Exercise in Pregnancy: The Impact of an Intervention Program in the Duration of Labor and Mode of Delivery

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.

Influence of pelvic floor muscle training alone or as part of a general physical activity program during pregnancy on urinary incontinence, episiotomy and third- or fourth-degree perineal tear: Systematic review and meta-analysis of randomized clinical trials

INTRODUCTION

The complex process of pregnancy and childbirth significantly influences the well-being of both mother and child. Today all pregnant women without medical contraindications are recommended to start or continue regular aerobic and strength training for at least 150 min per week to prevent pregnancy-related diseases and conditions. Urinary incontinence in pregnancy, episiotomy and third- or fourth-degree perineal tear during labor can greatly impact womens' health, quality of life and ability to be physically active. The aim of this study was to examine the efficacy of pelvic floor muscle training (PFMT) during pregnancy in the prevention of urinary incontinence, episiotomy, and third- or fourth-degree perineal tear.

MATERIAL AND METHODS

A systematic review and meta-analysis (CRD42022370600) was performed. Only randomized clinical trials published between 2010 and 2023 were included. The following databases were examined: EBSCO (including Academic Search Premier, Education Resources Information Center, MEDLINE, SPORTDiscus and OpenDissertations databases), Clinicaltrials.gov, Web of Science, Scopus, Cochrane Database of Systematic Reviews and Physiotherapy Evidence Database (PEDro). Three meta-analyses to investigate the effect of PFMT exclusively or implemented as a section within a physical activity program during pregnancy on urinary incontinence, episiotomy, and third- or fourth-degree perineal tear were conducted.

RESULTS

Thirty studies were analyzed (N = 6691). An effective preventive action of PFMT was found for urinary incontinence (z = 3.46; p < 0.0005; relative risk [RR] = 0.72, 95% confidence interval [CI]: 0.59, 0.87, I2 = 59%) and third- or fourth-degree perineal tear (z = 2.89; p = 0.004; RR = 0.50, 95% CI: 0.31, 0.80, I2 = 48%) but not for episiotomy (z = 0.80; p = 0.42; RR = 0.95, 95% CI: 0.85, 1.07, I2 = 75%).

CONCLUSIONS

PFMT during pregnancy proves to be an effective preventive intervention for reducing the risk of urinary incontinence and the occurrence of third- or fourth-degree perineal tears. These findings highlight the importance of incorporating PFMT into antenatal care and training programs to improve maternal well-being and overall childbirth outcomes.

Influence of Physical Activity during Pregnancy on Type and Duration of Delivery, and Epidural Use: Systematic Review and Meta-Analysis

Cesarean delivery may increase the need for anesthesia administration, thereby causing potential risks to both maternal and fetal health. This article aimed to investigate the effect of physical activity during pregnancy on the type of delivery, the duration of labor, and the use of epidurals (registration No.: CRD42022370646). Furthermore, 57 RCTs (n = 15301) were included showing that physical activity could decrease the risk of cesarean section (z = 3.22, p = 0.001; RR = 0.87, 95% CI = 0.79, 0.95, I2 = 37%, Pheterogeneity = 0.004), and 32 RCTs (n = 9468) showed significant decreases in instrumental delivery through performing physical activity (z = 3.48, p < 0.001; RR = 0.84, 95% CI = 0.76, 0.93, I2 = 0%, Pheterogeneity = 0.63). A significant decrease in the 15 RCTs' (n = 4797) duration of first stage labor was found in physically active pregnant women (z = 2.09, p = 0.04; MD = -62.26, 95% CI = -120.66, -3.85, I2 = 93%, Pheterogeneity < 0.001) compared to those not active. Prenatal physical activity could decrease the risk of cesarean section and instrumental delivery and the duration of first stage labor.

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.

Maternal Physical Activity at Term and Spontaneous Labor: A Case-Crossover Study

BACKGROUND

This study assessed associations between antenatal physical activity and the onset of spontaneous labor (SL).

METHODS

Data were taken from 541 participants in the third pregnancy, infection, and nutrition study who had no contraindications to antenatal physical activity. An interviewer-administered questionnaire assessed labor triggers, gestational age at birth, and physical activity within the week (24 h to 7 d) and the 24-hour period (0-24 h) prior to SL. A case-crossover design examined the association between physical activity (recreational, occupational, or any) and the risk of onset of SL within the subsequent 24 hours.

RESULTS

Overall, 21% (any), 26% (recreational), and 14% (occupational) of participants reported physical activity during the week; whereas 5% (any), 7% (recreational), and 3% (occupational) reported physical activity during the 24-hour period, prior to SL onset. Participants who reported any or occupational physical activity during the 24-hour period had a decreased likelihood of SL within the subsequent 24 hours, while participants who reported at least 30 minutes of recreational physical activity had an increased likelihood. Results remained consistent among early, full, or postterm participants.

CONCLUSION

Recreational, but not occupational, physical activity at term may increase the likelihood of SL; however, the authors cannot rule out reverse causality.

Application of pelvic floor ultrasound during pregnancy to detect patients at risk of cesarean section due to failure of labor progression in a Spanish population

OBJECTIVE

Our study is aimed at evaluating the characteristics of the pelvic floor, assessed through transperineal ultrasound, since it may influence or increase the possibility of having a cesarean delivery, with the objective of acting on those variables that can be modified during pregnancy.

STUDY DESIGN

Transperineal ultrasound was performed on 109 primiparous pregnant women in their first trimester of pregnancy, recruited between May 2018 and February 2019, with the purpose of studying the hiatus area at rest, retention and Valsalva. We have reassessed them at the end of pregnancy and delivery data were recorded. We selected 8 patients as case-study, who had cesarean section delivery due to failure of labor progression. We selected 4 control-cases for each, reaching the total of 32 controls, with similar age and body mass index, to avoid obtaining a biased result from these data.

RESULTS

In the study of hiatal areas, patients who delivered by cesarean section had a smaller hiatal area at rest, during levator ani muscle contraction and during Valsalva maneuver, at all visits. In early pregnancy, the range of the resting hiatal area was 13.8 ± 2.0 cm² for cesarean sections, compared to 16.2 ± 2.7 cm² for vaginal deliveries with an OR of 0.57 (0.34-0.95, 95% CI). For hiatal area on Valsalva, the OR was 0.55 (0.35-0.88, 95% CI). Therefore, the smaller the hiatal area, the greater the possibility of cesarean section. At the end of pregnancy, between 34 and 36 weeks of gestation, the OR of hiatal area on Valsalva was 0.78 (0.60-1.00, 95% CI).

CONCLUSION

The hiatus area measured by transperineal ultrasonography at the beginning and at the end of the pregnancy may be useful to identify the patients who are at a higher risk of cesarean delivery due to failure of labor progression.

The impact of physical activity during pregnancy on labor and delivery

BACKGROUND

Physical activity in pregnancy is associated with decreased risks of adverse pregnancy outcomes such as gestational diabetes and preeclampsia. However, the relationship between the amount and type of physical activity during pregnancy and subsequent labor outcomes remains unclear.

OBJECTIVE

This study aimed to test the hypothesis that higher levels of physical activity across different lifestyle domains in pregnancy are associated with a shorter duration of labor.

STUDY DESIGN

This study is a secondary analysis of a prospective cohort study in which patients with singleton pregnancies without a major fetal anomaly were administered the Kaiser Physical Activity Survey in each trimester. The Kaiser Physical Activity Survey was designed specifically to quantify various types of physical activities in women and includes 4 summative indices-housework/caregiving, active living habits, sports, and occupation. The study included women at full-term gestations admitted for induction of labor or spontaneous labor. The primary outcome of this analysis was duration of the second stage of labor. Secondary outcomes were duration of the active stage, prolonged first and second stage, mode of delivery, rates of second-stage cesarean delivery, operative vaginal delivery, severe perineal lacerations, and postpartum hemorrhage. These outcomes were compared between patients with and without high physical activity levels, defined as overall Kaiser Physical Activity Survey score ≥75th percentile in the third trimester. Multivariable logistic regression was used to adjust for obesity and epidural use. In addition, a subgroup analysis of nulliparous patients was performed.

RESULTS

A total of 811 patients with complete Kaiser Physical Activity Survey data in the third trimester were included in this analysis. The median Kaiser Physical Activity Survey score was 9.5 (8.2-10.8). Of the 811 patients, 203 (25%) had higher levels of physical activity in pregnancy. There was no difference in the duration of the second stage of labor between patients with and without higher physical activity levels (1.29±2.94 vs 0.97±2.08 hours; P=.15). The duration of active labor was significantly shorter in patients with higher levels of physical activity (5.77±4.97 vs 7.43±6.29 hours; P=.01). Patients with higher physical activity levels were significantly less likely to have a prolonged first stage (9.8% vs 19.4%; P<.01; adjusted relative risk, 0.55; 95% confidence interval, 0.34-0.83). However, rates of prolonged second-stage cesarean delivery, operative vaginal deliveries, and perineal lacerations were similar between the 2 groups.

CONCLUSION

Patients who are more physically active during pregnancy have a shorter duration of active labor.

Development of an exercise attitude scale in Turkish for pregnant women: validity and reliability

This study, conducted between October 2018 and May 2019, aimed to develop an Exercise Attitude Scale in Turkish (EAS-Turkish) for pregnant women and to determine its validity and reliability. The scale was prepared in Turkish to comprehensively measure pregnant women's exercise attitudes. Then, it administered in 253 pregnant women, who were native speakers of Turkish and older than 18 years, in the Obstetrics Polyclinic at Ataturk Training and Research Hospital, Ankara, Turkey. Validity with exploratory and confirmatory factor analysis and reliability with test-retest and internal consistency methods were tested. The 37-item scale was found to be 2-dimensional (knowledge and benefit; barrier). All indexes of the goodness of fit (χ2/df = 2.0, Comparative Fit Index = 0.90, Goodness-of-fit Index = 0.85, Root Mean Square Error of Approximation = 0.06) indicated that the fit between the model and the sample data was acceptable. The item-total score correlations varied between r = 0.22 and 0.60. The Cronbach alpha coefficients were found as 0.90 for the whole scale, 0.91 for the knowledge and benefit sub-dimension, and 0.87 for the barrier sub-dimension. In the test-retest analysis conducted with 41 pregnant women, the reliability coefficients were detected as 0.93 for the whole scale and 0.84 for each sub-dimension. The EAS-Turkish for pregnant women was found to be a valid and reliable tool.

The Evidence Base in Exercise Knowledge of Pregnant Women: A Latent Class Analysis

BACKGROUND

Exercise has many benefits for women with uncomplicated pregnancies. However, poor exercise knowledge may contribute to problems or barriers that reduce a woman's level of exercise after becoming pregnant.

AIM

This study was performed to identify pregnancy exercise knowledge among pregnant women using latent class analysis and to examine the relationship between pregnancy exercise knowledge patterns and sociodemographic characteristics.

DESIGN

A descriptive, cross-sectional approach was used in this study.

METHODS

Participants were recruited from the prenatal outpatient departments of two hospitals and a certified prenatal center in Taipei, Taiwan. A total of 618 participants completed a pregnancy exercise knowledge test. The data were analyzed using WINMIRA and SPSS 20.0 software.

RESULTS

Two latent classes were identified based on exercise knowledge among pregnant women. The Accurate Knowledge group (n = 543, 87.9%), which had a higher latent trait for exercise knowledge (M = 1.31, SD = 0.94), was larger than the Limited Knowledge group (n = 75, 12.1%), which had a lower latent trait (M = -0.22, SD = 1.14). The principles of exercise for pregnant women, particularly the appropriate intensity and duration, may be difficult items for women in the Limited Knowledge group to understand. Women with Limited Knowledge had significantly lower education levels and greater rates of unemployment, multiparity, and miscarriage than women in the Accurate Knowledge group.

LINKING EVIDENCE TO ACTION

A two-class system for interpreting exercise knowledge among pregnant women is statistically supported. We believe that this study has evidence-based potential to help healthcare providers improve pregnant women's exercise knowledge as part of routine prenatal care to promote exercise.

Effect of supervised group exercise on psychological well-being among pregnant women with or at high risk of depression (the EWE Study): A randomized controlled trial

INTRODUCTION

Depression is expected to be the leading cause of disability worldwide by 2030. The prevalence is increasing and is two-fold higher in women than in men, women being at particularly high risk during hormonal transition phases such as pregnancy and the postpartum period. The objective for this trial was to assess the effect of supervised group exercise on psychological well-being and symptoms of depression among pregnant women with or at high risk of depression.

MATERIAL AND METHODS

This study was undertaken at the Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Denmark, from August 2016 to September 2018. Pregnant women with a current or previous history of depression and/or anxiety requiring treatment within the last 10 years, or use of antidepressants 3 months before or during pregnancy, were randomly assigned to 12 weeks of supervised group exercise from 17 to 22 weeks of gestation twice weekly, or to a control group. The primary outcome was self-reported psychological well-being at 29-34 weeks of gestation, measured by the five-item World Health Organization Well-being Index (WHO-5). Secondary outcomes included delivery outcomes and psychological well-being (WHO-5) 8 weeks postpartum.

RESULTS

The intention-to-treat analysis showed no significant effect on psychological well-being on the primary outcome. Mean WHO-5 score in the intervention group was 2.0 (95% CI -1.3 to 5.2, P = .2) higher than in the control group. Per protocol analysis of women who attended ≥75% of the exercise sessions showed a statistically significant higher mean WHO-5 score relative to the control group at gestational weeks 29-34. Eight weeks postpartum the intervention group reported higher psychological well-being than the control group, mean difference in WHO-5 score of 5.5 (95% CI 1.0-10.1, P = .04).

CONCLUSIONS

Supervised group exercise did not improve psychological well-being for women with or at high risk of depression at 29-34 weeks of gestation. Eight weeks postpartum the intervention group reported significantly higher psychological well-being than the control group. Based on our results, supervised exercise in groups is a safe complementary course of treatment alongside the existing antenatal care.

Risk factors associated with gestational diabetes mellitus: The role of pregnancy-induced hypertension and physical inactivity

BACKGROUND

Gestational diabetes mellitus (GDM) causes serious complications affecting the mother and fetus. Physical activity (PA) during pregnancy has positive effects on the mother and fetus. The objectives of this study were to assess GMD prevalence in Kuwait, identify its risk factors, and to evaluate its association with PA.

METHODS

A cross-sectional study was conducted among a randomly selected 653 post-partum women from all public maternal centers and five private centers. An anonymous self-administered questionnaire was used to collect participants' socio-demographic data, medical and obstetric history. Pregnancy Physical Activity Questionnaire (PPAQ) was used to assess PA level.

RESULTS

Participants' mean age was 30.1 ± 5.3. GMD was diagnosed among 14.1% (95% CI: 11.6-17.0) of participants. Binary logistic regression revealed that poor income, having 2 + chronic diseases, past history of GDM, hypothyroidism, high systolic or diastolic blood pressure during pregnancy were independently correlated with developing GDM. For physical activity, the overall means of PPAQ total and sub-scores were below average and only PPAQ sub-score -Vigorous Intensity Activity- was significantly higher amid women without GMD than those with. However, PPAQ mean scores showed significant positive correlation with women's pre-pregnancy BMI and birth weight; and a significant negative association with gestational systolic and diastolic blood pressure.

CONCLUSIONS

GDM prevalence is relatively high in Kuwait, notably amid expatriates. Pregnancy-induced hypertension along with social and pre-pregnancy medical conditions correlated with developing GDM. PA helped mitigated pregnancy blood pressure, and fetal birth weight. Promoting additional medical monitoring and PA during pregnancy might aid reduce the prevalence of GDM.