Shining a light on gestational diabetes

Dr Monique Francois is an exercise physiologist and clinical researcher at the University of Wollongong (UOW) and Illawarra Health and Medical Research Institute (IHMRI) with a research interest in the prevention and treatment of diabetes. 

In 2018, Dr Francois began researching gestational diabetes mellitus (GDM), a condition that affects up to one in five pregnant people.  

“It’s so common, and because it’s often hormonal, it can seem completely random,” she says.  

Less than a year into her research, Dr Francois was diagnosed with GDM.  

“I had friends, similarly active and health conscious to me, who had also been diagnosed with it. Even though I knewit was still possible to get GDM without risk factors, I was still really surprised (and a bit upset).” 

GDM occurs when hormones created by the placenta reduce the body’s response to insulin , causing glucose to build up in the blood instead of being absorbed by the cells. 

There is little empirical research into lifestyle (diet and exercise) prevention or treatment of GDM, with Dr Francois explaining the individuality of each diagnosis and patient means there is no one-size-fits-all approach. 

Currently, people with GDM are prescribed to do 30 minutes of light-to-moderate exercise per day, and told to maintain a healthy diet to manage glucose levels – advice also given to the general population. 

“There is no specific diet. Mainly patients work with dietitians and are recommended to eat low glycaemic foods and spread their carbohydrates throughout the day, ” says Dr Francois.  

Exercise and physical activity is currently not a large focus of GDM management.  

“However we know physiologically exercise will lower your glucose levels, so that’s an easy way to manage glucose levels in real time.” 

In July 2022 Dr Francois, along with PhD candidate Hannah Christie, completed a randomised study to analyse the effects of exercise on GDM. The study investigated whether the timing and accumulation of exercising amongst pregnant people affected glucose level regulation.  

“Our intervention had them break the standard 30-minutes of continuous exercise up into ten-minute bouts after meals. We wanted to see if that could be a strategy that women could adhere to during pregnancy (as only one in six women meet the activity recommendations) and would it improve glucose levels,” said Dr Francois. 

The study included forty women who were less than 30 weeks pregnant, diagnosed with GDM and not currently taking insulin.  

“We have published one acute study from the findings and found that there was no difference between whether women did 30 minutes of exercise or 10 minutes of exercise. They were both really similar,” says Dr Francois.  

“Some secondary analysis that we're doing now found the women that were doing more steps per day or more incidental activity had better glucose levels or better glucose control. It appears it doesn’t matter how you do it, or when you do it, as long as you are active.” 

Dr Francois says she would like to see more education around the effects of exercise on GDM to easily regulate glucose, and more awareness around the ‘not one size all approach’ to the condition to break any stigma. 

“We would like to see more advice and exercise physiologist support given on the benefits of exercise in GDM,” she says. 

“You have people panicking that their blood glucose is high, and they are surprised that going for a walk can help lower it. It’s just not really emphasised that something like walking can lower it so quickly and easily. How much walking or exercise is required, however, is something we are looking into. But something is better than nothing, depending on how you are feeling.” 

Dr Francois reminds women to look out for their own wellbeing, not just during Women’s Health Week, but year-round. 

“We want to encourage women to focus on their own health, because we know a lot of mothers will just worry about baby during the critical postpartum period. Make sure to also focus on your own health and wellbeing and nutrition,” she says. 

She also reminds women to be easy on themselves and not compare their progress to others.  

 “What works for someone else, won't necessarily work for you. It can be trial and error with your health practitioner so don’t be disheartened right away,” she says. 

“Don’t be so down on yourself if you do eat something you shouldn’t have, mitigate that by going for a walk, playing backyard sports, activities with the children or using resistance bands after eating. Something as simple as moving after eating, particularly in nature, can also make you feel better to improve your overall wellbeing.”