Glucoregulatory and Inflammatory Trajectories in Pregnancy with Obesity: Secondary Analysis of a Randomized Exercise Trial
Abstract
ObjectiveTo evaluate moderate-intensity exercise effects on glucoregulatory and inflammatory markers in pregnant women with obesity.
MethodsSecondary analysis of the Expecting Study (NCT02125149) included 263 sedentary pregnant women with pre-pregnancy BMI [≥]30kg/m2 randomized to exercise (EX, n=157) or standard-of-care (SoC, n=106). Fasting biomarkers were assessed at 12.14{+/-}0.50, 24.19{+/-}0.68, and 36.03{+/-}0.58 weeks gestation. Linear mixed-effects models evaluated intervention and gestational effects at 24-36 weeks. Exploratory repeated-measures continuous glucose monitoring (CGM) included 18 participants (SoC=6, EX=12), evaluating 24-h/temporal glycemia and exploring inflammatory marker associations.
ResultsInsulin, C-peptide, HOMA2-IR, HOMA2-%B, IL-6, and TNF- increased with gestation, while HOMA2-%S and CRP decreased (all p<0.001). Exercise did not affect fasting glucose or inflammatory markers. CGM-wear yielded 12-15 days/trimester with >95% valid wear time; glycemia remained normoglycemic. By 36-weeks, SoC-metrics declined in 24-h and nocturnal glucose and time-in-range (TIR), with increased time-below-range (all p<0.022). TIR was inversely associated with IL-6 at 24-weeks (-0.23 [95%CI: -0.43,-0.02] p=0.035), and mean amplitude of glycemic excursion positively with TNF- at 36-weeks (0.02 [95%CI: 0.00,0.04] p=0.033).
ConclusionExercise did not modify mid-to late-gestation fasting glucoregulatory or inflammatory profiles. High CGM-adherence and preliminary indications of distinct longitudinal glycemic patterns support further CGM evaluation in antepartum behavioral interventions.
What is already known about this subject?O_LIPregnancy and obesity increase insulin resistance and metabolic stress; exercise may improve maternal metabolic health. C_LIO_LIContinuous Glucose Monitoring (CGM) can detect glycemic patterns not captured by fasting measures but is understudied in pregnancies with obesity without diabetes. C_LI
What are the new findings in your manuscript?O_LIExercise did not alter fasting glucoregulatory or inflammatory trajectories despite substantial gestational metabolic adaptation. C_LIO_LIExploratory CGM showed declining late-gestation glycemic metrics in the standard of care group, whereas these metrics remained stable in the exercise group. C_LI
How might your results change the direction of research or the focus of clinical practice?O_LIFasting biomarkers alone may not capture metabolic responses to antepartum exercise. C_LIO_LILarger trials should evaluate CGM-derived glycemic patterns and clinically meaningful targets in pregnancies with obesity. C_LI
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BibTeX
@misc{jansen2026glucoregulatory,
title = {{Glucoregulatory and Inflammatory Trajectories in Pregnancy with Obesity: Secondary Analysis of a Randomized Exercise Trial}},
author = {Lisa T. Jansen and Simon Chung and Aaron R. Caldwell and Andrew W. Brown and Brittany N. Burgener and Audrey Martinez and Elisabet Børsheim and Aline Andres},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.21.26366153},
url = {https://www.medrxiv.org/content/10.64898/2026.10.21.26366153v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Glucoregulatory and Inflammatory Trajectories in Pregnancy with Obesity: Secondary Analysis of a Randomized Exercise Trial
AU - Lisa T. Jansen
AU - Simon Chung
AU - Aaron R. Caldwell
AU - Andrew W. Brown
AU - Brittany N. Burgener
AU - Audrey Martinez
AU - Elisabet Børsheim
AU - Aline Andres
PY - 2026
DA - 2026/10/21
PB - medRxiv
DO - 10.64898/2026.10.21.26366153
UR - https://www.medrxiv.org/content/10.64898/2026.10.21.26366153v1
AB - ObjectiveTo evaluate moderate-intensity exercise effects on glucoregulatory and inflammatory markers in pregnant women with obesity. MethodsSecondary analysis of the Expecting Study (NCT02125149) included 263 sedentary pregnant women with pre-pregnancy BMI [≥]30kg/m2 randomized to exercise (EX, n=157) or standard-of-care (SoC, n=106). Fasting biomarkers were assessed at 12.14{+/-}0.50, 24.19{+/-}0.68, and 36.03{+/-}0.58 weeks gestation. Linear mixed-effects models evaluated intervention and gestational effects at 24-36 weeks. Exploratory repeated-measures continuous glucose monitoring (CGM) included 18 participants (SoC=6, EX=12), evaluating 24-h/temporal glycemia and exploring inflammatory marker associations. ResultsInsulin, C-peptide, HOMA2-IR, HOMA2-%B, IL-6, and TNF- increased with gestation, while HOMA2-%S and CRP decreased (all p<0.001). Exercise did not affect fasting glucose or inflammatory markers. CGM-wear yielded 12-15 days/trimester with >95% valid wear time; glycemia remained normoglycemic. By 36-weeks, SoC-metrics declined in 24-h and nocturnal glucose and time-in-range (TIR), with increased time-below-range (all p<0.022). TIR was inversely associated with IL-6 at 24-weeks (-0.23 [95%CI: -0.43,-0.02] p=0.035), and mean amplitude of glycemic excursion positively with TNF- at 36-weeks (0.02 [95%CI: 0.00,0.04] p=0.033). ConclusionExercise did not modify mid-to late-gestation fasting glucoregulatory or inflammatory profiles. High CGM-adherence and preliminary indications of distinct longitudinal glycemic patterns support further CGM evaluation in antepartum behavioral interventions. What is already known about this subject?O_LIPregnancy and obesity increase insulin resistance and metabolic stress; exercise may improve maternal metabolic health. C_LIO_LIContinuous Glucose Monitoring (CGM) can detect glycemic patterns not captured by fasting measures but is understudied in pregnancies with obesity without diabetes. C_LI What are the new findings in your manuscript?O_LIExercise did not alter fasting glucoregulatory or inflammatory trajectories despite substantial gestational metabolic adaptation. C_LIO_LIExploratory CGM showed declining late-gestation glycemic metrics in the standard of care group, whereas these metrics remained stable in the exercise group. C_LI How might your results change the direction of research or the focus of clinical practice?O_LIFasting biomarkers alone may not capture metabolic responses to antepartum exercise. C_LIO_LILarger trials should evaluate CGM-derived glycemic patterns and clinically meaningful targets in pregnancies with obesity. C_LI
ER -