this variable during pregnancy to avoid complications

Agreement and Validity Between 2 Bioimpedance Devices Including Portable Device, DXA, and Isotope Dilution for Estimating Body Composition in Women

Body composition is an important metric for evaluating metabolic health. The InBody (IB) 720 and the portable and more affordable InBody 230 (InBody, Seoul, South Korea) are multi-frequency bioelectrical impedance analysis (BIA) devices used to estimate body composition. The gold standard for estimating lean mass and fat mass is dual-energy X-ray absorption (DXA), and the gold standard for body water is isotope dilution with deuterium oxide (D2O). However, the gold standards are more expensive and require technically-trained personnel. Hence, we set out to see if BIA devices can match the standards. Forty-five women (21.56±2.82 years; BMI 26.71±6.39; 27.6% Caucasian) were evaluated using the IB720, IB230, DXA, and D2O for total body water (TBW), lean body mass (LBM), and total fat mass (TFM). Validity and agreement were determined by correlation statistics and Bland-Altman plots of differences between measures versus mean. Both LBM and TFM were strongly correlated between the BIA devices and DXA, as were TBW measures by D2O and the BIA devices (r\u3e0.90, p2O were in agreement, while LBM and TFM measures by both BIA devices and DXA were not in agreement. Our findings suggest that the IB720 and IB230 can be used in place of D2O method to measure TBW; however, they cannot be used in place of DXA for fat mass and regional lean mass. The IB720 and IB230 were in agreement and can be used interchangeably for TBW and TFM

Gestational Weight Gain and Birth Weight: A Comparison by Maternal Race and Socioeconomic Status.

Introduction: Socioeconomic status and race play a role in health of pregnancies. Racial disparities in maternal health have been reported and are linked to inequities in access to equitable prenatal health care. Excessive gestational weight gain (GWG) can lead to gestational diabetes mellitus and childhood obesity in offspring. The objective of this research was to compare GWG and birthweight between socioeconomic status and maternal race groups. Methods: Women (32.9±4.6 years, N=229) who had given birth in the past two years completed a Qualtrics survey in 2019. The survey included questions regarding socioeconomic status, race, age, GWG, and birthweight. Kruskal Wallis and Mann Whitney U tests were performed. Results: Of the participants, 75.11% were Non-Hispanic/White (NHW), and 24.89% were another race (other). Educationally, 5.20% had some college or below, 41.90% Bachelor’s or Associate\u27s, 52.84% graduate degree. Economically, 16.44% made$100K. Birthweight was significantly higher for NHW when compared to others (3.48 kg±0.53 vs 3.08 kg±0.61, p=0.001). There was no difference in birthweight between educations (3.16kg±0.76 vs 3.41kg±0.58 vs 3.38kg±0.55) or between incomes (3.18kg±0.74 vs 3.34kg±0.57 vs 3.45kg±0.51). Similarly, there was no significant difference in GWG between races(13.13kg±6.12 vs 13.22kg±9.88), between educations (7.67kg±17.34 vs 12.64kg±6.34 vs 14.10kg±5.75), or between incomes (10.91kg±12.11 vs 13.25kg±6.27 vs 13.64kg±5.81). Conclusion: Babies born to NHW women had higher birthweight than those of other races, even when no differences exist in GWG. Birthweight and GWG were similar across socioeconomic statuses. Racial and ethnic disparities exist in maternal health and must be considered by health care providers

The Association between Physical Activity levels and Insulin Resistance in College Women

Introduction: The World Health Organization recommends young adults engage in physical activity (PA) daily. Regular PA has been shown to promote a better quality of life and improve overall health. Insulin resistance is a strong indicator of metabolic health in women because of its link to the development of disorders like polycystic ovarian syndrome (PCOS) and diabetes. The objective of this research was to determine the relationships between insulin resistance, and amount of time spent in sedentary, light, moderate, and vigorous PA. Methods: Thirty-eight women (20.8±2.7 years, 28.57±4.11kg/m2, 42.1% white) were asked to wear an accelerometer (Actigraph GT3X) on the waist over the course of 5 days to record their free-living physical activity. Insulin resistance was assessed using fasting blood samples and was estimated using Homeostatic Model Assessment of Insulin Resistance HOMA-IR. HOMA-IR = fasting insulin[microU/L] x fasting glucose [nmol/L]/22.5). To determine associations between HOMA-IR and levels of PA, a Pearson Correlation test was performed. Results: No correlation was found between any level of PA and HOMA-IR (sedentary: r=0.240, p=0.147, light: r=0.275, p=0.095, moderate: r=0.158, p=0.344, vigorous: r=0.239, p=0.148). Conclusion: Our findings did not show an association among different levels of PA and insulin resistance. This is inconsistent with other existing studies. To further confirm the results of this study, more research on accelerometer usage may be needed. Key Words: HOMA-IR, accelerometry, physical activity, healt