Effects on the maternal-fetal health outcomes of various physical activity types in healthy pregnant women. A systematic review and meta-analysis

An umbrella review of systematic reviews on interventions of physical activity before pregnancy, during pregnancy, and postpartum to control and/or reduce weight gain

BACKGROUND

The increasing prevalence of overweight and obesity worldwide represents a (chronic) complex public health problem. This is also seen among women of childbearing age despite increased efforts to promote physical activity (PA) interventions. Excessive gestational weight gain (GWG) is associated with negative health outcomes for both mothers and offspring.

OBJECTIVES

To summarize current systematic reviews (SRs) on PA interventions during pregnancy and postpartum to prevent excessive GWG and identify the most effective approaches.

SEARCH STRATEGY

A literature search was conducted on major electronic databases (MEDLINE/Pubmed, Cochrane, Web of Science, Epistemonikos) from inception to March 2023.

SELECTION CRITERIA

This study included SRs and meta-analyses of studies involving women aged 18 years or older from diverse ethnic backgrounds, who were either in the preconception period, pregnant, or within 1 year postpartum and who had no contraindications for exercise. Women with chronic diseases, such as pre-existing diabetes (type 1 or type 2) were excluded.

DATA COLLECTION AND ANALYSIS

Two reviewers extracted data from selected studies assessing the impact of PA in preconception, pregnancy, and postpartum. Methodologic quality was assessed with the AMSTAR-2 tool. A narrative summary of results addresses relationships between PA and weight before, during, and after pregnancy, informing future research priorities for preventing excessive weight gain. This study is registered on PROSPERO (CRD420233946666).

MAIN RESULTS

Out of 892 identified articles, 25 studies were included after removing duplicates, unrelated titles, and screening titles and abstracts for eligibility. The results demonstrate that PA can help prevent excessive GWG and postpartum weight retention. Structured and supervised moderate-intensity exercise, at least twice a week, and each session lasting a minimum of 35 min seems to provide the greatest benefits.

CONCLUSIONS

Women who comply with the PA program and recommendations are more likely to achieve adequate GWG and return to their pre-pregnancy body mass index after delivery. Further research is warranted to explore how preconception PA influences pregnancy and postpartum outcomes given the absence of identified preconception-focused interventions.

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.

Gestational Metabolic Risk: A Narrative Review of Pregnancy-Related Complications and of the Effectiveness of Dietary, Exercise and Lifestyle Interventions during Pregnancy on Reducing Gestational Weight Gain and Preventing Gestational Diabetes Mellitus

Objective: This study is a Narrative Review that aims at investigating the implications of obesity, excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM). Additionally, this Review seeks to explore the effectiveness of nutrition, and/or exercise interventions during pregnancy on reducing GWG and preventing GDM. Materials and Methods: The search in literature included studies that identified obesity, GWG, GDM and associated risks during pregnancy. Also, SR and MA focusing on interventions including diet, or physical activity (PA), or combined (i.e., lifestyle interventions) and their impact on metabolic risk during pregnancy, were identified through searches in PubMed, Cochrane Database of Systematic Reviews (CDSRs), and Scopus. Results: The study findings suggest that lifestyle interventions during pregnancy may be effective in reducing excessive GWG. Regarding the prevention of GDM, results from studies evaluating lifestyle interventions vary. However, significant and less controversial results were reported from studies assessing the efficacy of exercise interventions, particularly in high-risk pregnant women. Conclusions: Lifestyle interventions during pregnancy may reduce excessive GWG. Exercise during pregnancy may prevent GDM, especially in high-risk pregnant women. Future research is warranted to tailor lifestyle interventions for optimal effectiveness during pregnancy.

Physical Activity during Pregnancy and Risk of Gestational Diabetes Mellitus: A Meta-Review

BACKGROUND

Nowadays, pregnant women require more individualized attention in their assistance process during pregnancy. One of the aspects that requires the most focus is the suitability of carrying out physical activity. The objective of this meta-review is to find out the effects of physical activity during pregnancy on the incidence of GDM compared to women who do not perform physical activity.

METHODS

A search was conducted in Cochrane, CSIC, Ebscohost, Proquest, Pubmed, Scielo, and Scopus. The search focused on systematic reviews and meta-analyses published in the last five years. The AMSTAR-2 scale was used as a quality assessment tool for the final sample.

RESULTS

A total of 18 systematic reviews and meta-analyses were included. Sixteen of them found out that physical activity during pregnancy has preventive effects for GDM compared with women who lacked physical activity. Among the studies, we found a reduction in the risk of GDM of between 24% and 38% and odds ratios ranging between 0.39 and 0.83 calculated for a 95% CI. Only two studies did not find statistically significant effects. Other variables such as type and duration of physical activity, overweight and obesity, gestational age, etc., were also considered.

CONCLUSIONS

Physical activity prevents the incidence of GDM. The main characteristics that enhance this preventive effect are starting at the initial stages of pregnancy and maintaining during the whole pregnancy as well as combining strength and aerobic exercise at a low to moderate intensity.

Systematic Reviews on the Prevention of Adverse Pregnancy Outcomes Related to Maternal Obesity to Improve Evidence-Based Counselling

Background

Health professionals and their patients should understand the importance of evidence. In the case of gestational diabetes mellitus, which is often associated with an abnormally high body mass index, the immediate and long-term outcome of women and their offspring depends in part on advice and implementation of lifestyle changes before, during and after pregnancy.

Methods

Up to September 2023, MEDLINE, CENTRAL, and WEB OF SCIENCE were used to identify systematic reviews and meta-analyses on the prevention of gestational diabetes. The ROBIS and AMSTAR criteria were analyzed for all systematic reviews.

Results

A total of 36 systematic reviews were identified. Dietary interventions, physical activity or a combined approach all reduced adverse pregnancy outcomes such as gestational diabetes, pregnancy-induced hypertension and related morbidities. Within the randomized controlled trials included in the 36 systematic reviews, the type, intensity and frequency of interventions varied widely. The primary outcomes, reporting and methodological quality of the 36 systematic reviews and meta-analyses also varied.The meta-analysis with the highest ROBIS and AMSTAR-2 scores was selected to design an icon array based on a fact box simulating 100 patients.

Conclusions

We propose a methodology for selecting the best evidence and transforming it into a format that illustrates the benefits and harms in a way that can be understood by lay patients, even if they cannot read. This model can be applied to counselling for expectant mothers in low and high-income countries, regardless of socioeconomic status, provided that women have access to appropriately trained healthcare providers.

Physical activity promotion among pregnancy - the role of physician from the women's perspective

Objective

The clear benefits of planned and supervised physical activity (PA) during pregnancy make it imperative that women are encouraged and educated about this activity. This study aimed to investigate how effectively physician promote physical activity and exercise among pregnant women. It also examines pro-health changes in selected health behaviours during pregnancy.

Methods

This cross-sectional study recruited a total of 353 pregnant women in Wielkopolskie Voivodship in Poland. An anonymous survey (on-line or in-paper) was used to assess physical activity before and during pregnancy (with Pregnancy Physical Activity Questionnaire), physical activity self-efficacy, well-being (WHO-5 Well-Being Index), and guidance received from physicians on physical activity during pregnancy.

Results

Only 41% of women surveyed followed WHO recommendations for PA before pregnancy, and they were much more likely to discuss safety and the need to change the intensity or type of PA with their doctor or gynaecologist. Only 23% of women were asked about their PA before pregnancy and less than 40% were encouraged to be active during pregnancy. We observed a higher probability of poor well-being among pregnant women who were inactive before pregnancy (OR = 1.873, 95%CI 1.026 to 3.421, p = 0.041).

Conclusion

Health professionals infrequently educate and motivate women to be physically active during pregnancy. Physician advice, as it is currently perceived by women, seems to be insufficient to help pregnant women meet the recommendations for PA during pregnancy.

Counselling on physical activity in Danish antenatal care: A qualitative study of experiences from both the pregnant woman's and the care provider's perspective

OBJECTIVES

Physical activity during pregnancy is beneficial to maternal and fetal health, but most pregnant women do not achieve the recommended level of physical activity. To investigate how antenatal care can promote physical activity during pregnancy, this study explores experiences of physical activity counselling from the perspectives of pregnant women and antenatal care providers.

METHODS

In a qualitative design with an inductive approach individual semi-structured interviews with 19 pregnant women and seven antenatal care providers were performed and analyzed using thematic analysis.

RESULTS

The themes "Experiencing inadequate counselling", "Benefiting from individualized guidance", and "Voicing a need for enhanced support" cover the perspectives from the participating pregnant women. They often experienced insufficient physical activity counselling that left them insecure about proper physical activity during pregnancy. The pregnant women desired individualized and concrete advice and early and continuous support. From antenatal care providers the themes "Providers' perceived barriers in counselling", "Balancing the act of counselling", and "Acknowledging potential for enhanced counselling" were identified. They perceived barriers towards counselling including time restraints, lack of interest, and doubts about certain physical activity during pregnancy but expressed trying to adjust the counselling to meet the woman's individual situation. They acknowledged that continuous support during pregnancy and updated knowledge and increased focus among providers might improve physical activity counselling.

CONCLUSIONS

Pregnant women received scarce counselling on physical activity in antenatal care, while care providers described several barriers towards counselling on physical activity. Both pregnant women and antenatal care providers recognized opportunities for enhanced physical activity counselling.

Effects of prenatal exercise on gestational weight gain, obstetric and neonatal outcomes: FitMum randomized controlled trial

BACKGROUND

To investigate the effects of two different exercise interventions during pregnancy on gestational weight gain (GWG) and obstetric and neonatal outcomes compared to standard care. Additionally, we aimed to improve standardization of GWG measurements by developing a model to estimate GWG for a standardized pregnancy period of 40 weeks and 0 days accounting for individual differences in gestational age (GA) at delivery.

METHODS

In a randomized controlled trial we compared the effects of structured supervised exercise training (EXE) three times per week throughout pregnancy versus motivational counselling on physical activity (MOT) seven times during pregnancy with standard care (CON) on GWG and obstetric and neonatal outcomes. Uniquely, to estimate GWG for a standardized pregnancy period, we developed a novel model to predict GWG based on longitudinally observed body weights during pregnancy and at admission for delivery. Observed weights were fitted to a mixed effects model that was used to predict maternal body weight and estimate GWG at different gestational ages. Obstetric and neonatal outcomes, among them gestational diabetes mellitus (GDM) and birth weight, were obtained after delivery. GWG and the investigated obstetric and neonatal outcomes are secondary outcomes of the randomized controlled trial, which might be underpowered to detect intervention effects on these outcomes.

RESULTS

From 2018-2020, 219 healthy, inactive pregnant women with median pre-pregnancy BMI of 24.1 (21.8-28.7) kg/m² were included at median GA 12.9 (9.4-13.9) weeks and randomized to EXE (n = 87), MOT (n = 87) or CON (n = 45). In total 178 (81%) completed the study. GWG at GA 40 weeks and 0 days did not differ between groups (CON: 14.9 kg [95% CI, 13.6;16.1]; EXE: 15.7 kg [14.7;16.7]; MOT: 15.0 kg [13.6;16.4], p = 0.538), neither did obstetric nor neonatal outcomes. For example, there were no differences between groups in the proportions of participants developing GDM (CON: 6%, EXE: 7%, MOT: 7%, p = 1.000) or in birth weight (CON: 3630 (3024-3899), EXE: 3768 (3410-4069), MOT: 3665 (3266-3880), p = 0.083).

CONCLUSIONS

Neither structured supervised exercise training nor motivational counselling on physical activity during pregnancy affected GWG or obstetric and neonatal outcomes compared to standard care.

TRIAL REGISTRATION

ClinicalTrials.gov; NCT03679130; 20/09/2018.

Determination of Pregnant Women's Physical Activity and Exercise Status During Pregnancy and Affecting Factors

Objective: This study aims to determine pregnant women's physical activity and exercise status during pregnancy and affecting factors. Methods: The research was conducted in a cross-sectional design with 220 low-risk pregnant women who were in their third trimester between March 3 and June 29 2022 at Training and Research Hospital. Research data were collected by face-to-face interview method using the forms developed by the authors. Results: It was seen that among the pregnant women who participated in the research, 35.9% exercised regularly before pregnancy and 25.9% regularly exercised during pregnancy. The most common exercises performed during pregnancy were walking and pilates. The assessment of the physical activity of pregnant women revealed that 80.5% were sedentary. The rate of exercising during pregnancy was 4.04 times (aOR 4.04, 95% CI 1.33-12.27) higher in women with planned pregnancies compared to unplanned pregnancies and 30.57 times higher in women who exercised regularly before pregnancy compared to those who did not do so (aOR 30.57, 95% CI 12.53-74.55). Likewise, compared to those who were obese during pregnancy, non-obese ones were 0.36 times more physically active (aOR 0.36, 95% CI 0.16-0.84). Similarly, it was established that women who exercised before pregnancy were 10.51 times more physically active than those who did not (aOR 10.51, 95% CI 4.60-24.02). Conclusion: In the research, it was concluded that the rates of exercising and being physically active during pregnancy were low, that planned pregnancy and regular exercise before pregnancy increased exercise behavior during pregnancy, and that obesity decreases physical activity.

Exercise during pregnancy for preventing gestational diabetes mellitus and hypertensive disorders: An umbrella review of randomised controlled trials and an updated meta-analysis

OBJECTIVE

This study aimed to provide, through an umbrella review, an overview of the effect of single exercise interventions during pregnancy on gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP). Also, to update the current evidence through an updated meta-analysis.

DESIGN

Umbrella review.

SETTING

PubMed, EMBASE, Web of Science, Cochrane database of systematic reviews, Epistemonikos, SPORTDiscus, Clinicaltrials.gov, and PROSPERO register were searched from the database inception until August 2021.

POPULATION

Peer-reviewed systematic reviews and meta-analyses of randomised controlled trials (RCTs) and RCTs samples.

METHODS

Random-effects model was used to calculate relative risk with 95% confidence interval in the updated meta-analysis. The reference category was the groups that received usual prenatal care. AMSTAR 2 and the Cochrane Collaboration tool were used to assess the quality and GRADE approach was used to assess the overall certainly of evidence.

MAIN OUTCOME MEASURES

GDM and HDP relative risk.

RESULTS

Twenty-three systematic reviews and meta-analyses; and 63 RCTs were included. Single exercise interventions reduced the incidence of GDM and HDP in most systematic reviews and meta-analyses. Moreover, exercise interventions during pregnancy decrease the incidence of developing GDM and GH, particularly when they are supervised, have a low to moderate intensity level, and are initiated during the first trimester of pregnancy.

CONCLUSION

Based on the findings, obstetric and physical exercise professionals could recommend exercise interventions during pregnancy as an effective strategy to improve maternal outcomes.

Application of the COM-B Framework to Understand Facilitators and Barriers for Practising Physical Activity among Pregnant Women and Midwives Participating in the WELL-DONE! Study

Regular physical activity (PA) is protective and reduces disease burden but remains a challenge for pregnant women (PW). According to the World Health Organization (WHO) guidelines, PW without contraindications should practice 150 min of moderate PA per week. Nonetheless, PA levels are concerningly low among PW. The aim of this study was to investigate PW's and midwives' perceptions regarding PA and recommended guidelines, and use this information to inform future health promotion strategies. We recruited 10 PW and 10 midwives to participate in online focus groups conducted between July 2020 and April 2021. Focus group probes and data analysis were guided by the COM-B (capability, opportunity, motivation-behaviour) framework. The majority of the sample had already practised PA, recognized the importance of PA during pregnancy, and considered the WHO guidelines reasonable. Notwithstanding, PW wanted more specific instruction on PA and desired opportunities to practice. Additional barriers reported by PW included low self-efficacy and lack of motivation. Midwives considered the lack of specific knowledge and confidence in managing PA as the main obstacles. The current findings suggest that PW and midwives need specific training in PA to overcome both psychological and physical barriers. Midwives play a vital role in educating and encouraging PA among PW.

Adherence to recommended physical activity restrictions due to threatened preterm delivery - a descriptive multi-center study

BACKGROUND

Threatened preterm delivery is a serious obstetrical complication and has for decades been prescribed physical activity restrictions (AR). Adherence to the recommended level of physical AR is however unknown. This study aimed to assess the objectively measured different physical positions and activities of pregnant women recommended AR due to threatened preterm delivery complications, compared to a reference group of uncomplicated pregnant women without restrictions, and to explore if admission status influenced adherence to AR.

METHODS

A Danish descriptive, clinical multi-center study included singleton pregnancies between 22-33 gestational weeks admitted to an antenatal ward or during midwife consultations either prescribed AR due to threatened preterm delivery or uncomplicated controls without restrictions. For seven days participants wore two tri-axial accelerometric SENS® monitors. Accelerometric data included time spent in five different positions, activities, and step counts. At inclusion demographic and obstetric information was collected.

RESULTS

Seventy-two pregnant women participated; 31% were prescribed strict AR, 15% moderate, 3% light, 8% unspecified, and 43% had no AR. Strict AR participants rested in the supine/lateral position for 17.7 median hours/day (range:9.6-24.0); sat upright 4.9 h/day (0.11-11.7); took 1,520steps/day (20-5,482), and 64% were inpatients. Moderate AR participants rested in the supine/lateral position for 15.1 h/day (11.5-21.6); sat upright 5.6 h/day (2.0-9.3); took 3,310steps/day (467-6,968), and 64% were outpatients. Participants with no AR rested 10.5 h/day (6.3-15.4) in supine/lateral position; sat upright 7.6 h/day (0.1-11.4) and took 9,235steps/day (3,225-20,818). Compared to no restrictions, participants with strict or moderate AR spent significant more time in physical resting positions and took significant fewer mean steps. Among strict AR admission status did not alter time spent in the physical positions, nor the step count.

CONCLUSIONS

Overall, participants adhered highly to the recommended AR. However, discriminating between strict and moderate AR recommendations did not alter how physical resting positions and activities were carried out. The admission status did not influence how participants adhered to strict AR.

Physical activity in pregnancy: a mixed methods process evaluation of the FitMum randomised controlled trial interventions

BACKGROUND

Physical activity (PA) at moderate intensity is recommended for healthy pregnant women. The three-arm FitMum randomised controlled trial showed that it was possible to increase PA level during pregnancy with structured supervised exercise training (EXE) compared to standard care. Motivational counselling on PA (MOT) did not increase PA. This process evaluation aims to understand the implementation and mechanisms of impact of EXE and MOT.

METHODS

A mixed methods process evaluation was conducted using the UK Medical Research Council's process evaluation framework by assessing implementation (reach, fidelity, and dose) and mechanisms of impact of the two interventions provided to pregnant women in FitMum. Data was collected both quantitatively (n = 220) and qualitatively (n = 20).

RESULTS

The FitMum trial reached educated pregnant women (80% having an educational level ≥ bachelor's degree) with high autonomy of everyday life. Most participants (58%) were recruited at their first-trimester ultrasonic scan. Reasons to participate were personal (91%) and altruistic (56%). The intervention dose was delivered as intended with high fidelity in the original physical intervention setup and in the altered online setup during the COVID-19 restrictions. A low dose received in EXE (1.3 [95% CI, 1.1; 1.5] sessions/week) was partly explained by the pre-scheduled EXE sessions favouring participants with a flexible everyday life and a supportive social network. Dose received in EXE increased during online intervention delivery. Participants in MOT received 5.2 [4.7; 5.7] of 7 sessions. Mechanisms of impact comprised a perception of intervention commitment among participants in EXE due to the scheduled EXE sessions, whereas participants in MOT considered themselves as PA self-determined. PA was considered as constrained activities in EXE and included in daily activities in MOT.

CONCLUSION

The FitMum interventions was delivered with high fidelity. During COVID-19, the dose received in EXE increased compared to the previous physical setup. Mechanisms of impact as commitment, perception of empowerment and perception of PA as well as the paradox between prioritising PA and family and the need of a flexible everyday life need to be considered when offering pregnant women PA interventions. Future interventions should consider a combination of physical and online exercise training for pregnant women.

ACTIVE PREGNANCY: Workshop on Promotion of Physical Activity in Pregnancy for Exercise Professionals

Introduction

A one-day workshop on promotion of physical activity in pregnancy for exercise professionals was delivered during 2021, to 137 participants. The main aim of this workshop was to motivate and prepare exercise professionals for promoting physical activity and implementing prenatal exercise programs, in their respective private or public fitness centers or other physical activity settings.

Methods

The contents of the workshop were focused on six topics based on the “Pregnancy and Postpartum Exercise Specialist” educational standards by EuropeActive and the “Exercise and Physical Activity during Pregnancy and Postpartum” textbook published by Springer. Participants provided feedback on the effectiveness and satisfaction with the workshop.

Results

Overall evaluations from the feedback forms showed that majority of the participants agreed that the workshop achieved its objectives with a major recommendation as to the organization of more short duration workshops, the inclusion of practical sessions, and the separation of the contents addressing the postpartum period.

Discussion

The workshop on promotion of physical activity in pregnancy for exercise professionals was successfully organized and the participants are looking forward for future ones.

Effects of Structured Supervised Exercise Training or Motivational Counseling on Pregnant Women's Physical Activity Level: FitMum - Randomized Controlled Trial

Background

Physical activity (PA) during pregnancy is an effective and safe way to improve maternal health in uncomplicated pregnancies. However, compliance with PA recommendations remains low among pregnant women.

Objective

The purpose of this study was to evaluate the effects of offering structured supervised exercise training (EXE) or motivational counseling on PA (MOT) during pregnancy on moderate-to-vigorous intensity physical activity (MVPA) level. Additionally, complementary measures of PA using the Pregnancy Physical Activity Questionnaire (PPAQ) and gold standard doubly labeled water (DLW) technique were investigated. The hypotheses were that both EXE and MOT would increase MVPA in pregnancy compared with standard care (CON) and that EXE would be more effective than MOT. In addition, the association between MVPA and the number of sessions attended was explored.

Methods

A randomized controlled trial included 220 healthy, inactive pregnant women with a median gestational age of 12.9 (IQR 9.4-13.9) weeks. A total of 219 women were randomized to CON (45/219), EXE (87/219), or MOT (87/219). The primary outcome was MVPA (minutes per week) from randomization to the 29th gestational week obtained by a wrist-worn commercial activity tracker (Vivosport, Garmin International). PA was measured by the activity tracker throughout pregnancy, PPAQ, and DLW. The primary outcome analysis was performed as an analysis of covariance model adjusting for baseline PA.

Results

The average MVPA (minutes per week) from randomization to the 29th gestational week was 33 (95% CI 18 to 47) in CON, 50 (95% CI 39 to 60) in EXE, and 40 (95% CI 30 to 51) in MOT. When adjusted for baseline MVPA, participants in EXE performed 20 (95% CI 4 to 36) minutes per week more MVPA than participants in CON (P=.02). MOT was not more effective than CON; EXE and MOT also did not differ. MVPA was positively associated with the number of exercise sessions attended in EXE from randomization to delivery (P=.04). Attendance was higher for online (due to COVID-19 restrictions) compared with physical exercise training (P=.03). Adverse events and serious adverse events did not differ between groups.

Conclusions

Offering EXE was more effective than CON to increase MVPA among pregnant women, whereas offering MOT was not. MVPA in the intervention groups did not reach the recommended level in pregnancy. Changing the intervention to online due to COVID-19 restrictions did not affect MVPA level but increased exercise participation.

Trial Registration

ClinicalTrials.gov NCT03679130; https://clinicaltrials.gov/ct2/show/NCT03679130

International Registered Report Identifier (IRRID)

RR2-10.1136/bmjopen-2020-043671

Preventing Gestational Diabetes Mellitus by Improving Healthy Diet and/or Physical Activity during Pregnancy: An Umbrella Review

Several epidemiological studies have analyzed the effects of lifestyle modification on reducing the risk of gestational diabetes mellitus (GDM); however, their results remain inconsistent. This umbrella review aims to evaluate the effects of diet and/or physical activity interventions during pregnancy on preventing GDM. Systematic reviews and meta-analysis of randomized clinical trials reporting preventive effects of diet and/or physical activity in reducing the incidence of GDM were included from PubMed, Web of Science, Scopus and Cochrane library. Two authors independently assessed the overlapping and quality of the 35 selected reviews using AMSTAR 2. The results, although variable, tend to defend the protective role of diet and physical activity interventions separately and independently of each other in the prevention of GDM. However, the results for the combined interventions show a possible protective effect; however, it is not entirely clear because most of the analyzed meta-analyses tend to approach 1, and heterogeneity cannot be ruled out. Establishing conclusions about the most efficient type of intervention and a dose–effect relationship was not feasible given the low quality of systematic reviews (83% low to critically low) and the variability in reporting interventions. Therefore, more studies with better quality and definition of the interventions are required. The protocol was previously registered in PROSPERO as CRD42021237895.

Active Pregnancy: A Physical Exercise Program Promoting Fitness and Health during Pregnancy-Development and Validation of a Complex Intervention

Physical activity during pregnancy is a public health issue. In the view of reproducibility and the successful implementation of exercise interventions, reporting the quality of such study design must be ensured. The objective of this study was to develop and validate a physical exercise program promoting fitness and health during pregnancy. A qualitative methodological study was carried out. For the description of the exercise program, the Consensus on Exercise Reporting Template (CERT) was used. For the validation of the program, the revised guideline of the Criteria for Reporting the Development and Evaluation of Complex Interventions in Health Care (CReDECI2) was followed and went through three stages of development, piloting, and evaluation. The customizable exercise program was designed and validated by exercise and health specialists based on evidence-based, international recommendations and supported by different educational tools to be implemented by qualified exercise professionals in health and fitness settings. A 12-week testing intervention addressing a group of 29 pregnant women was carried out. The program's feasibility was subsequently evaluated by all the pregnant women. The CReDECI2 process guides practitioners and researchers in developing and evaluating complex educational interventions. The presented intervention may assist exercise specialists, health professionals, and researchers in planning, promoting, and implementing a prenatal exercise program.

Can Group Exercise Programs Improve Health Outcomes in Pregnant Women? An Updated Systematic Review

Current scientific evidence supports the recommendation to initiate or continue physical exercise in healthy pregnant women. Group exercise programs have positive effects on improving health, well-being, and social support. In 2015, a systematic review was provided to evaluate the evidence on the effectiveness of group exercise programs in improving pregnant women's and newborns' health outcomes and to assess the content of the programs. This review aims to update this knowledge between 2015 and 2020. The exercise program designs were analyzed with the Consensus of Exercise Reporting Template (CERT) model, the compliance with the current guidelines, and effectiveness in the maternal health and fitness parameters. Three databases were used to conduct literature searches. Thirty-one randomized control trials were selected for analysis. All studies followed a supervised group exercise program including aerobic, resistance, pelvic floor training, stretching, and relaxation sections. Group interventions during pregnancy improved health and fitness outcomes for the women and newborns, although some gaps were identified in the interventions. Multidisciplinary teams of exercise and health professionals should advise pregnant women that group exercise improves a wide range of health outcomes for them and their newborns.

Clinical Practice Guidelines That Address Physical Activity and Exercise During Pregnancy: A Systematic Review

INTRODUCTION

Physical activity is recommended for healthy pregnant women. Clinical practice guidelines vary with regard to initial time, duration, or type of physical activity that is recommended, which is confusing for health care professionals and pregnant women alike. This study aimed to appraise clinical guidelines relevant to physical activity for pregnant women and summarize consensus and discrepant recommendations.

METHODS

The websites of organizations that develop guidelines including those of obstetricians, gynecologists, midwives, and medical sports associations were searched in addition to 9 literature databases for the period from January 2010 through November 2020. Guidelines were included if they were published in a journal or on a website in English or Chinese; were labeled as a recommendation guideline, position paper, practice parameter, or consensus statement; and addressed physical activity for pregnant women. Two authors independently extracted recommendations. Four reviewers independently assessed guideline quality using the AGREE II instrument.

RESULTS

Thirteen guidelines met the inclusion criteria. The guidelines developed by the World Health Organization and the National Institute for Health and Clinical Excellence were deemed to have the highest methodological quality. The recommendations were consistent with regard to recommended exercise duration, frequency, intensity, and type of physical activity. The main discrepant recommendations included best tools for conducting pre-exercise screening and assessing intensity of exertion. Guidelines also differ on optimal heart rate during exercise, when in pregnancy to initiate an exercise regimen, and duration or frequency of strengthening exercises.

DISCUSSION

Of the 13 guidelines, 2 were found to have good methodological quality. The recommendations that were consistent across the differing guidelines can support health care providers in counseling women about physical activity during pregnancy. The recommendations that are discrepant among these guidelines may contribute to confusion and a reluctance to recommend exercise during pregnancy. Research is needed to clarify discrepant recommendations.

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.

Current Resources for Evidence-Based Practice, November 2021

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 autonomy and respect in maternity care and commentaries on reviews focused on whether to induce women who present with mild preeclampsia in the late preterm period and the extent to which urinary incontinence symptoms prevent women from participating in exercise. It also includes a brief update about the USPSTF guidelines on screening for gestational diabetes.

Current Resources for Evidence-Based Practice, September 2021

An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes an assessment of safety of birth centers in the United States and commentaries on reviews focused on aspirin prophylaxis in pregnancy and the new gestational weight gain evidence summary from the United States Preventive Services Task Force.