Aim: To evaluate the implementation and effectiveness of an exercise program for gestational diabetes.
Design: Hybrid effectiveness-implementation study
Methods: Pregnant women at an Australian Maternity Hospital diagnosed with or at higher risk of gestational diabetes (GDM) were invited to join the GDM gym. Gym attendance, birthing and neonatal outcomes and referrals to the program between April 2023 and March 2024 were assessed using the RE-AIM framework. Comparisons using chi-squared tests were made between 153 gym-goers and 582 non-participants to evaluate effectiveness.
Results: Nearly 20% of women diagnosed with GDM attended the program, with an average of 8 sessions each, and 50 at risk women avoided a diagnosis. Gym-goer characteristics were similar for parity, BMI and endocrine history to gym non-attenders. More gym-goers were aged over 35 (61% v 44% p=0.002). Compared to non-attenders, less gym-goers gave birth before 37 weeks (RR 0.34 95%CI 0.2,0.7), by caesarean section (RR 0.80 95%CI 0.7,1.0) and had low birth-weight infants under 2500g (RR 0.41 95%CI 0.2,0.8). The program was delivered over seven sessions per week, with a maximum of 25 minutes of vigorous intensity exercise, including safety screening. All diabetes team staff referred patients and self-referral within the weekly diabetes education session was most common.
Conclusion: The GDM Gym program has adequate reach, is clinically effective and was implemented and adopted within a maternity hospital gestational diabetes model of care.
Practice points: Supervised exercise was regularly attended, readily adopted by staff and effectively reduced adverse birthing and neonatal outcomes associated with gestational diabetes.