Motivational interviewing to increase physical activity in women with gestational diabetes
Regular physical activity improves glycaemic control in pregnant women with gestational diabetes. Motivational interviewing is an effective technique for increasing activity levels. This report evaluates a clinical pathway developed to integrate physical activity motivational interviewing into routine gestational diabetes care. Women attending a single-centre NHS clinic were invited to engage in a physical activity-focused motivational interview. The aerobic physical activity levels of 62 women were evaluated at baseline and at a 2-week telephone follow up, coded into three categories by minutes of moderate intensity physical activity per week: red (<30 minutes), amber (30–149 minutes) and green (≥150 minutes). At baseline, 30.6% of participants were coded red, 41.9% amber and 27.4% green. At follow up, 4.8% women coded red, 38.7% amber and 56.5% green, demonstrating a significant association for increased activity levels after motivational interviewing (P<0.001). This clinical pathway provides encouraging results that physical activity increased significantly in the short term.
Gestational diabetes mellitus (GDM) is defined as glucose intolerance first identified in pregnancy that resolves postpartum (Basri et al, 2018). It has an increasing prevalence worldwide and is associated with potentially serious complications for both mother and baby (Metzger et al, 2008; Galtier, 2010). Fundamental to the management of GDM is controlling blood glucose levels, with elevated levels of hyperglycaemia suggested as the mechanism that causes increased risk of adverse maternal and infant outcomes (Lowe et al, 2012).
Management of GDM includes lifestyle interventions and pharmacological therapy. Lifestyle interventions (including as a minimum healthy eating, physical activity and self-monitoring of blood glucose concentrations) are the only interventions that have reported health improvements for maternal and fetal outcomes (Martis et al, 2018).
There is growing evidence surrounding the benefits of physical activity amongst women with GDM. Meta-analyses of physical activity and exercise interventions have shown improvements in glycaemic control and reduced insulin requirements (Harrison et al, 2016; Cremona et al, 2018; Hillyard et al, 2018). Other benefits include improved cardiovascular fitness, mental wellbeing and prevention of hypertensive disorders (Mottola et al, 2018; Dipietro et al, 2019). It is recommended by the UK chief medical officer physical activity guidelines (Royal College of Obstetricians and Gynaecologists, 2017) that women undertake at least 150 minutes of aerobic physical activity and perform muscle strengthening activities twice per week throughout pregnancy (Mottola et al, 2018; Dipietro et al, 2019). Despite this, a report found at least 65% of women with GDM are not meeting recommendations (Galliano et al, 2019). Common reported barriers are fatigue, lack of time and pregnancy discomfort. Frequent enablers include maternal and fetal health benefits, social support and pregnancy-specific programs (Harrison et al, 2018). It has been highlighted that women with GDM require clear, simple and specific messages to feel confident and safe about being physically active (Harrison et al, 2019). However, time allocation and resources compete with other components of care, and many inactive women forgo the benefits of physical activity.
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