Development of guidelines and resources to encourage and support exercise in pregnant women with pre-existing Type 2 Diabetes. MRC GW4 BioMed DTP PhD studentship 2025/26

Summary: 

A physically active pregnancy including regular exercise reduces pregnancy complications in women with pre-existing type 2 diabetes (T2D) and supports the health of mother and baby, but most women do not do enough exercise to get this benefit. This project will measure exercise levels and barriers to exercise in pregnant women with T2D and determine what insulin dose adjustments and carbohydrate intake is needed to exercise safely. This work can inform the first national guidelines to support pregnant women with T2D to increase their exercise levels and improve outcomes for mothers and babies.

Description

A physically active pregnancy including regular exercise improves cardiovascular function, decreases the risk of gestational hypertension, limits weight gain, and improves mood. Diabetes affects around 10% of all pregnancies in the UK (~ 65 thousand per year): type 2 diabetes (T2D) accounts for around 56% of these. T2D increases the risk of preterm delivery, preeclampsia, macrosomia, intrauterine death and congenital malformations.

Regular exercise is therefore likely to have an even greater effect on improving the health of pregnant women with T2D. Based on these benefits it is recommended all pregnant women aim for at least 150 minutes of moderate intensity activity and two muscle strengthening sessions each week. However, physical activity both

amongst pregnant women, and amongst those with pre-existing T2D is disproportionately low. There is currently no evidence-based guidance to support physical activity (PA) for pregnant women with pre-existing T2D, as key questions remain unanswered.

No studies have looked at habitual activity levels, or barriers to physical activity in pregnant women with T2D and crucially, how they change over time during pregnancy. In addition, it is not known how exercise affects glucose control in pregnant women with pre-existing T2D, and whether advice on insulin dosage adjustment and carbohydrate intake for exercise that is used for non- pregnant women with T2D is effective in pregnant women with T2D who are treated with insulin, (estimated 40-80% of cases). As such, healthcare professionals have told us that they are unsure how to support pregnant women with T2D, when this support might be most useful and appreciated.

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