Differential Impact of Early Versus Mid-Pregnancy Physical Activity on Gestational Diabetes Mellitus: The Mediation Effect of Blood Lipid Profiles

IF 6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes/Metabolism Research and Reviews Pub Date : 2025-08-25 DOI:10.1002/dmrr.70082

Jing Peng, Bo Jiao, Zhen Huang, Feixue Shao, Yuan Liu, Cunjie Lin, Xiaolin Hua

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Abstract

Aims

Emerging evidence links low physical activity (PA) and dysregulated lipid metabolism to gestational diabetes mellitus (GDM) risk. This study aimed to determine which gestational stage is more vulnerable to low PA and whether changes in blood lipids mediate this risk.

Materials and Methods

A retrospective analysis was conducted among 3997 pregnant women (614 with GDM) during the COVID-19 lockdown in Shanghai, a unique natural experiment provided by the uniform imposition of PA restrictions. Multivariable logistic regression estimated the association between low PA at different gestational stages and GDM risk, while mediation analyses explored the role of blood lipids.

Results

Women with GDM were older and had higher rates of overweight/obesity compared with non-GDM participants. Notably, the GDM group exhibited a higher prevalence of low PA during early pregnancy and elevated lipid levels. Logistic regression demonstrated that low PA during early pregnancy was significantly associated with increased GDM risk (OR = 2.041, 95% CI: 1.577–2.644). Moreover, low PA was significantly linked to dysregulated lipid profiles in both early and mid-pregnancy. Mediation analysis further indicated that elevated total cholesterol (TC) levels partially mediated this relationship. In contrast, low PA in mid-pregnancy was not directly linked to GDM (OR = 1.244, 95% CI: 0.966–1.6), although increased triglyceride (TG) levels during this stage mediated an effect on GDM risk.

Conclusions

Early pregnancy is a critical window for GDM prevention. Additionally, these findings advocate for stage-specific exercise and lipid management strategies to reduce GDM risk and improve maternal and neonatal outcomes.

Abstract Image

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妊娠早期和中期体力活动对妊娠期糖尿病的差异影响：血脂谱的中介作用

目的越来越多的证据表明，低体力活动（PA）和脂质代谢失调与妊娠糖尿病（GDM）的风险有关。本研究旨在确定哪个妊娠阶段更容易受到低PA的影响，以及血脂的变化是否介导了这种风险。材料与方法回顾性分析上海市新冠肺炎疫情防控期间3997名孕妇（其中614名患有GDM）的数据，这是一项独特的自然实验，是统一实施PA限制的结果。多变量logistic回归估计了不同妊娠阶段低PA与GDM风险之间的关系，而中介分析探讨了血脂的作用。结果与非GDM参与者相比，患有GDM的女性年龄更大，超重/肥胖的比例更高。值得注意的是，GDM组在妊娠早期表现出更高的低PA患病率和血脂水平升高。Logistic回归显示，妊娠早期低PA与GDM风险增加显著相关（OR = 2.041, 95% CI: 1.577-2.644）。此外，低PA与妊娠早期和中期的脂质失调显著相关。中介分析进一步表明，总胆固醇（TC）水平升高部分介导了这种关系。相比之下，妊娠中期低PA与GDM没有直接联系（OR = 1.244, 95% CI: 0.966-1.6），尽管该阶段甘油三酯（TG）水平升高介导了GDM风险的影响。结论妊娠早期是预防GDM的关键窗口期。此外，这些发现提倡针对特定阶段的运动和脂质管理策略，以降低GDM风险并改善孕产妇和新生儿结局。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes/Metabolism Research and Reviews 医学-内分泌学与代谢

CiteScore

17.20

自引率

2.50%

发文量

审稿时长

4-8 weeks

期刊介绍： Diabetes/Metabolism Research and Reviews is a premier endocrinology and metabolism journal esteemed by clinicians and researchers alike. Encompassing a wide spectrum of topics including diabetes, endocrinology, metabolism, and obesity, the journal eagerly accepts submissions ranging from clinical studies to basic and translational research, as well as reviews exploring historical progress, controversial issues, and prominent opinions in the field. Join us in advancing knowledge and understanding in the realm of diabetes and metabolism.