Impact of prenatal exercise on maternal harms, labour and delivery outcomes: a systematic review and meta-analysis

Davenport, Margie H.; Ruchat, Stéphanie-May; Sobierajski, Frances; Poitras, Veronica J.; Gray, Casey; Yoo, Courtney; Skow, Rachel J.; Garcia, Alejandra Jaramillo; Barrowman, Nick; Meah, Victoria L.; Nagpal, Taniya S.; Riske, Laurel; James, Marina; Nuspl, Megan; Weeks, Ashley; Marchand, Andrée-Anne; Slater, Linda; Adamo, Kristi B.; Davies, Gregory; Barakat, Rubén; Mottola, Michelle F.

doi:10.1136/bjsports-2018-099821

Cited by 109 publications

(96 citation statements)

References 106 publications

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“…26,27 A recent systematic review that evaluated potential maternal and fetal harms as a result of exercise during pregnancy reported that exercise did not have an association with preterm rupture of membranes, caesarean births, induction of labor, length of labor, vaginal tears, or musculoskeletal trauma. 28 In fact, exercise has actually shown protective effects for both maternal and fetal health, including improvement in cardiovascular fitness that can assist with labor and recovery. 29 As women who are pregnant continue to report fear for safety as a concern and deterrent for participating in exercise, this may indicate a lack of knowledge translation for the known benefits and lack of harms associated with prenatal exercise.…”

Section: Discussionmentioning

confidence: 99%

Exploring Beliefs About Exercise Among Pregnant Women in Rural Communities

Tinius

Nagpal

Edens

et al. 2020

J Midwife Womens Health

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Introduction Women who are pregnant in rural communities are disproportionally impacted by obesity and sedentary behavior, and this could be related to having negative beliefs about exercise during pregnancy, leading to inactivity. The purpose of this study was to identify self‐reported beliefs about exercise among pregnant women in a rural community. Methods Pregnant participants (N = 70) between 8 and 16 weeks’ gestation were recruited from an obstetric clinic serving a rural population. An open‐ended questionnaire addressing beliefs about exercise and based on the constructs of the theory of planned behavior was administered. Descriptive survey results were analyzed by calculating means and frequencies. Open‐ended responses were assessed by inductive content analysis. Results Commonly reported advantages of exercise during pregnancy included improved perinatal health outcomes and weight management. Commonly reported disadvantages included an increase in fatigue and concerns for maternal and fetal safety. Common facilitators of exercise included access to resources, free time or a decrease in demands from work, and support systems including family and friends. Common barriers to exercise included a lack of time, physical changes including feelings of nausea and fatigue, and lack of access to resources. Discussion This study was the first to report beliefs about exercise during pregnancy in a rural setting. Responses in the current study suggest potential gaps in knowledge of evidence‐based information regarding physical activity during pregnancy. Beliefs as well as reported barriers and facilitators of physical activity during pregnancy were similar those reported in other populations. In addition, access to resources (or lack of) appears to be an important facilitator (or barrier) among women in rural settings; thus, developing strategies designed to overcome this barrier, specifically in rural areas, is critically important. Future intervention strategies need to be tailored specifically to the needs of women living in rural areas.

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Section: Discussionmentioning

confidence: 99%

Exploring Beliefs About Exercise Among Pregnant Women in Rural Communities

Tinius

Nagpal

Edens

et al. 2020

J Midwife Womens Health

View full text Add to dashboard Cite

show abstract

“…A systematic review by the 2016 Evidence summary of the International Olympic Committee expert group meeting on exercise and pregnancy in recreational and elite athletes concluded that exercise did not increase the risk of induction, epidural, episiotomy or perineal tears, and forceps or vacuum delivery, but appeared to be associated with a shorter first stage of labor and lower risk of cesarean delivery [85]. Similarly, a recent systematic review and meta-analysis concluded that based on moderate quality evidence from 20 exercise-only RCTs conducted antenatally (n = 3819), the odds of instrumental delivery in women who exercised was lower than those who did not; there were no differences between groups in any other labor/delivery variables studied [86]. However, the conclusions were based on few studies (mostly retrospective and prospective observational studies) and the studies had low-to-moderate quality [85,86].…”

Section: Easier Labor and Birthmentioning

confidence: 99%

Is Physical Activity Good or Bad for the Female Pelvic Floor? A Narrative Review

2019

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More women participate in sports than ever before and the proportion of women athletes at the Olympic Games is nearly 50%. The pelvic floor in women may be the only area of the body where the positive effect of physical activity has been questioned. The aim of this narrative review is to present two widely held opposing hypotheses on the effect of general exercise on the pelvic floor and to discuss the evidence for each. Hypothesis 1: by strengthening the pelvic floor muscles (PFM) and decreasing the levator hiatus, exercise decreases the risk of urinary incontinence, anal incontinence and pelvic organ prolapse, but negatively affects the ease and safety of childbirth. Hypothesis 2: by overloading and stretching the PFM, exercise not only increases the risk of these disorders, but also makes labor and childbirth easier, as the PFM do not obstruct the exit of the fetus. Key findings of this review endorse aspects of both hypotheses. Exercising women generally have similar or stronger PFM strength and larger levator ani muscles than non-exercising women, but this does not seem to have a greater risk of obstructed labor or childbirth. Additionally, women that specifically train their PFM while pregnant are not more likely to have outcomes associated with obstructed labor. Mild-to-moderate physical activity, such as walking, decreases the risk of urinary incontinence but female athletes are about three times more likely to have urinary incontinence compared to controls. There is some evidence that strenuous exercise may cause and worsen pelvic organ prolapse, but data are inconsistent. Both intra-abdominal pressure associated with exercise and PFM strength vary between activities and between women; thus the threshold for optimal or negative effects on the pelvic floor almost certainly differs from person to person. Our review highlights many knowledge gaps that need to be understood to understand the full effects of strenuous and non-strenuous activities on pelvic floor health.

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“…Those women are counselled to seek physiotherapy advice and avoid abdominal strengthening exercises (eg, abdominal curls) as this may worsen the condition,31 increasing the likelihood of requiring postnatal repair. However, continuing aerobic exercise such as walking is associated with decreased odds of developing diastasis recti 4. While there has been less research on resistance exercises as compared with aerobic exercises in pregnancy, available evidence regarding resistance exercise in pregnancy has not identified adverse impacts on the mother, the fetus or the neonate.…”

Section: Considerations For Implementationmentioning

confidence: 99%

2019 Canadian guideline for physical activity throughout pregnancy

et al. 2018

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The objective is to provide guidance for pregnant women and obstetric care and exercise professionals on prenatal physical activity. The outcomes evaluated were maternal, fetal or neonatal morbidity, or fetal mortality during and following pregnancy. Literature was retrieved through searches of MEDLINE, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Scopus and Web of Science Core Collection, CINAHL Plus with Full Text, Child Development & Adolescent Studies, Education Resources Information Center, SPORTDiscus, ClinicalTrials.gov and the Trip Database from inception up to 6 January 2017. Primary studies of any design were eligible, except case studies. Results were limited to English-language, Spanish-language or French-language materials. Articles related to maternal physical activity during pregnancy reporting on maternal, fetal or neonatal morbidity, or fetal mortality were eligible for inclusion. The quality of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation methodology. The Guidelines Consensus Panel solicited feedback from end users (obstetric care providers, exercise professionals, researchers, policy organisations, and pregnant and postpartum women). The development of these guidelines followed the Appraisal of Guidelines for Research and Evaluation II instrument. The benefits of prenatal physical activity are moderate and no harms were identified; therefore, the difference between desirable and undesirable consequences (net benefit) is expected to be moderate. The majority of stakeholders and end users indicated that following these recommendations would be feasible, acceptable and equitable. Following these recommendations is likely to require minimal resources from both individual and health systems perspectives.

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Impact of prenatal exercise on maternal harms, labour and delivery outcomes: a systematic review and meta-analysis

Cited by 109 publications

References 106 publications

Exploring Beliefs About Exercise Among Pregnant Women in Rural Communities

Exploring Beliefs About Exercise Among Pregnant Women in Rural Communities

Is Physical Activity Good or Bad for the Female Pelvic Floor? A Narrative Review

2019 Canadian guideline for physical activity throughout pregnancy

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