15, 95% CI −0.33

to 0.03), or oral glucose tolerance tests at 2 hours (−0.13 mmol/L, 95% CI −0.28 to 0.03) between the groups. Fasting insulin was significantly lower in the intervention group by 1.0 international units/mL (95% CI −0.1 to −1.9). The groups did not differ significantly on any of the secondary outcomes. Adherence to the exercise protocol in the intervention group was 55%. A per protocol analysis of 217 women in the intervention group who adhered to the exercise program demonstrated similar results with no difference in prevalence of diabetes. Conclusion: A 12-week exercise program undertaken during the second trimester of pregnancy did not reduce the prevalence Perifosine cost of gestational diabetes in pregnant women with BMI in the normal range. Diabetes causes 5% of deaths worldwide, mainly in low-to-middle income countries XAV-939 purchase and affects over 220 million people. About 60% of women with gestational diabetes mellitus (GDM) are at high-risk of developing Type 2 diabetes within 20 years (Boerschmann et al 2010). Current guidelines (Artal and O’Toole 2003) recommend regular exercise for pregnant women, including those who are sedentary. However, the effect of exercise on the development of GDM has been studied little, and the results of published studies are conflicting (Callaway et al 2010).

Stafne et al (2012) have presented a paper of excellent methodological quality, reported according to CONSORT, and dealing with the controversial question of exercise during pregnancy. In this trial, the incidence of GDM was similar in both groups and levels of insulin resistance (HOMA-IR) also showed no difference between groups, regardless of adjustment for factors such as baseline fasting insulin levels. Of note, only 55% of women in the exercise group adhered to the study protocol and 10% of women in the control group exercised at least three days per week. An exploratory analysis, in which adherent women in the exercise group were compared with

women in the control group, showed no difference in incidence of GDM, but fasting insulin was lower in the adherent women. Given that the trial was not powered to compare adherent and non adherent women, results of the exploratory analysis should be interpreted with caution. The lack of Ketanserin adherence to the exercise protocol among the study participants confirms a pressing priority in this area is effective promotion of exercise in pregnant women. It is unclear whether the effect on GDM alone is large enough for pregnant women to feel it justifies the time, effort, and cost of an exercise program. Other trials should determine whether any specific type of exercise before pregnancy prevents GDM. Despite the uncertainty about whether exercise during pregnancy prevents GDM, exercise provides other benefits such as reducing depressive symptoms (Robledo-Colonia 2012) suggesting we should continue prescription of exercise during pregnancy.