**9. Conclusion**

*Sugar Intake - Risks and Benefits and the Global Diabetes Epidemic*

**Relation of no. of steps per day and amount of change in HbA1c (comparison** 

Relation between avg. no. of steps and amount of change in GA (comparison of

**Relation between no. of steps per day and amount of change in maternal body weight (comparison of 2-week based data)**

**Relation between no. of steps per day and average amount of insulin administered per day (comparison of 1-week based** 

*HbA1c: haemoglobin A1c, GA: Glycoalbumin, n.s.: not significant.*

**of 4-week based data)**

4-week based data)

**data)**

**Table 2.**

consecutive days [34]. The data stored in the pedometer are transferred through USB port of the computer and analysed chronologically (**Figures 1** and **2**). In a 24-hour time frame, there was no correlation between the number of steps walked and pre- or postprandial blood glucose level immediately after walking, nor between the average number of steps per day and the fasting blood glucose level on the next day (**Table 1**). However, the 4-week data showed that there was a negative correlation between the number of steps per day and the change in HbA1c levels (**Table 2**). Moreover, there was a negative correlation between the average number of steps per day and change in the maternal body weight (**Table 2**). A 1-week based data from the subjects administered with insulin indicated that there was a negative correlation between the average number of steps per day and the total amount of insulin administered per day. Our results indicated that pedometer-monitored walking improved insulin resistance without affecting blood glucose levels just after the bouts of walking. In addition, carrying the pedometer may have self-promoting effect for sustaining the exercise for the women with impaired glucose tolerance by noticing the improvement in the changes in the body weight and HbA1c levels in response to her steps walked. To conclude, our report was the first to show the usefulness of a pedometer for the management of IGT in pregnant women. We plan to continue studying this issue in future studies with higher numbers of participants along with nutritional counselling. Further studies are anticipated in order to design appropriate pedometer-monitored exercise plans not only for the management of IGT in pregnant women but also for that of the obese pregnant women. Nowadays, so many kinds of applications for pregnant women dealing with weight control, nutrition, foetal movement, maternal heart rates, it would be worthwhile to develop applications for incorporating pedometer data with body weight, maternal heart rate, ultrasound foetometric data and the parameters of the blood glucose control for the women with impaired glucose tolerance.

*Comparison of average number of steps per day and all data items (from Ref. [34], with permission).*

No. of steps per day for entire period and infant birthweight (SD score) −0.22 n.s.

**Correlation coefficient**

**Entire pregnancy −0.43 0.0263 Second trimester −0.64 0.0330** Third trimester 0.24 n.s.

Entire pregnancy −0.38 n.s.

Second trimester −0.57 n.s.

Third trimester 0.24 n.s.

**Entire pregnancy −0.49 0.0005** First trimester −1(n = 2) n.s. **Second trimester −0.76 0.0003** Third trimester −0.11 n.s.

**Entire pregnancy −0.43 <0.0001** First trimester 0.69 n.s. **Second trimester −0.42 0.0111 Third trimester −0.52 0.0005**

**P value**

(0.082)

(0.109)

**142**

With the widespread use of smartphones equipped with pedometer function, walking exercises are easily monitored and utilised not only in normal but also in pregnant women with obesity and impaired glucose tolerance. Furthermore, data including footsteps, and pulse rates if smart watch will be used together with smartphone and information of the foetal growth, comprehensive management of the exercise and body weight control will be achieved. Further studies are expected to assess how many steps per day and how many bouts are optimal for the best blood sugar and body weight control during pregnancy.
