Effectiveness and safety of moderate-intensity aerobic water exercise during pregnancy for reducing use of epidural analgesia during labor: protocol for a randomized clinical trial

Obstetric, maternal, and neonatal outcomes after Pilates exercise during pregnancy: A systematic review and meta-analysis

BACKGROUND

One of the major exercises to improve the psychological and physical functions of pregnant women is Pilate's exercises. The aim of this study is to collect evidence about Pilates exercise effects on many consequences in pregnant women, such as maternal and neonatal outcomes and obstetric outcomes.

METHODS

PubMed, Clinical Key, Cochrane Library, Scopus, Embase, and Web of Science were scoured from their inception. Research comparing Pilates during pregnancy to other methods, or to the control was included. For randomized controlled trials (RCTs), The researcher utilized the Cochrane risk of bias tool; for non-RCTs, risk of bias tool to assess non-randomized studies of interventions, was used for cohort studies, and the national heart, lung, and blood institute tool. Meta-analysis was done using the Review manager 5.4. For continuous data, calculated the mean difference and 95% confidence interval (CI), and the risk ratio (RR) and 95% CI for dichotomous data.

RESULTS

Finally, 13 studies included with a total number of 719 pregnant women. The analysis showed that the Pilates group was significantly more likely to deliver vaginally than the control group (RR = 1.21, 95% CI [1.05 to 1.41], P value = .009). Women in the Pilates group were significantly lower than the control group to have Cesarean delivery (RR = 0.67, 95% CI [0.48-0.94], P value = .02). Moreover, Pilates-treated women were less likely to gain weight during pregnancy than control (mean difference = -3.48, 95% CI [-6.17 to -0.79], P value = .01).

CONCLUSION

Pilates exercise improved the outcomes of pregnant women. It decreases the rate of Cesarean delivery and the time of delivery. Moreover, Pilates has a role in decreasing weight gain in pregnant women. As a result, that may improve the pregnancy experience for women. However, more RCTs needed with larger sample sizes to assess the Pilates effect on neonatal outcomes.

Effect of aerobic water exercise during pregnancy on epidural use and pain: A multi-centre, randomised, controlled trial

OBJECTIVE

The physical and psychological benefits of exercise during pregnancy are well established. However, the impact of exercise on pain during labour and the use of epidural analgesia has been less explored. The main aim of this study was to analyse the effectiveness and safety of moderate aerobic water exercise by pregnant women on the subsequent use of epidural analgesia during labour, induction of labour, mode of delivery, and pain perception.

DESIGN

A multi-centre, parallel, randomised, evaluator blinded, controlled trial in a primary care setting.

SETTING

Primary care centres in a health district of a tertiary obstetric metropolitan hospital in Mallorca, Spain.

PARTICIPANTS

Pregnant women (14 to 20 weeks' gestation) who had low risk of complications.

METHODS

Three hundred and twenty pregnant women were randomly assigned to two groups: women who practiced moderate aquatic aerobic exercise with usual antenatal care, and those who received usual prenatal care alone. The gynaecologist, anaesthesiologist and midwife who assisted the women during labour were blinded to group allocations. Principal outcome: use of epidural analgesia during labour. Other outcomes: use of epidural analgesia before 6 cm cervical dilation, labour pain, type of delivery, time of active labour, episiotomy or perineal tear, and induction of labour.

RESULTS

The exercise program did not affect the use of epidural analgesia (OR = 0.79, 95% CI = 0.44 to 1.40), vaginal delivery (OR = 1.35, 95% CI = 0.73 to 2.41), or caesarean section (OR = 0.94, 95% CI = 0.47 to 1.89). However, women in the exercise group reported less pain during labour (mean difference: -0.6, 95% CI = -1.11 to -0.09). The two groups (moderate aquatic aerobic exercise versus usual antenatal care) showed no significant differences in maternal or newborn adverse events.

CONCLUSION

Aquatic aerobic exercise during pregnancy had no effect on the use of epidural analgesia during labour, whereas pain perception was lower after aquatic exercise compared to usual care in pregnancy. The intervention was safe for pregnant women and their newborns.

The effectiveness of a Pilates exercise program during pregnancy on childbirth outcomes: a randomised controlled clinical trial

Background

Performing exercise with medium intensity has positive effects on the maternal health. The aim of this study was to investigate the effectiveness of Pilates exercise program during pregnancy on childbirth outcomes:

Methods

This clinical trial study was performed on 110 primiparous women who were randomly divided into two groups of intervention (n = 55) and control (n = 55). The intervention group performed Pilates exercises from 26 to 28 weeks of gestation for 8 weeks while the control group did not do any exercise. Data collection tools included Visual Analog Scale (VAS), Mackey Childbirth Satisfaction Rating Scale, and a checklist including demographic and obstetrics information.

Results

The results of the study showed that Pilates exercise during pregnancy significantly reduces the labor pain intensity, length of the active phase and second stage of labor and increases maternal satisfaction of the labor process (p < 0.05). Based on the Kaplan Meyer analysis, the mean whole length of labor was shorter in Pilates exercise group than in the control group (P = .004). There was no statistically significant difference between the two groups in terms of Episiotomy, type of delivery, first and fifth Apgar score of neonates (p > 0.05).

Conclusion

According to the results of this study, Pilates exercise during pregnancy improved the labor process and increased maternal satisfaction of chidbirthprocess, without causing complications for the mother and baby. However, studies with larger sample sizes are recommended to prove the efficacy and safty of this practiceduring labor.

Trial registration

IRCT registration number:IRCT20200126046266N1. Registration date: 2020-05-02 (retrospectively registered).

Effectiveness of Moderate-Intensity Aerobic Water Exercise during Pregnancy on Quality of Life and Postpartum Depression: A Multi-Center, Randomized Controlled Trial

Background: The global prevalence of postpartum depression is about 20%. This disease has serious consequences for women, their infants, and their families. The aim of this randomized clinical trial was to analyze the effectiveness and safety of a moderate-intensity aerobic water exercise program on postpartum depression, sleep problems, and quality of life in women at one month after delivery. Methods: This was a multi-center, parallel, randomized, evaluator blinded, controlled trial in a primary care setting. Pregnant women (14–20 weeks gestational age) who had low risk of complications and were from five primary care centers in the area covered by the obstetrics unit of Son Llatzer Hospital (Mallorca, Spain) were invited to participate. A total of 320 pregnant women were randomly assigned to two groups, an intervention group (moderate aquatic aerobic exercise) and a control group (usual prenatal care). One month after birth, sleep quality (MOS sleep), quality of life (EQ-5D), and presence of anxiety or depression (EPDS) were recorded. Findings: Women in the intervention group were less likely to report anxiety or depression on the EQ5D (11.5% vs. 22.7%; p < 0.05) and had a lower mean EPDS score (6.1 ± 1.9 vs. 6.8 ± 2.4, p < 0.010). The two groups had no significant differences in other outcomes, maternal adverse events, and indicators of the newborn status. Conclusion: Moderate-intensity aquatic exercise during pregnancy decreased postpartum anxiety and depressive symptoms in mothers and was safe for mothers and their newborns.

The investigation of effects of static immersion and calming in water on pregnant women's stress participating in preparation classes for childbirth

INTRODUCTION

Stress in pregnancy can have a negative effect on mother and fetus and at last on childhood. The use of stress reduction techniques in pregnant women has an effective role in the reduction of the mother and child's mental problems. This study aimed at determining the effect of static immersion and relaxing the pregnant women in water on stress, participating in preparation classes for childbirth in Isfahan, Iran, 2017.

METHODS

The present study was a semi-experimental and had pre- and post-test one on 55 pregnant women aged 20-30 weeks (20 test group and 35 control group) participating in the preparation classes for delivery by available sampling method selected in 2017 and their stress level was assessed by depression, anxiety, and stress scale questionnaire. Then, they were divided into test and control groups. In the control group, no intervention was performed, and in the test group, static immersion and calming in water was done in Isfahan University's 9-Dey Pool. To analyze the data, paired t-test, Chi-square t-test, and independent t-test were used.

RESULTS

In this study, stress in the test group decreased after the intervention, so that the mean stress score decreased from 20.20 to 16.67 (P < 0.05). Of course, the stress level declined in the control group, but in the control group, it decreased significantly.

CONCLUSION

Based on the findings of the present study, static immersion and calming in water are considered as reducing women's stress intervention in improving pregnancy period and are therefore recommended to be included in the sanitary system.

Attitude of primiparous women towards their preference for delivery method: a qualitative content analysis

Background

The delivery method is one of the primary concerns of primiparous women. Today, due to the fear of delivery, the number of cesarean sections has increased significantly. Considering the importance of choosing the type of delivery and the lack of study in this regard, the present study was conducted to explain the attitude of primiparous women towards their preference for delivery method.

Method

In this qualitative study, in-depth interview was conducted with 12 primiparous women. The transcripts of the interviews were read carefully by the researcher for several times. Finally, using the analytical method, the codes were extracted and subsequent subcategories and main categories were determined. To assess the credibility of the data, the Denzin & Lincoln’s criteria were used, which include Credibility, Transferability, Dependability, and Confirmability.

Results

Because of inexperience in delivery and ambiguity in process, most of the woman had a specific fear and they commonly affected by other advices and experiences. The majority of the participants had desire to vaginal delivery with announcing its advantages such as shortage of pain process, easy breast feeding, and mother ability to better carryout the newborn works. Other participants believed on adverse effects of normal vaginal delivery including bladder prolapse, uterus rupture, and probability of experience of both happenings (CS and NVD), frequent examination, pain and urine incontinence. Some stated cesarean section have benefits of less injury to neonate and preserving her/his beauty.

Conclusion

Results showed that, choosing a delivery method is difficult for primiparous women, and their attitude toward the type of delivery is influenced by subjective and internal factors. Giving awareness to primiparous women greatly enhances their tendency towards vaginal delivery.

Randomized Clinical Trial of an Aquatic Physical Exercise Program During Pregnancy

OBJECTIVE

To determine the effect of an aquatic physical exercise program performed during pregnancy on rate of intact perineum after childbirth.

DESIGN

Randomized clinical trial.

SETTING

Health centers in the metropolitan health district of Granada, Spain.

PARTICIPANTS

A total of 129 pregnant women (control group [CG] = 64; aquatic exercise group [EG] = 65).

METHODS

The intervention was an aquatic physical exercise program specifically designed for pregnant women (Study of Water Exercise During Pregnancy [SWEP] method). Participants were randomly assigned to the CG or EG by simple random sampling. Participants in the EG performed three sessions per week of physical exercises, which were led by the principal investigator. All participants received routine prenatal care. We evaluated status of the perineum after birth, including laceration and episiotomy rates. We also evaluated participants' weight, body mass index (BMI) in the first and third trimesters, parity, the administration of anesthesia, and birth weight of the neonate as potential confounding variables.

RESULTS

The women in the EG had a greater rate of intact perineum than those in the CG (odds ratio [OR] = 13.54, 95% confidence interval [CI] [2.75, 66.56]). After adjusting for infant birth weight, the effect of the intervention on intact perineum was an OR of 8.57 (95% CI [1.85, 39.68]. Maternal weight gain did not influence the odds of intact perineum (OR = 1.072, 95% CI [0.896, 1.283]). Women who previously gave birth and followed the SWEP method had an OR of 10.197 (95% CI [2.190, 47.476] for an intact perineum. The administration of anesthesia and previous pregnancy also were associated with intact perineum (OR = 6.68, 95% CI [1.21, 36.84] and OR = 5.42, 95% CI [1.64, 17.89] respectively.

CONCLUSION

The women who followed the SWEP method were significantly more likely to have intact perinea after childbirth.