Effects of Supervised Exercise on the Development of Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis

Abstract

Hypertensive disorders of pregnancy (HDP) are the most common medical complication in pregnancy, affecting approximately 10–15% of pregnancies worldwide. HDP are a major cause of maternal and perinatal morbidity and mortality, and each year, worldwide, around 70,000 mothers and 500,000 babies die because of HDP. Up-to-date high-quality systematic reviews quantifying the role of exercise and the risks of developing HDP are currently lacking. Physical exercise is considered to be safe and beneficial to pregnant women. Supervised exercise has been shown to be safe and to be more beneficial than unsupervised exercise in the general population, as well as during pregnancy in women with obesity and diabetes. Therefore, we undertook a systematic review and meta-analysis to investigate the effects of women performing supervised exercise during pregnancy compared to a control group (standard antenatal care or unsupervised exercise) on the development of HDP. We searched Medline, Embase, CINHAL, and the Cochrane Library, which were searched from inception to December 2021. We included only randomized controlled trials (RCTs) investigating the development of HDP compared to a control group (standard antenatal care or unsupervised exercise) in pregnant women performing supervised exercise. Two independent reviewers selected eligible trials for meta-analysis. Data collection and analyses were performed by two independent reviewers. The PROSPERO registration number is CRD42020176814. Of 6332 articles retrieved, 16 RCTs met the eligibility criteria, comparing a total of 5939 pregnant women (2904 pregnant women in the intervention group and 3035 controls). The risk for pregnant women to develop HDP was significantly reduced in the intervention compared to the control groups, with an estimated pooled cumulative incidence of developing HDP of 3% in the intervention groups (95% CI: 3 to 4) and of 5% in the control groups (95% CI: 5 to 6), and a pooled odds ratio (OR) comparing intervention to control of 0.54 (95% CI:0.40 to 0.72, p < 0.001). A combination of aerobic and anaerobic exercise, or yoga alone, had a greater beneficial effect compared to performing aerobic exercise only (mixed-OR = 0.50, 95% CI:0.33 to 0.75, p = 0.001; yoga-OR = 0.28, 95% CI:0.13 to 0.58, p = 0.001); aerobic exercise only-OR = 0.87, 95% CI:0.55 to 1.37, p = 0.539). Pregnancy is an opportunity for healthcare providers to promote positive health activities, thus optimizing the health of pregnant women with potential short- and long-term benefits for both mother and child. This systematic review and meta-analysis support a beneficial effect of either structured exercise (combination of aerobic, strength, and flexibility workouts) or yoga for preventing the onset of HDP. Yoga, considered a low-impact physical activity, could be more acceptable and safer for women in pregnancy in reducing the risk of developing HDP.

Effects of aerobic, strength, and combined training during pregnancy in the blood pressure: A systematic review and meta-analysis

“…In addition, a meta-analysis has previously demonstrated the maintenance of blood pressure values in SBP and the reduction in DBP after an AT + ST program ( Cornelissen & Smart, 2013 ). Considering that the SBP remained stable and was evidenced in a reduction in DBP, these findings are under the literature, which reaffirms the role of physical exercise in reducing the risk of disorders related to blood pressure in pregnancy ( Magro-Malosso et al, 2017 ; Du et al, 2019 ; Syngelaki et al, 2019 ; Danielli et al, 2022 ). To the best of the authors’ knowledge, there are no meta-analyses that synthesize longitudinal studies that evaluated the impacts of regular physical exercise on BP values during pregnancy.…”

“…There is evidence regarding the impacts of physical exercise on BP in pregnant women. However, there are only a few systematic reviews with meta-analyses addressing these effects during pregnancy ( Magro-Malosso et al, 2017 ; Du et al, 2019 ; Syngelaki et al, 2019 ; Danielli et al, 2022 ).…”

“…After searching the literature, some meta-analyses were found to assess the risk of developing blood pressure-related disorders in pregnant women ( Magro-Malosso et al, 2017 ; Du et al, 2019 ; Syngelaki et al, 2019 ; Danielli et al, 2022 ). However, none of them analyzed the behavior of systolic or diastolic blood pressure in its quantitative aspects, considering different types of physical exercises.…”

Gestasyonel hipertansiyon ve güncel tedavi yaklaşımları

“…Tüm gebelere sağlıklı bir diyet ve egzersizin sürdürülmesiyle ilgili genel yaşam tarzı tavsiyeleri verilmelidir. Gebelik sırasında düzenli aerobik egzersiz yapan kadınlarda hipertansif bozukluklar ve gestasyonel diyabet oranı daha düşüktür (18). ASPRE (Kanıta Dayalı Preeklampsi Önleme Aspirin) Denemesi, 11-14 haftadan 36 haftaya kadar günde 150 mg aspirin alan kadınlarda plaseboya kıyasla daha düşük preterm-preeklampsi oranı olduğu sonucuna varmıştır (%1,6'ya karşı %4,3) (19).…”

Effects of physical exercise on blood pressure during pregnancy

“…Significant changes in posture and shifts in centre of gravity alter maternal balance and coordination. In the past, Physical exercise is not recommended for women with high blood pressure during pregnancy because of concerns about the safety of the fetus and the pregnant woman, however, recent studies have showed that proper exercise is associated with a significantly reduced risk of gestational hypertensive disorders overall, either structured exercise or yoga have a beneficial effect for preventing the onset of pregnancy-induced hypertension (HDP) [ 9 , 15 ].…”