The effects of vigorous intensity exercise in the third trimester of pregnancy: a systematic review and meta-analysis

Abstract

Background Fetal growth is dependent upon utero-placental vascular supply of oxygen and nutrients from the mother and has been proposed to be compromised by vigorous intensity exercise in the third trimester. The aim of this systematic review was to investigate the effects of vigorous intensity exercise performed throughout pregnancy, on infant and maternal outcomes. Methods Electronic searching of the PubMed, Medline, EMBASE, Cochrane Library, Web of Science and CINAHL databases was used to conduct the search up to November 2018. Study designs included in the systematic review were randomised control trials, quasi-experimental studies, cohort studies and case-control studies. The studies were required to include an intervention or report of pregnant women performing vigorous exercise during gestation, with a comparator group of either lower intensity exercise or standard care. Results Ten cohort studies ( n = 32,080) and five randomized control trials ( n = 623) were included in the systematic review ( n = 15), with 13 studies included in the meta-analysis. No significant difference existed in birthweight for infants of mothers who engaged in vigorous physical activity and those who lacked this exposure (mean difference = 8.06 g, n = 8006). Moreover, no significant increase existed in risk of small for gestational age (risk ratio = 0.15, n = 4504), risk of low birth weight (< 2500 g) (risk ratio = 0.44, n = 2454) or maternal weight gain (mean difference = − 0.46 kg, n = 1834). Women who engaged in vigorous physical activity had a small but significant increase in length of gestational age before delivery (mean difference = 0.21 weeks, n = 4281) and a small but significantly reduced risk of prematurity (risk ratio = − 0.20, n = 3025). Conclusions Findings from this meta-analysis indicate that vigorous intensity exercise completed into the third trimester appears to be safe for most healthy pregnancies. Further research is needed on the effects of vigorous intensity exercise in the first and second trimester, and of exercise intensity exceeding 90% of maximum heart rate. Trial registration PROSPERO trial registration CRD42018102109 . Electronic supplementary material The online version of this article (10.1186/s12884-019-2441-1) contains supplementary material, which is available to authorized users.

Advancing the global physical activity agenda: recommendations for future research by the 2020 WHO physical activity and sedentary behavior guidelines development group

“…Some of the research gaps identified for other populations remain especially relevant for pregnant women (e.g., the health benefits of breaking up sedentary time with bouts of light-intensity activity, or the joint association of physical activity and sedentary time with maternal and fetal health). On the other hand, although the myriad benefits of moderate-intensity physical activity during pregnancy and the postpartum period have been established [ 9 , 21 , 25 ], the safety and benefits of vigorous-intensity physical activity have been examined only recently [ 26 ]. Women who participate in vigorous physical activity on a regular basis before pregnancy may want to continue such activity for as long as possible throughout pregnancy and the post-partum period.…”

Physical activity and gestational weight gain predict physiological and perceptual responses to exercise during pregnancy

“…Limited research has evaluated the effects of vigorous‐intensity exercise during pregnancy on maternal health and fitness outcomes. A recent systematic review and meta‐analysis suggested that for most women undergoing a healthy pregnancy without any contraindications, engaging in vigorous‐intensity exercise is safe and may not increase the risk for maternal and fetal health complications such as preterm delivery (Beetham et al, 2019). However, it must be noted that maternal fitness‐related outcomes were not assessed by Beetham et al (2019).…”

“…A recent systematic review and meta‐analysis suggested that for most women undergoing a healthy pregnancy without any contraindications, engaging in vigorous‐intensity exercise is safe and may not increase the risk for maternal and fetal health complications such as preterm delivery (Beetham et al, 2019). However, it must be noted that maternal fitness‐related outcomes were not assessed by Beetham et al (2019). Further inquiry, including high quality interventions and randomized controlled trials, are required to understand the effects of vigorous‐intensity exercise during pregnancy.…”

Physical activity, sitting time and sleep duration before and during pregnancy and pregnancy outcomes: A prospective panel study

“…Some studies have found that recommended levels of PA do not decrease the risk of CS (Lindqvist et al, 2016) or SGA (Pastorino et al, 2019), while others have found that exercise is associated with a decreased risk for CS (Di Mascio, Magro-Malosso, Saccone, Marhefka, & Berghella, 2016;Owe et al, 2016;Poyatos-Leon et al, 2015). Vigorous-intensity exercise in late pregnancy was not associated with an increased risk of SGA (Beetham et al, 2019).…”

“…Notwithstanding, this study did not adjust for important confounders such as pregestational body mass index (BMI) and maternal complications during pregnancy. Systematic reviews showed that PA in late pregnancy was not associated with an increased risk of SGA, but exercise in the other trimesters of pregnancy and risk of SGA was less clear (Beetham et al, 2019;Bisson et al, 2016). Therefore, it…”