Am J Perinatol 2014; 31(01): 039-048
DOI: 10.1055/s-0033-1334455
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Physical Activity, Maternal Metabolic Measures, and the Incidence of Gallbladder Sludge or Stones during Pregnancy: A Randomized Trial

Cynthia W. Ko
1   Division of Gastroenterology, University of Washington, Seattle, Washington
,
Peter G. Napolitano
2   Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, Washington
,
Sum P. Lee
1   Division of Gastroenterology, University of Washington, Seattle, Washington
,
Scott D. Schulte
3   Department of Radiology, University of Washington, Seattle, Washington
†   Deceased.
,
Marcia A. Ciol
4   Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
,
Shirley A. A. Beresford
5   Department of Epidemiology, University of Washington, Seattle, Washington
› Author Affiliations
Further Information

Publication History

29 October 2012

21 December 2012

Publication Date:
01 March 2013 (online)

Abstract

Objective To evaluate the effect of a physical activity intervention upon the incidence of gallbladder sludge or stones during pregnancy.

Study Design Pregnant women without gallstones were randomized to an intervention to increase moderate to vigorous physical activity or control. Intervention group women received motivational materials and small-group instruction to increase physical activity. Gallbladder ultrasound and blood draws were obtained at entry, 18 weeks' gestation, and 36 weeks' gestation.

Results In all, 591 were randomized to the intervention and 605 women to control groups. Women in the intervention group reported modestly higher levels of physical activity compared with control women, and fewer women in the intervention group reported no physical activity during pregnancy. The incidence of gallbladder sludge or stones was similar in intervention and control groups at 18 weeks (4.8% versus 5.4%; relative risk 0.89; 95% confidence interval 0.53, 1.47) and 36 weeks (4.3% versus 3.3%; relative risk 1.31; 95% confidence interval 0.70, 2.54). Fasting glucose, lipid, insulin, leptin, and adiponectin levels were similar in the two groups, as was insulin sensitivity and the incidence of gestational diabetes.

Conclusion An intervention to increase moderate to vigorous physical activity did not decrease the incidence of gallbladder sludge or stones during pregnancy and did not result in improvement in maternal metabolic measures.

Note

ClinicalTrials.gov registration number: NCT00131131.


 
  • References

  • 1 Kato I, Nomura A, Stemmermann GN, Chyou PH. Prospective study of clinical gallbladder disease and its association with obesity, physical activity, and other factors. Dig Dis Sci 1992; 37: 784-790
  • 2 Leitzmann MF, Giovannucci EL, Rimm EB , et al. The relation of physical activity to risk for symptomatic gallstone disease in men. Ann Intern Med 1998; 128: 417-425
  • 3 Leitzmann MF, Rimm EB, Willett WC , et al. Recreational physical activity and the risk of cholecystectomy in women. N Engl J Med 1999; 341: 777-784
  • 4 Everhart JE. Contributions of obesity and weight loss to gallstone disease. Ann Intern Med 1993; 119: 1029-1035
  • 5 Ruhl CE, Everhart JE. Relationship of serum leptin concentration and other measures of adiposity with gallbladder disease. Hepatology 2001; 34: 877-883
  • 6 Attili AF, Capocaccia R, Carulli N , et al; Multicenter Italian Study on Epidemiology of Cholelithiasis. Factors associated with gallstone disease in the MICOL experience. Hepatology 1997; 26: 809-818
  • 7 Barbara L, Sama C, Morselli Labate AM , et al. A population study on the prevalence of gallstone disease: the Sirmione Study. Hepatology 1987; 7: 913-917
  • 8 Ruhl CE, Everhart JE. Association of diabetes, serum insulin, and C-peptide with gallbladder disease. Hepatology 2000; 31: 299-303
  • 9 Nervi F, Miquel JF, Alvarez M , et al. Gallbladder disease is associated with insulin resistance in a high risk Hispanic population. J Hepatol 2006; 45: 299-305
  • 10 The Rome Group for Epidemiology and Prevention of Cholelithiasis (GREPCO). The epidemiology of gallstone disease in Rome, Italy. Part II. Factors associated with the disease. Hepatology 1988; 8: 907-913
  • 11 Ko CW, Beresford SA, Schulte SJ, Matsumoto AM, Lee SP. Incidence, natural history, and risk factors for biliary sludge and stones during pregnancy. Hepatology 2005; 41: 359-365
  • 12 Maringhini A, Ciambra M, Baccelliere P , et al. Biliary sludge and gallstones in pregnancy: incidence, risk factors, and natural history. Ann Intern Med 1993; 119: 116-120
  • 13 Maringhini A, Marceno MP, Lanzarone F , et al. Sludge and stones after pregnancy. J Hepatol 1987; 5: 218-223
  • 14 Valdivieso V, Covarrubias C, Siegel F, Cruz F. Pregnancy and cholelithiasis: pathogenesis and natural course of gallstones diagnosed in early puerperium. Hepatology 1993; 17: 1-4
  • 15 ACOG Committee Obstetric Practice. ACOG Committee opinion. Number 267, January 2002: Exercise during pregnancy and the postpartum period. Obstet Gynecol 2002; 99: 171-173
  • 16 Bowen DJ, Fesinmeyer MD, Yasui Y , et al. Randomized trial of exercise in sedentary middle aged women: effects on quality of life. Int J Behav Nutr Phys Act 2006; 3: 34
  • 17 McTiernan A, Yasui Y, Sorensen B , et al. Effect of a 12-month exercise intervention on patterns of cellular proliferation in colonic crypts: a randomized controlled trial. Cancer Epidemiol Biomarkers Prev 2006; 15: 1588-1597
  • 18 Godin G, Shephard RJ. A simple method to assess exercise behavior in the community. Can J Appl Sport Sci 1985; 10: 141-146
  • 19 Ainsworth BE, Haskell WL, Whitt MC , et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 2000; 32 (9, Suppl) S498-S504
  • 20 Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412-419
  • 21 Venneman NG, van Erpecum KJ. Pathogenesis of gallstones. Gastroenterol Clin North Am 2010; 39: 171-183 , vii
  • 22 Ko CW, Beresford SA, Schulte SJ, Lee SP. Insulin resistance and incident gallbladder disease in pregnancy. Clin Gastroenterol Hepatol 2008; 6: 76-81
  • 23 Dempsey JC, Sorensen TK, Williams MA , et al. Prospective study of gestational diabetes mellitus risk in relation to maternal recreational physical activity before and during pregnancy. Am J Epidemiol 2004; 159: 663-670
  • 24 Oken E, Ning Y, Rifas-Shiman SL, Radesky JS, Rich-Edwards JW, Gillman MW. Associations of physical activity and inactivity before and during pregnancy with glucose tolerance. Obstet Gynecol 2006; 108: 1200-1207
  • 25 Butler CL, Williams MA, Sorensen TK, Frederick IO, Leisenring WM. Relation between maternal recreational physical activity and plasma lipids in early pregnancy. Am J Epidemiol 2004; 160: 350-359
  • 26 Sorensen TK, Williams MA, Lee IM, Dashow EE, Thompson ML, Luthy DA. Recreational physical activity during pregnancy and risk of preeclampsia. Hypertension 2003; 41: 1273-1280
  • 27 Dempsey JC, Butler CL, Sorensen TK , et al. A case-control study of maternal recreational physical activity and risk of gestational diabetes mellitus. Diabetes Res Clin Pract 2004; 66: 203-215
  • 28 Clapp III JF, Kiess W. Effects of pregnancy and exercise on concentrations of the metabolic markers tumor necrosis factor alpha and leptin. Am J Obstet Gynecol 2000; 182: 300-306
  • 29 Ehrenberg HM, Huston-Presley L, Catalano PM. The influence of obesity and gestational diabetes mellitus on accretion and the distribution of adipose tissue in pregnancy. Am J Obstet Gynecol 2003; 189: 944-948
  • 30 Rudra CB, Williams MA, Lee IM, Miller RS, Sorensen TK. Perceived exertion in physical activity and risk of gestational diabetes mellitus. Epidemiology 2006; 17: 31-37
  • 31 Dye TD, Knox KL, Artal R, Aubry RH, Wojtowycz MA. Physical activity, obesity, and diabetes in pregnancy. Am J Epidemiol 1997; 146: 961-965
  • 32 Dempsey JC, Butler CL, Williams MA. No need for a pregnant pause: physical activity may reduce the occurrence of gestational diabetes mellitus and preeclampsia. Exerc Sport Sci Rev 2005; 33: 141-149
  • 33 Thomas DE, Elliott EJ, Naughton GA. Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev 2006; (3) CD002968
  • 34 Orozco LJ, Buchleitner AM, Gimenez-Perez G, Roqué I Figuls M, Richter B, Mauricio D. Exercise or exercise and diet for preventing type 2 diabetes mellitus. Cochrane Database Syst Rev 2008; (3) CD003054
  • 35 Yates T, Khunti K, Bull F, Gorely T, Davies MJ. The role of physical activity in the management of impaired glucose tolerance: a systematic review. Diabetologia 2007; 50: 1116-1126
  • 36 Centers for Disease Control and Prevention (CDC). Prevalence of regular physical activity among adults—United States, 2001 and 2005. MMWR Morb Mortal Wkly Rep 2007; 56: 1209-1212