Clinical profile, walking activity, and the movement and musculoskeletal discomfort of the lower limbs of women with gestational diabetes during a period of hospitalization

Aim: The purpose of this study was to verify and compare the clinical profile, walking activity, and joint angle and perimetry of the lower limbs of women with and without gestational diabetes mellitus (GDM)during a period of hospitalization and to determine the relationship between walking activity andlower limb joint angle. Methods: This study used a cross-sectional design and consisted of 20 pregnant women with hospitalized in the High-Risk Pregnant Women Home at the Hospital Municipal Maternity and a control group (CG)of 20 pregnant women without GDM, recruited from the same hospital during medical visits for prenatal care. Information about glycemic control, before and after hospital discharge, was collected from the daily medical records. The nursing team used a glucometer for insulin control in the following periods: 6 h fasting, 10 h post-coffee, 2 h post-lunch, and 8 h and 24 h post-dinner. The joint angles of their lower limbs were evaluated using a goniometer, their pain assessed using a visual analogue scale and the perimetry measured using a tape. The 6-minute walk test (6MWT) was used to determine walking distance. Results: The first admission and last hospital readmission days proved to be important and effective for the control and reduction of blood glucose levels during fasting, after 8 h and 24 h post-dinner, totaling an average hospitalization period of 16.0 ± 3.2 days. Insulin treatment was increased significantly in the morning of the first admission compared with the hospitalization period and the hospital discharge but was reduced in the evening period. The women with GDM presented significant reductions in the joint angles of the hip, knee, and ankle/foot and of the 6MWT compared with the CG, but without differences for perimetry. A multiple regression analysis showed that the reduction in knee joint movements was a predictorto the decrease in the walking distance of these women. Conclusion: Pregnant women with GDM require long periods of hospitalization and re-hospitalization for effective blood glucose control and reduction insulin treatmen t, especially in the evening. In addition, during the hospitalization period these women reduce the movements of the lower limbs and walking. The reduction in knee joint movements was a good predictor to the reduction in the walking distance inpregnant women with GDM.