{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T16:20:33Z","timestamp":1792858833005,"version":"4.5.0"},"reference-count":56,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T00:00:00Z","timestamp":1766966400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T00:00:00Z","timestamp":1766966400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Fujian Medical University Affiliated First Hospital Technology Transformation Fund","award":["2025FY-ZH-02"],"award-info":[{"award-number":["2025FY-ZH-02"]}]},{"name":"Joint Funds for the innovation of science and Technology, Fujian province","award":["2023Y9075, L. Lu"],"award-info":[{"award-number":["2023Y9075, L. Lu"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Gestational diabetes mellitus (GDM) is a common pregnancy complication associated with adverse maternal and neonatal outcomes, characterised by inflammation and oxidative stress. While exercise interventions have been shown to alleviate some of these issues, the underlying molecular mechanisms, particularly in the placenta, remain poorly understood. This study investigates the impact of exercise on maternal immune function, oxidative stress, placental gene expression, and neonatal outcomes in GDM pregnancies. This pilot study involved 12 pregnant women, six with GDM and six with normal pregnancies. Participants were divided into four groups: normal pregnancies with exercise (NCE) or without exercise (NC), and GDM pregnancies with exercise (GDME) or without exercise (GDM). The exercise intervention included stationary cycling for 16 weeks, three times a week. Placental tissue and maternal blood were collected post-delivery. Placental gene expression was analysed using RNA sequencing, and oxidative stress was measured in maternal blood. Neonatal birth weight was significantly lower in the GDME group compared to the GDM group. Exercise significantly reduced oxidative stress and improved immune function in the GDME group, approaching levels observed in the NC and NCE groups. Transcriptomic analysis of placental samples revealed upregulation of antioxidant genes (e.g.,\n                    <jats:italic>GPX3, MTCO1P40<\/jats:italic>\n                    ) and downregulation of pro-inflammatory genes (e.g.,\n                    <jats:italic>CCL21<\/jats:italic>\n                    ), body weight regulatory gene (\n                    <jats:italic>IGFBP1<\/jats:italic>\n                    ), indicating enhanced immune and metabolic balance, and regulation of fetal birth weight. Exercise interventions in GDM pregnancies improve placental function by modulating immune response and oxidative stress, improving neonatal outcomes. These findings support the inclusion of exercise in GDM management to optimise maternal and fetal health.\n                  <\/jats:p>","DOI":"10.1038\/s41598-025-28642-x","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T14:51:51Z","timestamp":1767019911000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Pilot study on exercise-induced placental transcriptomic changes and oxidative stress reduction in gestational diabetes mellitus"],"prefix":"10.1038","volume":"15","author":[{"given":"Xuemei","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qimei","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xia","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lidan","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rongjin","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianbo","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,29]]},"reference":[{"issue":"4","key":"28642_CR1","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1016\/j.ajog.2022.12.315","volume":"228","author":"ST Bauer","year":"2023","unstructured":"Bauer, S. T. et al. Society for maternal-fetal medicine special statement: Quality metric on the rate of postpartum diabetes screening after pregnancies with gestational diabetes mellitus. Am. J. Obstet. Gynecol. 228(4), 2\u20139 (2023).","journal-title":"AM J OBSTET GYNECOL."},{"issue":"1","key":"28642_CR2","first-page":"5677073","volume":"2022","author":"Z Song","year":"2022","unstructured":"Song, Z., Li, S. & Li, R. An investigation into the correlation of intestinal flora with obesity and gestational diabetes mellitus. Comput. Math. Methods Med. 2022(1), 5677073 (2022).","journal-title":"Computational and Mathematical Methods in Medicine."},{"issue":"5","key":"28642_CR3","doi-asserted-by":"publisher","first-page":"1260","DOI":"10.3390\/jcm13051260","volume":"13","author":"V Bart\u00e1kov\u00e1","year":"2024","unstructured":"Bart\u00e1kov\u00e1, V. et al. Metabolic syndrome prevalence in women with gestational diabetes mellitus in the second trimester of gravidity. J. Clin. Med. 13(5), 1260 (2024).","journal-title":"Journal of Clinical Medicine."},{"key":"28642_CR4","doi-asserted-by":"publisher","unstructured":"Francesca, P., Roberta, M., Valeria M, S. & Irene, C. Maternal low-grade chronic inflammation and intrauterine programming of health and disease. Int. J. Mol. Sci. 22(4), 1732  https:\/\/doi.org\/10.3390\/ijms22041732(2021) .","DOI":"10.3390\/ijms22041732"},{"key":"28642_CR5","doi-asserted-by":"publisher","unstructured":"Tove, L., Errol R, N., Pal, A. & Thor, U. Impact of systemic inflammation on the progression of gestational diabetes mellitus. Curr. Diab. Rep. 16(4), 26 https:\/\/doi.org\/10.1007\/s11892-016-0715-9 (2016).","DOI":"10.1007\/s11892-016-0715-9"},{"key":"28642_CR6","doi-asserted-by":"publisher","unstructured":"Tatjana, R., Ali, V., Patrick, C., & Sylvie, H.-d.M. Gestational diabetes induces placental genes for chronic stress and inflammatory pathways. Diabetes. 52(12), 2951\u20132958 https:\/\/doi.org\/10.2337\/diabetes.52.12.2951 (2003).","DOI":"10.2337\/diabetes.52.12.2951"},{"key":"28642_CR7","doi-asserted-by":"publisher","unstructured":"Tatjana, R., Ali, V., Patrick, C. & Sylvie, H.-d.M. Gestational diabetes induces placental genes for chronic stress and inflammatory pathways. Diabetes. 52(12), 2951\u20132958https:\/\/doi.org\/10.2337\/diabetes.52.12.2951 (2003).","DOI":"10.2337\/diabetes.52.12.2951"},{"key":"28642_CR8","doi-asserted-by":"publisher","unstructured":"Xuan Nguyen, K. et al. Low-grade inflammation in gestational diabetes mellitus and its correlation with maternal insulin resistance and fetal growth indices. Int. J. General Med. 16, 1429\u20131436 https:\/\/doi.org\/10.2147\/IJGM.S408856 (2023).","DOI":"10.2147\/IJGM.S408856"},{"key":"28642_CR9","doi-asserted-by":"publisher","unstructured":"Francisco, V. et al. Maternal elevated inflammation impairs placental fatty acids $$\\beta$$-oxidation in women with gestational diabetes mellitus. Front Endocrinol (Lausanne). https:\/\/doi.org\/10.3389\/fendo.2023.1146574 (2023).","DOI":"10.3389\/fendo.2023.1146574"},{"key":"28642_CR10","doi-asserted-by":"publisher","unstructured":"Zhang, L. et al. Maternal high-fat diet impairs placental fatty acid $$\\beta$$-oxidation and metabolic homeostasis in the offspring. Front. Nutrition. https:\/\/doi.org\/10.3389\/fnut.2022.849684 (2022).","DOI":"10.3389\/fnut.2022.849684"},{"key":"28642_CR11","doi-asserted-by":"publisher","unstructured":"Simmons, D. et al. Treatment of gestational diabetes mellitus diagnosed early in pregnancy. New England J. Med. 388(23),  2132\u20132144 https:\/\/doi.org\/10.1056\/NEJMoa2214956 (2023).","DOI":"10.1056\/NEJMoa2214956"},{"key":"28642_CR12","doi-asserted-by":"publisher","unstructured":"Dipla, K. et al. Exercise as a therapeutic intervention in gestational diabetes mellitus. Endocrines. 2(2), 65\u201378 https:\/\/doi.org\/10.3390\/endocrines2020007 (2021).","DOI":"10.3390\/endocrines2020007"},{"key":"28642_CR13","doi-asserted-by":"publisher","unstructured":"Antunes, B. M. M., Rossi, F. E., Cholewa, J. M. & Lira, F. S. Regular physical activity and vascular aging. Curr. Pharmaceutical Design. 22(24), 3715\u20133729. https:\/\/doi.org\/10.2174\/1381612822666160322144724 (2016).","DOI":"10.2174\/1381612822666160322144724"},{"key":"28642_CR14","doi-asserted-by":"publisher","unstructured":"Pedersen, B. K. The anti-inflammatory effect of exercise: its role in diabetes and cardiovascular disease control. Essays Biochem. 42, 105\u2013117 https:\/\/doi.org\/10.1042\/bse0420105 (2006).","DOI":"10.1042\/bse0420105"},{"key":"28642_CR15","doi-asserted-by":"publisher","unstructured":"John, A., Howarth, F. C. & Raza, H. Exercise alleviates diabetic complications by inhibiting oxidative stress-mediated signaling cascade and mitochondrial metabolic stress in gk diabetic rat tissues. Front. Physiol. 13, 1052608 https:\/\/doi.org\/10.3389\/fphys.2022.1052608 (2022).","DOI":"10.3389\/fphys.2022.1052608"},{"issue":"8","key":"28642_CR16","doi-asserted-by":"publisher","first-page":"0272711","DOI":"10.1371\/journal.pone.0272711","volume":"17","author":"GI Tsironikos","year":"2022","unstructured":"Tsironikos, G. I. et al. Effectiveness of exercise intervention during pregnancy on high-risk women for gestational diabetes mellitus prevention: A meta-analysis of published rcts. PloS one. 17(8), 0272711 (2022).","journal-title":"PloS one."},{"issue":"4","key":"28642_CR17","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1007\/s42000-018-0085-6","volume":"17","author":"D Savvaki","year":"2018","unstructured":"Savvaki, D. et al. Guidelines for exercise during normal pregnancy and gestational diabetes: a review of international recommendations. Hormones 17(4), 521\u2013529 (2018).","journal-title":"Hormones"},{"key":"28642_CR18","doi-asserted-by":"publisher","unstructured":"Mu, A., Chen, Y., Lv, Y. & Wang, W. Exercise-diet therapy combined with insulin aspart injection for the treatment of gestational diabetes mellitus: A study on clinical effect and its impact. Comput. Math. Methods Med. 2022, 4882061 https:\/\/doi.org\/10.1155\/2022\/4882061 (2022).","DOI":"10.1155\/2022\/4882061"},{"key":"28642_CR19","doi-asserted-by":"crossref","unstructured":"Huang, X. et al. Different exercises for pregnant women with gestational diabetes: a meta-analysis of randomized controlled trials. J. Sports Med. Phys. Fitness. 60(3), 464\u201371 https:\/\/doi.org\/10.23736\/S0022-4707.19.10131-4 (2020)","DOI":"10.23736\/S0022-4707.19.10131-4"},{"key":"28642_CR20","doi-asserted-by":"publisher","unstructured":"Stanford, K. Maternal exercise improves glucose tolerance in female offspring. Diabetes. 66(8), 2124\u20132136 https:\/\/doi.org\/10.2337\/db17-0098 (2017).","DOI":"10.2337\/db17-0098"},{"key":"28642_CR21","doi-asserted-by":"publisher","unstructured":"Kautzky-Willer, A., et al. Gestational diabetes mellitus (update 2023)]. Wiener Klinische Wochenschrift. https:\/\/doi.org\/10.1007\/s00508-023-02181-9 (2023).","DOI":"10.1007\/s00508-023-02181-9"},{"issue":"4","key":"28642_CR22","doi-asserted-by":"publisher","first-page":"9754","DOI":"10.2196\/mhealth.9754","volume":"6","author":"J Xie","year":"2018","unstructured":"Xie, J. et al. Evaluating the validity of current mainstream wearable devices in fitness tracking under various physical activities: comparative study. JMIR mHealth uHealth 6(4), 9754 (2018).","journal-title":"JMIR mHealth and uHealth"},{"key":"28642_CR23","doi-asserted-by":"publisher","unstructured":"Brislane, A., Matenchuk, B. A., Skow, R. J., Steinback, C. D. & Davenport, M. H. Correction: Prenatal exercise and cardiovascular health (peach) study: impact of pregnancy and exercise on rating of perceived exertion during non-weight-bearing exercise. Appl. Physiol. Nutrition, Metabolism = Physiol. Appliquee, Nutrition et Metabolisme. 48(1), 96 https:\/\/doi.org\/10.1139\/apnm-2022-0428 (2023).","DOI":"10.1139\/apnm-2022-0428"},{"issue":"10","key":"28642_CR24","doi-asserted-by":"publisher","first-page":"998","DOI":"10.3390\/metabo12100998","volume":"12","author":"E Taousani","year":"2022","unstructured":"Taousani, E. et al. Effect of exercise on the resting metabolic rate and substrate utilization in women with gestational diabetes mellitus: results of a pilot study. Metabolites. 12(10), 998 (2022).","journal-title":"Metabolites."},{"key":"28642_CR25","unstructured":"Norman, L. Manual of endocrinology and metabolism (Lippincott Williams & Wilkins 2012)."},{"key":"28642_CR26","first-page":"55847","volume":"126","author":"AM Holme","year":"2017","unstructured":"Holme, A. M. et al. The 4-vessel sampling approach to integrative studies of human placental physiology in vivo. J. Visual. Exp. JoVE. 126, 55847 (2017).","journal-title":"Journal of visualized experiments: JoVE."},{"issue":"D1","key":"28642_CR27","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1093\/nar\/gkv1070","volume":"44","author":"M Kanehisa","year":"2016","unstructured":"Kanehisa, M. et al. Kegg as a reference resource for gene and protein annotation. Nucleic Acids Res. 44(D1), 457\u2013462 (2016).","journal-title":"Nucleic acids research"},{"issue":"1","key":"28642_CR28","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1093\/nar\/28.1.27","volume":"28","author":"M Kanehisa","year":"2000","unstructured":"Kanehisa, M. & Goto, S. Kegg: kyoto encyclopedia of genes and genomes. Nucleic Acids Res. 28(1), 27\u201330 (2000).","journal-title":"Nucleic acids research"},{"key":"28642_CR29","doi-asserted-by":"publisher","first-page":"1475244","DOI":"10.3389\/fphar.2024.1475244","volume":"15","author":"A Chen","year":"2024","unstructured":"Chen, A., Tian, M., Luo, Z., Cao, X. & Gu, Y. Analysis of the evolution of placental oxidative stress research from a bibliometric perspective. Front. Pharmacol. 15, 1475244 (2024).","journal-title":"Frontiers in Pharmacology."},{"key":"28642_CR30","doi-asserted-by":"publisher","unstructured":"Mrizak, I. et al. Placental infiltration of inflammatory markers in gestational diabetic women. General Physiol. Biophys. 33(2), 169\u2013176 https:\/\/doi.org\/10.4149\/gpb_2013075 (2014).","DOI":"10.4149\/gpb_2013075"},{"key":"28642_CR31","doi-asserted-by":"publisher","unstructured":"Jimenez-Escutia, R. et al. High glucose promotes inflammation and weakens placental defenses against and infection: Protective role of insulin and metformin. Int. J. Mole. Sci. 24(6), 5243 https:\/\/doi.org\/10.3390\/ijms24065243 (2023).","DOI":"10.3390\/ijms24065243"},{"key":"28642_CR32","doi-asserted-by":"publisher","unstructured":"Kusuyama, J. et al. Placental superoxide dismutase 3 mediates benefits of maternal exercise on offspring health. Cell Metabolism. 33(5), 939\u2013956 https:\/\/doi.org\/10.1016\/j.cmet.2021.03.004(2021).","DOI":"10.1016\/j.cmet.2021.03.004"},{"key":"28642_CR33","doi-asserted-by":"publisher","unstructured":"Jones, M. L. et al. Antioxidant defenses in the rat placenta in late gestation: increased labyrinthine expression of superoxide dismutases, glutathione peroxidase 3, and uncoupling protein 2. Biol. Reprod. 83(2), 254\u2013260 https:\/\/doi.org\/10.1095\/biolreprod.110.083907 (2010).","DOI":"10.1095\/biolreprod.110.083907"},{"key":"28642_CR34","doi-asserted-by":"publisher","unstructured":"Liang, T., Jinglong, X., Shusheng, D. & Aiyou, W. Maternal obesity stimulates lipotoxicity and up-regulates inflammatory signaling pathways in the full-term swine placenta. Animal Sci. J. 89(9), 1310\u20131322 https:\/\/doi.org\/10.1111\/asj.13064 (2018).","DOI":"10.1111\/asj.13064"},{"key":"28642_CR35","doi-asserted-by":"publisher","unstructured":"Umekawa, T. et al. Overexpression of thioredoxin-1 reduces oxidative stress in the placenta of transgenic mice and promotes fetal growth via glucose metabolism. Endocrinology. 149(8), 3980\u20133988 https:\/\/doi.org\/10.1210\/en.2007-1682 (2008).","DOI":"10.1210\/en.2007-1682"},{"key":"28642_CR36","doi-asserted-by":"publisher","unstructured":"Qi, Z., He, J., Zhang, Y., Shao, Y. & Ding, S. Exercise training attenuates oxidative stress and decreases p53 protein content in skeletal muscle of type 2 diabetic goto-kakizaki rats. Free Radical Biol. Med. 50(7), 794\u2013800 https:\/\/doi.org\/10.1016\/j.freeradbiomed.2010.12.022 (2011).","DOI":"10.1016\/j.freeradbiomed.2010.12.022"},{"key":"28642_CR37","doi-asserted-by":"publisher","unstructured":"Kolac, U. K., Donmez Yalcin, G. & Yalcin, A. Chemical inhibition of mitochondrial fission improves insulin signaling and subdues hyperglycemia induced stress in placental trophoblast cells. Mole. Biol. Rep. 50(1), 493\u2013506 https:\/\/doi.org\/10.1007\/s11033-022-07959-0 (2023).","DOI":"10.1007\/s11033-022-07959-0"},{"key":"28642_CR38","doi-asserted-by":"publisher","first-page":"655","DOI":"10.7754\/Clin.Lab.2012.120227","volume":"59","author":"C Qiu","year":"2013","unstructured":"Qiu, C. et al. Mitochondrial dna copy number and oxidative dna damage in placental tissues from gestational diabetes and control pregnancies: a pilot study. Clin. Lab. 59, 655 (2013).","journal-title":"Clinical laboratory."},{"issue":"S7","key":"28642_CR39","doi-asserted-by":"publisher","first-page":"2811","DOI":"10.53730\/ijhs.v6nS7.12127","volume":"6","author":"S Sathya","year":"2022","unstructured":"Sathya, S., Bupesh, G. & Vasanth, S. Mitochondrial dna copy number by rt-pcr in patients with gestational diabetes mellitus in south indian population. Int. J. Health Sci. 6(S7), 2811\u20132820 (2022).","journal-title":"International journal of health sciences."},{"issue":"10","key":"28642_CR40","doi-asserted-by":"publisher","first-page":"1812","DOI":"10.3390\/antiox12101812","volume":"12","author":"R Saucedo","year":"2023","unstructured":"Saucedo, R. et al. Role of oxidative stress and inflammation in gestational diabetes mellitus. Antioxidants. 12(10), 1812 (2023).","journal-title":"Antioxidants."},{"key":"28642_CR41","doi-asserted-by":"publisher","unstructured":"Kim, Y.-W., West, X. Z. & Byzova, T. V. Inflammation and oxidative stress in angiogenesis and vascular disease. J. Mole. Med. Berlin, Germany). 91(3), 323\u2013328 https:\/\/doi.org\/10.1007\/s00109-013-1007-3 (2013)","DOI":"10.1007\/s00109-013-1007-3"},{"key":"28642_CR42","doi-asserted-by":"publisher","unstructured":"Peake, J. M., Suzuki, K. & Coombes, J. S. The influence of antioxidant supplementation on markers of inflammation and the relationship to oxidative stress after exercise. J. Nutritional Biochem. 18(6), 357\u2013371 https:\/\/doi.org\/10.1016\/j.jnutbio.2006.10.005 (2007).","DOI":"10.1016\/j.jnutbio.2006.10.005"},{"key":"28642_CR43","doi-asserted-by":"publisher","unstructured":"Lappas, M., Mitton, A. & Permezel, M. In response to oxidative stress, the expression of inflammatory cytokines and antioxidant enzymes are impaired in placenta, but not adipose tissue, of women with gestational diabetes. J. Endocrinol. 204(1), 75 https:\/\/doi.org\/10.1677\/JOE-09-0321 (2010).","DOI":"10.1677\/JOE-09-0321"},{"key":"28642_CR44","doi-asserted-by":"publisher","unstructured":"Vassalle, C. et al. New inflammatory and oxidative stress-based biomarker changes in response to a half-marathon in recreational athletes. J. Sports Med. Physi. Fitness. 60(10), 1390\u20131395 https:\/\/doi.org\/10.23736\/S0022-4707.20.10738-2 (2020).","DOI":"10.23736\/S0022-4707.20.10738-2"},{"key":"28642_CR45","doi-asserted-by":"publisher","unstructured":"Qi, Z., He, J., Zhang, Y., Shao, Y., & Ding, S. Exercise training attenuates oxidative stress and decreases p53 protein content in skeletal muscle of type 2 diabetic goto-kakizaki rats. Free Radical Biol. Med. 50(7), 794\u2013800 https:\/\/doi.org\/10.1016\/j.freeradbiomed.2010.12.022 (2011).","DOI":"10.1016\/j.freeradbiomed.2010.12.022"},{"key":"28642_CR46","doi-asserted-by":"publisher","unstructured":"Lili, F., Bowen, L., Yue, X., Mengxin, C. & Zhenjun, T. Aerobic exercise and resistance exercise alleviate skeletal muscle atrophy through igf-1\/igf-1r-pi3k\/akt pathway in mice with myocardial infarction. Am. J. Physiol. Cell Physiol. 322(2), C164\u2013C176. https:\/\/doi.org\/10.1152\/ajpcell.00344.2021 (2021).","DOI":"10.1152\/ajpcell.00344.2021"},{"key":"28642_CR47","doi-asserted-by":"publisher","unstructured":"Panagiotis, H. et al. Benefits of exercise in pregnancies with gestational diabetes. J. Matern Fetal Neonatal Med. 35(13), 2524\u20132529 https:\/\/doi.org\/10.1080\/14767058.2020.1786515 (2020).","DOI":"10.1080\/14767058.2020.1786515"},{"issue":"5","key":"28642_CR48","doi-asserted-by":"publisher","first-page":"1427","DOI":"10.1007\/s43032-024-01777-4","volume":"32","author":"S-H Yang","year":"2025","unstructured":"Yang, S.-H. et al. The bmp signaling pathway: Bridging maternal-fetal crosstalk in early pregnancy. Reproductive Sciences. 32(5), 1427\u20131445 (2025).","journal-title":"Reproductive Sciences."},{"key":"28642_CR49","doi-asserted-by":"crossref","unstructured":"Rodriguez-Saldana, J. The Diabetes Textbook: Clinical Principles, Patient Management and Public Health Issues (Springer, 2023).","DOI":"10.1007\/978-3-031-25519-9"},{"key":"28642_CR50","unstructured":"Robertson, R. P. DeGroot\u2019s Endocrinology, E-Book: Basic Science and Clinical Practice (Elsevier Health Sciences, 2022)."},{"key":"28642_CR51","doi-asserted-by":"publisher","unstructured":"Koistinen, H., Koistinen, R. I., Selenius, L. I., Ylikorkala, Q. & Seppala, M. A. Effect of marathon run on serum igf-i and igf-binding protein 1 and 3 levels. J. Appl. Physiol. (1985). 80(3), 760\u2013764 https:\/\/doi.org\/10.1152\/jappl.1996.80.3.760 (1996).","DOI":"10.1152\/jappl.1996.80.3.760"},{"key":"28642_CR52","doi-asserted-by":"publisher","unstructured":"Lewitt, M. S., Denyerf, G. S., Cooney, J. G. & Baxter, R. C. Insulin-like growth factor-binding protein-1 modulates blood glucose levels. Endocrinology. 129(4), 2254\u20132256 https:\/\/doi.org\/10.1210\/endo-129-4-2254 (1991).","DOI":"10.1210\/endo-129-4-2254"},{"key":"28642_CR53","doi-asserted-by":"publisher","unstructured":"Anthony, T. G., Anthony, J. C., Lewitt, M. S., Donovan, S. M. & Layman, D. K. Time course changes in igfbp-1 after treadmill exercise and postexercise food intake in rats. Am. J. Physiol. Endocrinol Metab.. 280(4), E650\u2013E656. https:\/\/doi.org\/10.1152\/ajpendo.2001.280.4.E650 (2001).","DOI":"10.1152\/ajpendo.2001.280.4.E650"},{"key":"28642_CR54","doi-asserted-by":"publisher","first-page":"1407569","DOI":"10.3389\/fphys.2024.1407569","volume":"15","author":"Y He","year":"2024","unstructured":"He, Y., Liu, X. & Yang, X. Effects of multidimensional exercise management on self-efficacy, blood glucose control, and delivery outcomes in pregnant women with gestational diabetes mellitus. Fronti. Physiol. 15, 1407569 (2024).","journal-title":"Frontiers in Physiology."},{"key":"28642_CR55","doi-asserted-by":"publisher","first-page":"1347754","DOI":"10.3389\/fendo.2024.1347754","volume":"15","author":"H Xu","year":"2024","unstructured":"Xu, H. & Liu, R. Comprehensive management of gestational diabetes mellitus: practical efficacy of exercise therapy and sustained intervention strategies. Fronti. Endocrinol. 15, 1347754 (2024).","journal-title":"Frontiers in endocrinology."},{"key":"28642_CR56","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1016\/j.placenta.2024.10.008","volume":"158","author":"B Aljani","year":"2024","unstructured":"Aljani, B. et al. Gene expression profiles in placenta and their association with anesthesia, delivery mode and maternal diabetes. Placenta. 158, 126\u2013135 (2024).","journal-title":"Placenta."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-28642-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-28642-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-28642-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T11:17:12Z","timestamp":1777115832000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-28642-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,29]]},"references-count":56,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["28642"],"URL":"https:\/\/doi.org\/10.1038\/s41598-025-28642-x","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,29]]},"assertion":[{"value":"12 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 November 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 December 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The trial was performed with respect for the individual participants according to the Declaration of Helsinki. Approval was granted by the First Affiliated Hospital of Fujian Medical University (MTCA, ECFAH of FMU[2023]393).","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"44821"}}