Effect of prenatal aerobic exercises on maternal and neonatal outcomes: A systematic review and meta-analysis

Association of physical activity during pregnancy with labor and delivery in nulliparous patients

Background

Physical activity during pregnancy is a positive behavior for improving pregnancy outcomes, yet the relationship between physical activity during pregnancy and labor is still debated.

Objective

This study aimed to test our hypothesis that a higher level of physical activity during pregnancy is associated with a shorter labor duration.

Study design

This was a prospective cohort study of pregnant women with singleton pregnancies and no contraindications to physical activity during pregnancy. physical activity according to type and intensity were evaluated with the Chinese version of the Pregnancy Physical Activity Questionnaire. This questionnaire categorizes physical activities into different types and intensities and quantifies them. The primary study outcome was labor duration. The secondary outcomes were delivery mode, conversion from vaginal delivery to cesarean section, prolonged second stage of labor, perineal tears, episiotomy, and postpartum hemorrhage within 24 hours. Generalized additive models were used to identify both linear and nonlinear relationships between physical activity during pregnancy and labor. A segmented linear model was employed to calculate the saturation effect. Stratified logistic regression was used for subgroup analysis.

Results

In total, 226 women participated in the physical activity survey during pregnancy and gave birth at our hospital. The energy expenditure of physical activity during pregnancy was 145.70 (111.92, 181.69) weekly energy expenditure (MET-h•wk-1). After full adjustment for covariates, a nonlinear relationship was observed between physical activity during pregnancy and the duration of the first stage of labor. Different correlations were observed when the energy expenditure of physical activity during pregnancy was 142.28 MET-h•wk-1. In the two-part regression model, the inflection point of physical activity during pregnancy was at 142.28 MET-h•wk-1. When the energy expenditure of physical activity during pregnancy exceeded 142.28 MET-h•wk-1, each standard deviation increase in physical activity was associated with a decrease of 149.85 minutes in the duration of the first stage of labor (β:-149.85, 95 % CI: -247.54 to -52.17, P = 0.0080).

Conclusions

A nonlinear relationship between physical activity during pregnancy and duration of the first stage of labor ha been identified.When physical activity exceeds 142.28 MET-h•wk-1, each additional standard deviation reduces the first stage of labor by 149.85 minutes. Physical activity is not limited to exercise programs; daily activities such as cleaning, shopping, and walking to and from work are effective ways to increase energy expenditure and help individuals achieve the recommended level of physical activity.

Optimizing labor duration with pilates: evidence from a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Pilates has captured interest due to its possible advantages during pregnancy and childbirth. Although research indicates that Pilates may reduce labor duration, alleviate pain, and improve satisfaction with the childbirth experience, consensus on these outcomes remains elusive, underscoring the necessity for additional studies.

AIM

This systematic review and meta-analysis aimed to assess the impact of Pilates exercises on labor duration among pregnant women.

METHODS

The online database was searched to yield the literature using the terms of 'Pilates', 'childbirth', and 'labor duration', and similar terms including PubMed, Clinical Key, Scopus, Web of Science, Embase, and Cochrane Database of Systematic Reviews up to June 25, 2023. Studies were considered eligible if they were randomized or clinical controlled trials (RCTs/CCTs) published in English, focusing on healthy pregnant women without exercise contraindications. The studies needed to include interventions involving Pilates or exercise movement techniques, a comparison group with no exercise, and outcomes related to labor duration, the period of the active phase, and the second stage of delivery.

RESULTS

Eleven studies, totalling 1239 participants, were included in the analysis. These studies provided high-quality evidence from exercise only RCTs/CCTs. The findings indicated a significant reduction in the active phase of labor (8 RCTs, n = 1195; Mean Difference [MD] = -56.35, 95% Confidence Interval [CI] [-89.46 to -23.25]) and overall labor duration (8 RCTs, n = 898; MD = -93.93, 95% CI [-138.34 to -49.51]) in pregnant women who engaged in Pilates exercises compared to those who did not but doesn't affect on the duration of the second stage of labor (7 RCTs, n = 1135; MD = -0.11, 95% CI [-7.21 to 6.99]).

CONCLUSIONS

While this review primarily addresses the effects of Pilates on healthy and low-risk pregnant women, the findings suggest a potential role for Pilates in shortening labor duration. Therefore, engaging in Pilates or similar physical activities is recommended for pregnant women to potentially facilitate a more efficient labor process.

Physical activity and sleep quality among pregnant women during the first and second trimesters are associated with mental health and adverse pregnancy outcomes

BACKGROUND

Appropriate physical activity (PA) and good sleep are beneficial to maternal and fetal health. This paper sought to explore the associations of PA and sleep quality among healthy women at the first and second trimesters of pregnancy on mental health and pregnancy outcomes.

METHODS

Totally 268 healthy pregnant women were retrospectively analyzed as study subjects, 134 each in the first trimester (FT) and second trimester (ST). Their baseline clinical data were obtained respectively at two stages of pregnancy. The PA/sleep quality of subjects were assessed through the Pregnancy Physical Activity Questionnaire-Chinese version (PPAQ-C)/Pittsburgh Sleep Quality Index (PSQI) scale. The mental health was assessed via the Hospital Anxiety and Depression Scale (HADS). The correlations of PA and sleep quality with mental health were analyzed using Spearman correlation analysis. Pregnancy outcomes of all subjects, associations of moderate intensity (MI) PA and sleep quality with adverse pregnancy outcomes, and independent influencing factors for adverse outcomes were analyzed.

RESULTS

Pregnant women in the ST group exhibited higher levels of MI, worse sleep quality, and lower levels of anxiety and depression than those in the FT group. Anxiety and depression were negatively correlated with MI but positively linked with PSQI scores at the first and second trimesters. MI ≥ 7.5 MET-h/week and good sleep quality were associated with a reduced incidence of adverse pregnancy outcomes.

CONCLUSION

MI ≥ 7.5 MET-h/week and good sleep quality at the first and second trimesters of pregnancy benefit mental health and markedly reduce the occurrence of adverse pregnancy outcomes.

Monitored home-based with or without face-to-face exercise for maternal mental health during the COVID-19 pandemic

INTRODUCTION

Despite the known beneficial effects of exercise, most pregnant women do not exercise regularly. Most studies on exercise have been conducted on supervised exercise and there is limited evidence regarding the adherence and effect of other exercise programs on pregnancy outcomes. Therefore, we aimed to investigate adherence to a face-to-face plus monitored home exercise program versus a monitored home-based exercise program on its own during pregnancy. In addition, effects of these two exercise programs on women's mental health during pregnancy and postpartum (primary outcomes) and on some other maternal and neonatal outcomes (secondary outcomes) will be assessed.

METHODS

In this superiority trial with three parallel arms, 150 women at 12-18 weeks of gestation will be randomised equally into three groups (face-to-face plus monitored home exercise, only monitored home-based exercise, and control). The exercise programs will be performed up to the 38th week of gestation during which participants will be assessed at specific intervals during the pregnancy, and post-partum and followed up until six months after childbirth. The exercise diary will be used to assess the adherence. The Edinburgh Depression Scale and the Positive and Negative Affect Schedule will be used to assess prenatal and postnatal depression and affect, respectively.

DISCUSSION

This study reflects the feasibility and acceptance of two exercise programs for pregnant women and their effects on important outcomes. If these programs are followed properly and effectively, pregnant women's health can be improved using these methods at a lower cost compared to the conventional supervised exercise program.

Comparative effect of different types of physical exercise and intensity levels on low birth weight: A systematic review and network meta-analysis

BACKGROUND

Low birth weight (LBW) has been established as a major determinant of neonatal mortality and morbidity. However, there is no evidence of the effectiveness of different types of physical exercise (PE) at different intensities during pregnancy to prevent LBW.

OBJECTIVES

To compare the effectiveness of different types of PE at different levels of intensity in pregnant women to prevent LBW.

DESIGN

A systematic review and network meta-analysis was performed according to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols for Network Meta-Analysis extension statement.

DATA SOURCES AND METHODS

We searched the PubMed, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science databases from inception to November 2023. We included randomized controlled trials (RCTs). A random effects method was used to calculate the pooled mean difference (MD). The effect of each intervention was calculated using a network meta-analysis with a frequentist perspective.

RESULTS

Forty-three RCTs were included in the systematic review, and 38 RCTs were included in the network meta-analysis. In the general population, although no significant results, the MDs for light-moderate strength, moderate-vigorous strength, and moderate-vigorous Pilates exercises were favorable for preventing LBW. Furthermore, moderate-vigorous strength exercise was effective to prevent LBW, reporting significant MD compared to control groups in the healthy population (310.00, 95% confidence interval: 78.40, 541.60; I2 = 81.3%).

CONCLUSION

Strength exercises at a moderate-vigorous intensity could be a potential strategy for the prevention of LBW in the healthy population. However, our findings should be interpreted with caution because the overall risk of bias was between "some concerns" and "high," and the overall certainty of the evidence was low.

REGISTRATION

PROSPERO CRD42023401770.

A narrative review of exercise dose during pregnancy

The current recommendations for prenatal exercise dose align with those from the American College of Sports Medicine; 150 min of moderate intensity every week of pregnancy. However, recent works suggest there may be a dose-dependent beneficial effect for mother and offspring; maternal and offspring health outcomes respond differently to low, medium, and high doses of prenatal exercise. It is, therefore, our aim to summarize the published evidence (years 1950-2023) for five metrics of prenatal exercise training commonly reported, that is, "FITT-V": Frequency (number of sessions), Intensity (metabolic equivalents "METs"), Time (duration of sessions), Type (exercise mode), Volume (exercise MET*mins). The target audience includes clinicians and health care professionals, as well as exercise professionals and physiologists. Data suggest that moderate exercise frequency (3-4 times weekly) appears safe and efficacious for mother and offspring, while there is contradictory evidence for the safety and further benefit of increased frequency beyond 5 sessions per week. Moderate (3-6 METs) and vigorous (>6 METs) intensity prenatal exercise have been shown to promote maternal and offspring health, while little research has been performed on low-intensity (<3 METs) exercise. Exercise sessions lasting less than 1 hr are safe for mother and fetus, while longer-duration exercise should be carefully considered and monitored. Taken together, aerobic, resistance, or a combination of exercise types is well tolerated at medium-to-high volumes and offers a variety of type-specific benefits. Still, research is needed to define (1) the "minimum" effective dose of exercise for mother and offspring health, as well as (2) the maximum tolerable dose from which more benefits may be seen. Additionally, there is a lack of randomized controlled trials addressing exercise doses during the three trimesters of pregnancy. Further, the protocols adopted in research studies should be more standardized and tested for efficacy in different populations of gravid women.

Does a longer second stage of labor worsen umbilical artery blood gas parameters in newborns?-a retrospective cohort study of 2,140 cases

Background

With the application of the new labor management model in China, the normal length of the second stage of labor is significantly longer than that of the old model. It is unclear whether a longer stage of labor worsens umbilical artery blood gas analysis (UABGA) in newborns. The aim of this study was to investigate the correlation between the second stage of labor length, UABGA results, and neonatal intensive care unit (NICU) transfer rates under the new labor management model.

Methods

This is a retrospective cohort study including full-term, cephalic, vaginal deliveries. Exclusion criteria were preterm deliveries or deliveries by cesarean section during labor. The pH, base excess (BE), and lactate results of UABGA in newborns clearly reflect neonatal metabolic acidosis and intrauterine oxygenation of the fetus. The correlation between the length of the second stage of labor and the results of UABGA and NICU transfer rate was analyzed using linear or logistic regression and curve fitting.

Results

Of the total 2,140 cases, after adjusting for maternal age, gestational week, high-risk pregnancy factors, body mass index (BMI) before pregnancy, induced delivery, oxytocin during labor stage, labor analgesia, abnormal fetal position in labor stage, vaginal device delivery, length of first labor stage, and weight of the newborn, every 1 hour increase in the length of the second stage of labor decreased the UABGA pH by 0.01 [95% confidence interval (CI): -0.02 to -0.01, P<0.001], decreased the UABGA BE by 0.66 mmol/L (95% CI: -0.84 to -0.48, P<0.001), increased the UABGA lactate level by 0.39 mmol/L (95% CI: 0.29 to 0.50, P<0.001), and increased the NICU transfer rate by 26% (95% CI: 1.07 to 1.48, P=0.005). In the stratified analysis, when the length of the second stage of labor increased from 3 to 4 or more hours, there was no significant change in UABGA pH, BE, lactate, or NICU transfer rates.

Conclusions

Under the new criteria for the management of labor stage, the length of the second stage increasing from 3 to 4 or more hours did not negatively impact newborns. Therefore, clinician should not be too worried about the longer second stage of labor worsening adverse outcomes in newborns.

Current Resources for Evidence-Based Practice, January 2022

An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of breastfeeding while employed and commentaries on reviews focused on mammography test characteristics and sexual health for gynecologic cancer survivors. It also includes a quick update on a USPSTF review for aspirin as pre-eclampsia prophylaxis.

Relationship between Physical Activity and the Metabolic, Inflammatory Axis in Pregnant Participants

Physical activity (PA) during pregnancy is beneficial for mother and child. Little is known regarding the effects of PA on specific adipokines/myokines and their impact during pregnancy. This study investigates the correlation between PA during late pregnancy, body composition, and maternal levels of leptin, IL-6, and TNF-α at delivery. In a cross-sectional study of 91 pregnant participants (mean age 33.9 ± 4.6 years) without gestational diabetes mellitus or preeclampsia, anthropometric data and blood samples were taken at delivery. PA during the third trimester was measured via the Pregnancy Physical Activity Questionnaire. Activities were ranked by intensity: sedentary (<1.5 metabolic equivalent (METs)), light (1.5–3.0 METs), moderate (3.0–6.0 METs), and vigorous activity (>6.0 METs). Leptin at delivery correlated positively with body composition and negatively with light PA intensity. Sedentary behaviour showed a positive correlation with IL-6 levels at delivery. Moderate activity during the last trimester, sedentary activity levels, and body composition had the greatest influence on maternal IL-6 at delivery. Completed weeks of pregnancy, moderate and light PA, and sedentary activity had the greatest influence on maternal TNF-α at delivery. PA during late pregnancy potentially affects circulating (adipo-)/myokines. Further studies are needed to examine causal relationships and the impact on maternal and new-born health.

Effect of prenatal aerobic exercises on maternal and neonatal outcomes: A systematic review and meta-analysis

Aim

This study aimed to evaluate the effect of prenatal aerobic exercises on maternal and neonatal outcomes.

Design

A systematic review and meta‐analysis.

Method

A search was carried out in databases including PubMed, ProQuest, EMBASE, Cochrane Library, Scopus, Web of Science, Magiran and SID until 30 September 2020. Two reviewers independently assessed the articles for quality and risk of bias using the Cochrane handbook. The statistical heterogeneity was determined using the Cochran's Q test and Higgins' I² coefficient.

Results

Of the 2,790 extracted articles, 16 were included in this review. The results of the meta‐analysis showed that prenatal exercise can increase the frequency of vaginal delivery significantly (RR: 1.24; 95% CI: 1.08–1.43), but had no statistically significant effect on other maternal and neonatal outcomes, such as first, second and third stages of labour, gestational age at birth, first and fifth‐minute Apgar score, umbilical cord pH, neonatal weight, height and head circumference (p > .05).

Conclusions

The meta‐analysis results suggested that prenatal exercise can reduce the frequency of caesarean section.