Objective: To evaluate the efficacy of an exercise intervention, in addition to usual care, to prevent or delay insulin prescription in women with gestational diabetes mellitus (GDM). Design: Randomised controlled trial Setting: University hospital Population: Women at 25-35 weeks pregnancy upon diagnosis of GDM. Methods: In the intervention arm, women had weekly, supervised, 30-45 min long exercise sessions and were encouraged to accumulate more than 5000 steps per day, monitored by a pedometer, in addition to usual care. Women in the control group had usual care only. Main outcome measure: Insulin prescription. Results: From February 2008 through April 2013, 109 women were randomized into intervention (n=57) or usual care (n=52). Two women, both in the intervention group, were excluded from the analysis (one randomised in error and one lost to follow-up). Six women never attended the exercise sessions and two women participated to less than two sessions, while two-third of women were considered as compliant to the intervention. Incidence of insulin prescription was not significantly different between groups: 31 (56%) in the intervention and 24 (46%) in the control group (RR 1.22, 95% CI 0.84 to 1.78); the median time between randomization and insulin prescription was not different between groups (14 and 13 days, respectively). Conclusion: We were unable to show that an exercise program reduces or delays insulin prescription. Low compliance with the intervention, small sample size and the short duration of the program may explain the apparent lack of benefit.

Background The impact of physical activity during pregnancy and postpartum on urinary incontinence in women is unclear. Objectives To assess the association of physical activity and urinary incontinence during pregnancy and postpartum in a systematic review of the literature. Search Strategy A search of publications indexed in five major electronic databases (CENTRAL, PubMed, EMBASE, CINAHL and PEDro) was performed from their respective inception dates to the 30 March 2020 with a combination of keywords to identify studies of interest. Google Scholar was used for non-indexed literature. Selection Criteria All studies comparing physical activity with standard care in pregnant and postpartum women were selected. Data collection and Analysis Two reviewers, independently, selected studies, assessed quality and extracted data. Odds ratio with 95% confidence intervals were calculated using fixed effects or random effects meta-analyses (Mantel-Haenszel method), for low and moderate heterogeneity between studies, respectively. Main Results Seven studies (n = 12479) were included. Data of four studies could be pooled for meta-analyses; subgroup and sensitivity analyses were not possible. Physical activity, either during pregnancy or postpartum, is not associated with urinary incontinence, OR 0.90 (95% CI: 0.69–1.18) and OR 1.31 (95% CI: 0.74–2.34), respectively. Conclusions The ‘low’ quality of evidence (GRADE) does not show that physical activity during pregnancy or postpartum has any impact on urinary incontinence. Moderate physical activities should therefore be encouraged for the evidence-based benefits associated on other obstetrical outcomes. Funding None to declare. Keywords Pregnancy; postpartum; urinary incontinence; physical activity; exercise