Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials

Mascio, Daniele Di; Magro-Malosso, Elena Rita; Saccone, Gabriele; Marhefka, Gregary D.; Berghella, Vincenzo

doi:10.1016/j.ajog.2016.06.014

Cited by 185 publications

(154 citation statements)

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“…Some previous studies have reported high risk of preterm delivery associated with exercise during pregnancy [60], but a recent meta-analysis did not find any association between aerobic exercise for 35–90 minutes 3–4 times per week and increased risk of preterm birth [61]. In the current trial two women in the exercise group had a preterm delivery, and we found no indication of this being related to participating in the exercise program.…”

Section: Discussioncontrasting

confidence: 70%

Effect of supervised exercise training during pregnancy on neonatal and maternal outcomes among overweight and obese women. Secondary analyses of the ETIP trial: A randomised controlled trial

et al. 2017

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BackgroundMaternal obesity associates with complications during pregnancy and childbirth. Our aim was to investigate if exercise during pregnancy in overweight/obese women could influence birth weight or other neonatal and maternal outcomes at delivery.Material and methodsThis is a secondary analysis of a randomised controlled trial of exercise training in pregnancy for women with body mass index (BMI) ≥ 28 kg/m2. Ninety-one women (31.3 ± 4.3 years, BMI 34.5 ± 4.2 kg/m2) were allocated 1:1 to supervised exercise during pregnancy or to standard care. The exercise group was offered three weekly training sessions consisting of 35 minutes of moderate intensity walking/running followed by 25 minutes of strength training. Data from 74 women (exercise 38, control 36) were analysed at delivery.ResultsBirth weight was 3719 ± 695 g in the exercise group and 3912 ± 413 g in the control group (CI -460.96, 74.89, p = 0.16). Birth weight > 4000 g was 35% in the exercise group and 52% in the control group (p = 0.16). Mean gestational age at delivery was 39.1 weeks in the exercise group and 39.5 weeks in the control group (CI -1.33, 0.43, p = 0.31). No significant between-group differences were found in neonatal body size, skinfold thickness, placental weight ratio, or Apgar score. The prevalence of caesarean section was 24% in the exercise group and 17% in the control group (CI 0.20, 2.05, p = 0.57). Mean length of hospital stay was 4.8 days in the exercise group and 4.5 days in the control group (CI -0.45, 1.00, p = 0.45).ConclusionsOffering supervised exercise during pregnancy for overweight and obese women did not influence birth weight or other neonatal and maternal outcomes at delivery. However our trial was limited by low sample size and poor adherence to the exercise protocol, and further research is needed.Trial registrationClinicalTrials.gov NCT01243554

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Section: Discussioncontrasting

confidence: 70%

Effect of supervised exercise training during pregnancy on neonatal and maternal outcomes among overweight and obese women. Secondary analyses of the ETIP trial: A randomised controlled trial

et al. 2017

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“…More importantly, women in the exercise arm had higher occurrences of vaginal delivery and lower occurrences of gestational diabetes, and no differences in low birthweight, thus giving providers and patients additional evidence on the safety and benefits of exercise during pregnancy. 52 …”

Section: Practical Approaches To Assist Providers and Patients In Meementioning

confidence: 99%

Gestational weight gain

Kominiarek

Peaceman

2017

American Journal of Obstetrics and Gynecology

304

259

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Prenatal care providers are advised to evaluate maternal weight at each regularly scheduled prenatal visit, monitor progress toward meeting weight gain goals, and provide individualized counseling if significant deviations from a woman’s goals occur. Today, nearly 50% of women exceed their weight gain goals with overweight and obese women having the highest prevalence of excessive weight gain. Risks of inadequate weight gain include low birth weight and failure to initiate breastfeeding whereas the risks of excessive weight gain include cesarean deliveries and post-partum weight retention for the mother and large for gestational age infants, macrosomia, and childhood overweight or obesity for the offspring. Prenatal care providers have many resources and tools they can use to incorporate weight and other health behavior counseling into their routine prenatal practices. Because many women are motivated to improve their health behaviors, pregnancy is often considered the optimal time to intervene for issues related to eating habits and physical activity so as to prevent excessive weight gain. Gestational weight gain is a potentially modifiable risk factor for a number of adverse maternal and neonatal outcomes and meta-analyses of randomized controlled trials report that diet or exercise interventions during pregnancy can help reduce excessive weight gain. However, health behavior interventions for gestational weight gain have not significantly improved other maternal and neonatal outcomes and have limited effectiveness in overweight and obese women.

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“…In this context, an international expert committee recently reviewed the literature and provided specific exercise recommendations for elite athletes throughout pregnancy (Bo et al, 2016) and postpartum (Bo et al, 2017b). In general, physical activity and moderate exercise during pregnancy are found to be safe both for the mother and the child (Hellenes et al, 2015; Di Mascio et al, 2016), although 30–60% reduced training volumes during the third trimester has been reported in recreational and competitive runners (Potteiger et al, 1993; Bailey et al, 1998; Tenforde et al, 2015). …”

Section: Introductionmentioning

confidence: 99%

Training Characteristics During Pregnancy and Postpartum in the World’s Most Successful Cross Country Skier

Solli

Sandbakk

2018

Front. Physiol.

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This case-study investigated the training characteristics, physiological capacity, and body composition of the world’s most successful cross country skier during the 40-week pregnancy, and the 61-week postpartum. Training data was systemized by training form (endurance, strength, and speed), intensity [low- (LIT), moderate- (MIT), and high-intensity training (HIT)], and mode (running, cycling, and skiing/roller skiing). The training volume [mean ± standard deviation (median)] during pregnancy was 12.9 ± 7.3(10.0) h/week in the first- (weeks 1–12), 18.3 ± 2.9(18.0) h/week in the second- (weeks 13–28), and 8.8 ± 4.4(9.6) h/week in the third trimester (weeks 29–40). Endurance training time was distributed into 10.9 ± 6.2(9.9), 15.2 ± 2.3(15.6), and 7.6 ± 3.8(7.9) LIT and 0.4 ± 0.5(0.0), 1.3 ± 0.4(1.4), and 0.7 ± 0.6(0.8) h/week MIT during the three trimesters. Only 2.2 h of HIT was performed during the entire pregnancy. During the first two trimesters, the distribution of exercise modes were approximately the same as pre-pregnancy, but the amount of running was reduced during the third trimester. Training volume during the postpartum periods 1–4 was 6.6 ± 3.8(7.1) (PP1; weeks 1–6), 14.1 ± 3.4(14.3) (PP2; weeks 7–12), 10.6 ± 3.8(10.4) (PP3; weeks 13–18), and 13.6 ± 4.1(14.5) h/week (PP4; weeks 19–24), respectively. Training during PP3 and PP4 was interfered with two fractions in the sacrum, leading to decreased amount of running and MIT/HIT, compensated by increased amounts of cycling. Thereafter, training volume progressively approached the pre-pregnancy values, being 18.0 ± 3.9(18.7) h/week during the general preparation- (weeks 25–44), 17.6 ± 4.4(17.3) h/week during the specific preparation- (weeks 45–53), and 16.9 ± 3.5(17.2) h/week during the competition period (CP; weeks 54–61) leading up to the subsequent world championship. The oxygen uptake at the estimated lactate threshold (LT) decreased to 90% of pre-pregnancy values in the second trimester, but remained to ∼100% in PP3. Body weight and fat-% was higher, while lean body mass and bone mineral density was lower after delivery compared to pre-pregnancy. These measurements gradually changed and were back to ∼pre-pregnancy values during CP. This study indicates that high-level cross country skiers can tolerate high training loads during pregnancy. Although the participant had some postpartum setbacks in her training due to fractures in the sacrum, reduced overall training load, followed by a slower progression and utilization of alternative exercise modes, led to a successful return to competitions.

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Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials

Cited by 185 publications

References 23 publications

Effect of supervised exercise training during pregnancy on neonatal and maternal outcomes among overweight and obese women. Secondary analyses of the ETIP trial: A randomised controlled trial

Effect of supervised exercise training during pregnancy on neonatal and maternal outcomes among overweight and obese women. Secondary analyses of the ETIP trial: A randomised controlled trial

Gestational weight gain

Training Characteristics During Pregnancy and Postpartum in the World’s Most Successful Cross Country Skier

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