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Marín-Jiménez N, Baena-García L, Coll-Risco I, Flor-Alemany M, Castro-Piñero J, Aparicio VA. Influence of a Concurrent Exercise Training Program on Health-Related Quality of Life During Advanced Pregnancy: The GESTAFIT Project. Sports Health 2024; 16:518-526. [PMID: 37525559 PMCID: PMC11195864 DOI: 10.1177/19417381231189730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) may be altered during pregnancy due to pregnancy-related changes in all domains of women's health. HYPOTHESIS A supervised concurrent exercise-training program from the 17th gestational week until birth positively influences HRQoL. STUDY DESIGN Randomized controlled trial. LEVEL OF EVIDENCE Level 1. METHODS Eighty-six pregnant women (age, 33.1 ± 4.6 years; prepregnancy body mass index, 23.5 kg/m2), divided into exercise (n = 41) and control (n = 45) groups, participated in this study (per-protocol basis). The exercise group followed a 60-min, 3 days/week, concurrent (aerobic + resistance) exercise training program. HRQoL was assessed with the 36-Item Short Form Health Survey (SF-36), where higher scores (0-100) indicate better HRQoL. RESULTS After adjusting for potential confounders, the exercise group decreased 16.1 points less than the control group in the SF-36 physical functioning domain [between-group differences (B): 95% confidence interval (CI), 9.02 to 23.22; P < 0.01], and 4.5 points less in the SF-36 physical component summary than the control group (between-group differences (B): 95% CI, 0.65 to 8.28; P = 0.02). Intention-to-treat basis analyses depicted similar results, where the exercise group decreased 10.03 points less than the control group the in the SF-36 social functioning domain (between-group differences (B): 95% CI, 0.39 to 19.68; P = 0.04). CONCLUSION A supervised concurrent exercise training program ameliorates HRQoL decreases along gestation. Although HRQoL decreased throughout pregnancy in both groups, this impact was less in the exercise group, especially in the SF-36 physical functioning, the SF-36 social functioning, and the SF-36 physical component summary. CLINICAL RELEVANCE Healthcare providers may encourage pregnant women to exercise in this physiological stage for a better HRQoL throughout pregnancy. CLINICALTRIALS.GOV IDENTIFIER NCT02582567; Date of registration: 20/10/2015.
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Affiliation(s)
- Nuria Marín-Jiménez
- Sport and Health University Research Institute (IMUDS), University of Granada, Granada, Spain
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
| | - Laura Baena-García
- Sport and Health University Research Institute (IMUDS), University of Granada, Granada, Spain
- Department of Nursing, Faculty of Health Sciences, University of Granada, Ceuta, Spain
- Instituto de Investigación Biosanitaria ibs, Granada, Spain
| | - Irene Coll-Risco
- Sport and Health University Research Institute (IMUDS), University of Granada, Granada, Spain
- Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
| | - Marta Flor-Alemany
- Sport and Health University Research Institute (IMUDS), University of Granada, Granada, Spain
- Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
| | - José Castro-Piñero
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
| | - Virginia A. Aparicio
- Sport and Health University Research Institute (IMUDS), University of Granada, Granada, Spain
- Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
- Glzartea, Kirola eta Ariketa Fisikoa Ikerkuntza Taldea (GIKAFIT), Society Sports and Exercise Research Group, Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section, University of Basque Country (UPV/EHU), Vitoria-Gasteiz, Araba/Álava, Basque Country, Spain
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Tsironikos GI, Zakynthinos GE, Tatsioni A, Tsolaki V, Kagias IG, Potamianos P, Bargiota A. 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. J Clin Med 2024; 13:3462. [PMID: 38929991 PMCID: PMC11204633 DOI: 10.3390/jcm13123462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/06/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
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.
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Affiliation(s)
- Georgios I. Tsironikos
- Department of Medicine, University of Ioannina, University Campus, 45110 Ioannina, Greece;
| | - George E. Zakynthinos
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Athina Tatsioni
- Department of Research for General Medicine and Primary Health Care, Faculty of Medicine, University of Ioannina, University Campus, 45110 Ioannina, Greece;
| | - Vasiliki Tsolaki
- Department of Critical Care, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece;
| | - Iraklis-Georgios Kagias
- Department of Neurosurgery, University Hospitals Sussex NHS Foundation Trust, Brighton BN2 5BE, UK;
| | - Petros Potamianos
- Department of Gastroenterology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece;
| | - Alexandra Bargiota
- Department of Internal Medicine-Endocrinology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece;
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He Y, Huang C, He Q, Liao S, Luo B. Effects of mHealth-Based Lifestyle Interventions on Gestational Diabetes Mellitus in Pregnant Women With Overweight and Obesity: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2024; 12:e49373. [PMID: 38231555 PMCID: PMC10831670 DOI: 10.2196/49373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The increasing incidence of gestational diabetes mellitus (GDM) is a global health problem that is more likely to occur in pregnant women with overweight or obesity. Adhering to a healthy lifestyle is associated with a reduced risk of GDM. With the development of IT, mobile health (mHealth) interventions have become widely available in health care. However, there are no definitive conclusions on the effectiveness of mHealth-based lifestyle interventions in preventing GDM. OBJECTIVE This study aims to evaluate the impact of mHealth-based lifestyle interventions on GDM and other pregnancy outcomes in pregnant women with overweight or obesity. METHODS A systematic literature search was conducted in 5 English databases (MEDLINE, Embase, Web of Science, CENTRAL, and CINAHL) and 4 Chinese databases (CBM, CNKI, Vip, and Wanfang) to identify randomized controlled trials (RCTs) on the effectiveness of mHealth-based interventions for GDM from inception to January 10, 2023. In total, 2 authors independently screened the studies and extracted the data. The quality of the included studies was examined using the Cochrane risk-of-bias tool. Data synthesis was conducted using Review Manager (version 5.4; The Cochrane Collaboration). RESULTS A total of 16 RCTs with 7351 participants were included in this study. The included studies were published between 2014 and 2021 and were conducted in China, the United States, Australia, New Zealand, the United Kingdom, Ireland, and Norway. The sample sizes of the studies ranged from 75 to 2202, and the duration of the mHealth-based lifestyle interventions ranged from 4 to 28 weeks. Compared with usual care, mHealth-based lifestyle interventions significantly reduced the incidence of GDM (odds ratio [OR] 0.74, 95% CI 0.56-0.96; P=.03; I2=65%), preterm birth (OR 0.65, 95% CI 0.48-0.87; P=.004; I2=25%), macrosomia (OR 0.59, 95% CI 0.40-0.87; P=.008; I2=59%), and gestational weight gain (mean difference=-1.12 kg, 95% CI -1.44 to -0.80; P<.001; I2=43%). The subgroup analysis showed that interventions delivered via apps (OR 0.55, 95% CI 0.37-0.83; P=.004; I2=44%), provided by obstetricians (OR 0.69, 95% CI 0.51-0.93; P=.02; I2=60%), and targeted at Asian populations (OR 0.44, 95% CI 0.34-0.58; P<.001; I2=0%) and that used the International Association of Diabetes and Pregnancy Study Groups diagnostic criteria (OR 0.58, 95% CI 0.39-0.86; P=.007; I2=69%) showed a statistically significant reduction in the risk of GDM. CONCLUSIONS mHealth-based lifestyle interventions had a favorable impact on the prevention of GDM in pregnant women with overweight and obesity. Future studies need to further explore the potential of mHealth-based interventions for GDM through better design and more rigorous large-scale RCTs. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021286995; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=286995.
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Affiliation(s)
- Yirong He
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Chuanya Huang
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Qiuyang He
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
- Department of Obstetric Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shujuan Liao
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Biru Luo
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
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Quotah OF, Andreeva D, Nowak KG, Dalrymple KV, Almubarak A, Patel A, Vyas N, Cakir GS, Heslehurst N, Bell Z, Poston L, White SL, Flynn AC. Interventions in preconception and pregnant women at risk of gestational diabetes; a systematic review and meta-analysis of randomised controlled trials. Diabetol Metab Syndr 2024; 16:8. [PMID: 38178175 PMCID: PMC10765912 DOI: 10.1186/s13098-023-01217-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/13/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Women at risk of gestational diabetes mellitus (GDM) need preventative interventions. OBJECTIVE To evaluate targeted interventions before and during pregnancy for women identified as being at risk of developing GDM. METHODS Systematic review and meta-analysis conducted following PRISMA guidelines. MEDLINE, EMBASE and the Cochrane Library in addition to reference and citation lists were searched to identify eligible randomised controlled trials (RCTs) utilising risk stratification during the preconception period or in the first/early second trimester. Screening and data extraction were carried out by the authors independently. Quality assessment was conducted based on the Cochrane risk-of-bias tool. Random effects meta-analysis and narrative synthesis were performed. RESULTS Eighty-four RCTs were included: two during preconception and 82 in pregnancy, with a pooled sample of 22,568 women. Interventions were behavioural (n = 54), dietary supplementation (n = 19) and pharmacological (n = 11). Predictive factors for risk assessment varied; only one study utilised a validated prediction model. Gestational diabetes was reduced in diet and physical activity interventions (risk difference - 0.03, 95% CI 0.06, - 0.01; I2 58.69%), inositol (risk difference - 0.19, 95% CI 0.33, - 0.06; I2 92.19%), and vitamin D supplements (risk difference - 0.16, 95% CI 0.25, - 0.06; I2 32.27%). Subgroup analysis showed that diet and physical activity interventions were beneficial in women with ≥ 2 GDM risk factors (risk difference - 0.16, 95% CI 0.25, - 0.07; I2 11.23%) while inositol supplementation was effective in women with overweight or obesity (risk difference - 0.17, 95% CI 0.22, - 0.11; I2 0.01%). Effectiveness of all other interventions were not statistically significant. CONCLUSIONS This review provides evidence that interventions targeted at women at risk of GDM may be an effective strategy for prevention. Further studies using validated prediction tools or multiple risk factors to target high-risk women for intervention before and during pregnancy are warranted.
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Affiliation(s)
- Ola F Quotah
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK.
- Department of Clinical Nutrition, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Daria Andreeva
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Katarzyna G Nowak
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
- Department of Nutrition and Dietetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Kathryn V Dalrymple
- Department of Nutritional Sciences, School of Life Course Sciences and Population Sciences, King's College London, London, UK
| | - Aljawharah Almubarak
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Anjali Patel
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Nirali Vyas
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Gözde S Cakir
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Zoe Bell
- Department of Nutritional Sciences, School of Life Course Sciences and Population Sciences, King's College London, London, UK
| | - Lucilla Poston
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Sara L White
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Angela C Flynn
- Department of Nutritional Sciences, School of Life Course Sciences and Population Sciences, King's College London, London, UK
- School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland
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5
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Sentilhes L, Schmitz T, Arthuis C, Barjat T, Berveiller P, Camilleri C, Froeliger A, Garabedian C, Guerby P, Korb D, Lecarpentier E, Mattuizzi A, Sibiude J, Sénat MV, Tsatsaris V. [Preeclampsia: Guidelines for clinical practice from the French College of Obstetricians and Gynecologists]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:3-44. [PMID: 37891152 DOI: 10.1016/j.gofs.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
OBJECTIVE To identify strategies to reduce maternal and neonatal morbidity related to preeclampsia. MATERIAL AND METHODS The quality of evidence of the literature was assessed following the GRADE® method with questions formulated in the PICO format (Patients, Intervention, Comparison, Outcome) and outcomes defined a priori and classified according to their importance. An extensive bibliographic search was performed on PubMed, Cochrane, EMBASE and Google Scholar databases. The quality of the evidence was assessed (high, moderate, low, very low) and recommendations were formulated as a (i) strong, (ii) weak or (iii) no recommendation. The recommendations were reviewed in two rounds with external reviewers (Delphi survey) to select the consensus recommendations. RESULTS Preeclampsia is defined by the association of gestational hypertension (systolic blood pressure≥140mmHg and/or diastolic blood pressure≥90mmHg) and proteinuria≥0.3g/24h or a Proteinuria/Creatininuria ratio≥30mg/mmol occurring after 20 weeks of gestation. Data from the literature do not show any benefit in terms of maternal or perinatal health from implementing a broader definition of preeclampsia. Of the 31 questions, there was agreement between the working group and the external reviewers on 31 (100%). In general population, physical activity during pregnancy should be encouraged to reduce the risk of preeclampsia (Strong recommendation, Quality of the evidence low) but an early screening based on algorithms (Weak recommendation, Quality of the evidence low) or aspirin administration (Weak recommendation, Quality of the evidence very low) is not recommended to reduce maternal and neonatal morbidity related to preeclampsia. In women with preexisting diabetes or hypertension or renal disease, or multiple pregnancy, the level of evidence is insufficient to determine whether aspirin administration during pregnancy is useful to reduce maternal and perinatal morbidity (No recommendation, Quality of the evidence low). In women with a history of vasculo-placental disease, low dose of aspirin (Strong recommendation, Quality of the evidence moderate) at a dosage of 100-160mg per day (Weak recommendation, Quality of the evidence low), ideally before 16 weeks of gestation and not after 20 weeks of gestation (Strong recommendation, Quality of the evidence low) until 36 weeks of gestation (Weak recommendation, Quality of the evidence very low) is recommended. In a high-risk population, additional administration of low molecular weight heparin is not recommended (Weak recommendation, Quality of the evidence moderate). In case of preeclampsia (Weak recommendation, Quality of the evidence low) or suspicion of preeclampsia (Weak recommendation, Quality of the evidence moderate, the assessment of PlGF concentration or sFLT-1/PlGF ratio is not routinely recommended) in the only goal to reduce maternal or perinatal morbidity. In women with non-severe preeclampsia antihypertensive agent should be administered orally when the systolic blood pressure is measured between 140 and 159mmHg or diastolic blood pressure is measured between 90 and 109mmHg (Weak recommendation, Quality of the evidence low). In women with non-severe preeclampsia, delivery between 34 and 36+6 weeks of gestation reduces severe maternal hypertension but increases the incidence of moderate prematurity. Taking into account the benefit/risk balance for the mother and the child, it is recommended not to systematically induce birth in women with non-severe preeclampsia between 34 and 36+6 weeks of gestation (Strong recommendation, Quality of evidence high). In women with non-severe preeclampsia diagnosed between 37+0 and 41 weeks of gestation, it is recommended to induce birth to reduce maternal morbidity (Strong recommendation, Low quality of evidence), and to perform a trial of labor in the absence of contraindication (Strong recommendation, Very low quality of evidence). In women with a history of preeclampsia, screening maternal thrombophilia is not recommended (Strong recommendation, Quality of the evidence moderate). Because women with a history of a preeclampsia have an increased lifelong risk of chronic hypertension and cardiovascular complications, they should be informed of the need for medical follow-up to monitor blood pressure and to manage other possible cardiovascular risk factors (Strong recommendation, Quality of the evidence moderate). CONCLUSION The purpose of these recommendations was to reassess the definition of preeclampsia, and to determine the strategies to reduce maternal and perinatal morbidity related to preeclampsia, during pregnancy but also after childbirth. They aim to help health professionals in their daily clinical practice to inform or care for patients who have had or have preeclampsia. Synthetic information documents are also offered for professionals and patients.
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Affiliation(s)
- Loïc Sentilhes
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France.
| | - Thomas Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, Paris, France
| | - Chloé Arthuis
- Service d'obstétrique et de médecine fœtale, Elsan Santé Atlantique, 44819 Saint-Herblain, France
| | - Tiphaine Barjat
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Saint-Etienne, Saint-Etienne, France
| | - Paul Berveiller
- Service de gynécologie-obstétrique, centre hospitalier intercommunal de Poissy St-Germain, Poissy, France
| | - Céline Camilleri
- Association grossesse santé contre la pré-éclampsie, Paris, France
| | - Alizée Froeliger
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - Charles Garabedian
- Service de gynécologie-obstétrique, University Lille, ULR 2694-METRICS, CHU de Lille, 59000 Lille, France
| | - Paul Guerby
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Toulouse, Toulouse, France
| | - Diane Korb
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, Paris, France
| | - Edouard Lecarpentier
- Service de gynécologie-obstétrique, centre hospitalier intercommunal de Créteil, Créteil, France
| | - Aurélien Mattuizzi
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - Jeanne Sibiude
- Service de gynécologie-obstétrique, hôpital Louis-Mourier, AP-HP, Colombes, France
| | - Marie-Victoire Sénat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Vassilis Tsatsaris
- Maternité Port-Royal, hôpital Cochin, GHU Centre Paris cité, AP-HP, FHU PREMA, Paris, France
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Silva-Jose C, May L, Sánchez-Polán M, Zhang D, Barrera-Garcimartín A, Refoyo I, Barakat R. Influence of Physical Activity during Pregnancy on Neonatal Complications: Systematic Review and Meta-Analysis. J Pers Med 2023; 14:6. [PMID: 38276221 PMCID: PMC10820764 DOI: 10.3390/jpm14010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024] Open
Abstract
Newborn hospitalisations after delivery are indicators of poor neonatal health with potential risks of future diseases for children. Interventions to promote a healthy environment have been used during pregnancy, with physical activity as a principal element. A systematic review and meta-analyses were performed to evaluate the effect of physical activity during pregnancy on neonatal intensive care unit (NICU) admissions and Apgar 1 and 5 scores (Registration No.: CRD42022372493). Fifty studies (11,492 pregnant women) were included. There were significantly different rates of NICU admissions between groups (RR = 0.76, 95% CI = 0.62, 0.93; Z = 2.65, p = 0.008; I2 = 0%, and Pheterogeneity = 0.78), and significant differences in Apgar 1 (Z = 2.04; p = 0.04) (MD = 0.08, 95% CI = 0.00, 0.17, I2 = 65%, Pheterogeneity = 0.00001) and Apgar 5 (Z = 3.15; p = 0.002) (MD = 0.09, 95% CI = 0.04, 0.15, I2 = 80%, and Pheterogeneity = 0.00001), favouring intervention groups. Physical activity during pregnancy could help to reduce the risk of NICU admissions that are related to neonatal complications.
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Affiliation(s)
- Cristina Silva-Jose
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.S.-J.); (M.S.-P.); (D.Z.); (A.B.-G.)
| | - Linda May
- Department of Kinesiology, East Carolina University, Greenville, NC 27834, USA;
| | - Miguel Sánchez-Polán
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.S.-J.); (M.S.-P.); (D.Z.); (A.B.-G.)
| | - Dingfeng Zhang
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.S.-J.); (M.S.-P.); (D.Z.); (A.B.-G.)
| | - Alejandro Barrera-Garcimartín
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.S.-J.); (M.S.-P.); (D.Z.); (A.B.-G.)
| | - Ignacio Refoyo
- Sports Department, Faculty of Physical Activity and Sports Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain;
| | - Rubén Barakat
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.S.-J.); (M.S.-P.); (D.Z.); (A.B.-G.)
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7
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Tsironikos GI, Potamianos P, Zakynthinos GE, Tsolaki V, Tatsioni A, Bargiota A. Effectiveness of Lifestyle Interventions during Pregnancy on Preventing Gestational Diabetes Mellitus in High-Risk Women: A Systematic Review and Meta-Analyses of Published RCTs. J Clin Med 2023; 12:7038. [PMID: 38002654 PMCID: PMC10672732 DOI: 10.3390/jcm12227038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/01/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Until now, it is uncertain whether lifestyle interventions during pregnancy can prevent gestational diabetes mellites (GDM) in high-risk pregnant women. OBJECTIVE This study aims at investigating the effectiveness of dietary interventions and/or exercise interventions during pregnancy for preventing GDM in high-risk pregnant women. MATERIALS AND METHODS Eligible randomized controlled trials (RCTs) were selected after a search in CENTRAL, Scopus, and PubMed. Synthesis was performed for the outcome of GDM in women with any identified GDM risk factor. Separate meta-analyses (MA) were performed to assess the efficacy of either nutrition or physical activity (PA) interventions or both combined compared with standard prenatal care for preventing GDM. Subgroup and sensitivity analyses, as well as meta-regressions against OR, were performed to assess potentional heterogeneity. Overall quality, the quality of RCTs, and publication bias were also evaluated. RESULTS A total of 13,524 participants comprising high-risk pregnant women in 41 eligible RCTs were analyzed for GDM. Women receiving only a nutrition intervention during pregnancy were less likely to experience GDM compared with women following standard prenatal care. Among 3109 high-risk pregnant women undergoing only dietary intervention for preventing GDM, 553 (17.8%) developed GDM; however, the result of the MA was marginally not significant (OR 0.73, 95%CI 0.51, 1.03; p-value 0.07), (Q 21.29, p-value 0.01; I2 58% (95%CI 10, 78%)). Subgroup analyses demonstrated an effect for studies that were conducted in Great Britain (OR 0.65, 95%CI 0.49, 0.81; p-value 0.003), and in Spain (OR 0.50, 95%CI 0.27, 0.94; p-value 0.03), for studies with forms of the Mediterranean diet as the intervention's component (OR 0.61; 95%CI 0.46, 0.81; p-value 0.0005), and for studies including a motivation arm in the intervention (OR 0.71, 95%CI 0.58, 0.87; p-value 0.0008). Among 2742 high-risk pregnant women being analyzed for GDM outcome after receiving only an exercise intervention, 461 (16.8%) were diagnosed with GDM. Women after receiving PA intervention were less likely to develop GDM (OR 0.64, 95%CI 0.51, 0.80; p-value < 0.0001), (Q 11.27, p-value 0.51; I2 0% (95%CI 0, 99%)). Finally, 1308 (17%) cases of GDM were diagnosed among 7673 high-risk pregnant women undergoing both diet and PA intervention. Women in the group of mixed lifestyle intervention had a significant reduction in incidence of GDM (OR 0.70, 95%CI 0.55, 0.90; p-value 0.005), (Q 50.32, p-value < 0.0001, I2 66%, (95% CI 44, 79%)). CONCLUSIONS The results of this study support the efficacy of lifestyle interventions during pregnancy for preventing GDM in high-risk women if an exercise component is included in the intervention arm, either alone, or combined with diet. A combined lifestyle intervention including physical exercise and a Mediterranean diet accompanied by motivation support may be considered the most effective way to prevent GDM among high-risk women during pregnancy. Future research is needed to strengthen these findings.
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Affiliation(s)
- Georgios I. Tsironikos
- Department of Medicine, University of Ioannina, University Campus, 45110 Ioannina, Greece;
| | - Petros Potamianos
- Department of Gastroenterology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece;
| | - George E. Zakynthinos
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Vasiliki Tsolaki
- Department of Critical Care, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece
| | - Athina Tatsioni
- Department of Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, University of Ioannina, University Campus, 45110 Ioannina, Greece;
| | - Alexandra Bargiota
- Department of Internal Medicine-Endocrinology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece;
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Kuang J, Sun S, Ke F. The effects of exercise intervention on complications and pregnancy outcomes in pregnant women with overweight or obesity: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e34804. [PMID: 37800765 PMCID: PMC10553027 DOI: 10.1097/md.0000000000034804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 07/27/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Being overweight or obese is closely related to adverse pregnancy outcomes and harms both pregnant women and neonates, increasing complications during pregnancy and leading to adverse pregnancy outcomes. Consequently, a meta-analysis was done to investigate exercise therapy impact on the complications and outcomes of pregnant women who are obese or overweight. MATERIALS AND METHODS The computer system searched PubMed, Cochrane Library, Wanfang, EMBASE, and CNKI databases. The search duration extended from the database establishment until October 2022. A thorough search was carried out for pertinent studies investigating exercise therapy impact on pregnancy complications and outcomes in obese or overweight pregnant women. The heterogeneity test was carried out using Cochrane Q and Chi-square tests. The combined findings from the meta-analysis were examined for reliability and robustness using sensitivity and publication bias analyses. All statistics used RevMan 5.3 software. RESULTS This meta-analysis included data from 8026 patients from 22 randomized controlled trials. The results demonstrated that exercise therapy might successfully decrease the incidence of gestational diabetes mellitus (GDM) (odds ratio [OR] = 0.85, 95% confidence interval [CI]: 0.74-0.96, P = .01) and macrosomia (OR = 0.78, 95% CI: 0.68-0.89, P < .001), and control weight gain during pregnancy (SMD = -0.2, 95% CI: -0.31 to -0.08, P < .001). CONCLUSIONS Exercise therapy can control weight gain during pregnancy, lower the incidence of GDM and the macrosomia rate, and improve adverse pregnancy outcomes.
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Affiliation(s)
- Jun Kuang
- Department of Obstetrics and Gynecology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
| | - Suwen Sun
- Department of Obstetrics and Gynecology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
| | - Fengmei Ke
- Department of Obstetrics and Gynecology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
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Yang X, Xiang Z, Zhang J, Song Y, Guo E, Zhang R, Chen X, Chen L, Gao L. Development and feasibility of a theory-guided and evidence-based physical activity intervention in pregnant women with high risk for gestational diabetes mellitus: a pilot clinical trial. BMC Pregnancy Childbirth 2023; 23:678. [PMID: 37726710 PMCID: PMC10510212 DOI: 10.1186/s12884-023-05995-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Physical activity has been utilized as an effective strategy to prevent gestational diabetes mellitus (GDM). However, most pregnant women with high risk for GDM did not achieve the recommended physical activity level. Furthermore, relevant physical activity protocols have varied without theory-guided and evidence-based tailored to pregnant women with high risk for GDM. This study aimed to develop and pilot test a theory-guided and evidence-based physical activity intervention protocol for pregnant women with high risk for GDM. METHODS The study design was guided by the Medical Research Council Framework for Developing and Evaluating Complex Intervention (the MRC framework). The preliminary protocol for physical activity intervention was developed based on self-efficacy theory, research evidence identified from systematic reviews and clinic trials, stakeholder engagement, context, and economic considerations. The preliminary intervention protocol was validated through a content validity study by an expert panel of 10 experts. A single-blinded randomized controlled trial (RCT) was designed to test the feasibility and acceptability of the intervention. RESULTS The validity of the preliminary intervention protocol was excellent as consensus was achieved. The final 13 sessions of self-efficacy enhancing physical activity intervention protocol were developed, including knowledge education, exercise clinic visits and video, and group discussions with face-to-face and online blended sessions. In the feasibility study, 34 pregnant women with high risk for GDM were randomized for the intervention (n = 17) or the control group (n = 17). The recruitment and retention rates were 82.9% and 58.9%, respectively. Women in the intervention group had a lower incidence of GDM (26.7% vs. 36.5%) than the control group (P >0.05). All participants were satisfied with the intervention and agreed that the intervention was helpful. CONCLUSIONS The developed self-efficacy-enhancing physical activity intervention is a feasible and acceptable intervention for enhancing physical activity among pregnant women with high risk for GDM and is ready to be tested in a more extensive RCT study. TRIAL REGISTRATION The study was registered on 4 February 2022 (ChiCTR2200056355) by the Chinese Clini Trial Registry (CHiCTR).
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Affiliation(s)
- Xiao Yang
- School of Nursing, Sun Yat-Sen University, No. 74 Zhongshan Road 2, Yuexiu District, Guangzhou, 510080 Guangdong Province P.R. China
| | - Zhixuan Xiang
- School of Nursing, Xiangtan Medicine & Health Vocational College, Xiangtan, China
| | - Ji Zhang
- Zhengzhou Maternal and Child Health Care Hospital, Zhengzhou, China
| | - Yingli Song
- Zhengzhou Maternal and Child Health Care Hospital, Zhengzhou, China
| | - Erfeng Guo
- School of Nursing, Zhengzhou University, Zhengzhou, China
| | - Ruixing Zhang
- School of Nursing, Zhengzhou University, Zhengzhou, China
| | - Xin Chen
- School of Nursing, Sun Yat-Sen University, No. 74 Zhongshan Road 2, Yuexiu District, Guangzhou, 510080 Guangdong Province P.R. China
| | - Lu Chen
- School of Nursing, Sun Yat-Sen University, No. 74 Zhongshan Road 2, Yuexiu District, Guangzhou, 510080 Guangdong Province P.R. China
| | - Lingling Gao
- School of Nursing, Sun Yat-Sen University, No. 74 Zhongshan Road 2, Yuexiu District, Guangzhou, 510080 Guangdong Province P.R. China
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10
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Bernardo DS, Carvalho CB, Conde M, Mota JA, Santos PC. Effectiveness of a structured exercise intervention in gestational weight gain in pregnant women with overweight and obesity: A systematic review with meta-analysis. Int J Gynaecol Obstet 2023; 162:811-822. [PMID: 36825992 DOI: 10.1002/ijgo.14741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 02/10/2023] [Accepted: 02/22/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVES To assess the effectiveness of exercise interventions during pregnancy in managing gestational weight gain (GWG), excessive GWG, gestational diabetes (GD), hypertensive disorders, 2-h post-oral glucose tolerance test (OGTT), and birth weight in pregnant women with overweight/obesity (OW/OB). METHODS The search strategy was conducted in five electronic databases, restricting to articles published within the past 10 years. Randomized controlled trials comparing exercise intervention with usual prenatal care in pregnant women with OW/OB were considered. Two reviewers extracted data and assessed the risk of bias using version 2 of the Cochrane risk-of-bias tool for randomized trials and the quality of studies using Grading of Recommendations Assessment, Development and Evaluation classification. Continuous data were calculated as mean differences (MDs) and dichotomous data as risk ratios (RRs). RESULTS Seven trials comprising 1648 pregnant women were included. Exercise interventions were associated with lower GWG (MD, -1.19 kg [95% confidence interval, CI, -1.79 to -0.60]) and lower incidence of GD (RR, 0.56 [95% CI, 0.40-0.78]). When analyzing excessive GWG, 2-h post-OGTT, birth weight, and hypertensive disorders, there was no statistically significant difference between the exercise and usual care groups. The strength of evidence was considered moderate. CONCLUSION Exercise interventions during pregnancy in women with OW/OB were shown to influence GWG and the incidence of GD.
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Affiliation(s)
- Diana Salvador Bernardo
- KinesioLab Research Unit in Human Movement, Department of Physiotherapy, School of Health, Piaget Institute, Vila Nova de Gaia, Portugal
- Faculty of Sport, Research Centre in Physical Activity, Health and Leisure (CIAFEL), University of Porto (FADEUP), Porto, Portugal
| | | | - Monserrat Conde
- Nuffield Department of Primary Care Health Sciences, Center for Evidence Based Medicine, University of Oxford, Oxford, UK
| | - Jorge Augusto Mota
- Faculty of Sport, Research Centre in Physical Activity, Health and Leisure (CIAFEL), University of Porto (FADEUP), Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), FADEUP-Faculty of Sport, University of Porto, Porto, Portugal
| | - Paula Clara Santos
- Faculty of Sport, Research Centre in Physical Activity, Health and Leisure (CIAFEL), University of Porto (FADEUP), Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), FADEUP-Faculty of Sport, University of Porto, Porto, Portugal
- Department of Physiotherapy, Health School, Polytechnic of Porto (ESS), Porto, Portugal
- Center for Rehabilitation Research (CIR), School of Health, Polytechnic of Porto, Porto, Portugal
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11
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Sánchez-Polán M, Adamo K, Silva-Jose C, Zhang D, Refoyo I, Barakat R. Physical Activity and Self-Perception of Mental and Physical Quality of Life during Pregnancy: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:5549. [PMID: 37685615 PMCID: PMC10487934 DOI: 10.3390/jcm12175549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Self-perception of health status (quality of life) is considered one of the best indicators of health and well-being. However, during pregnancy, it could be impacted not only by physiological and anatomical changes, but by poor lifestyle habits like high sedentary behaviour or bad nutrition. This study assesses the effects of physical activity RCT interventions during pregnancy on both mental and physical components of quality of life. A systematic review and two meta-analyses were performed (PROSPERO registration number: CRD42022370467). Of the 207 articles captured both in English and Spanish, seven articles were deemed eligible for inclusion. The two analyses performed found that physically active pregnant women had better scores of mental self-perception of quality of life (z = 2.08, p = 0.04; SMD = 0.34, 95% CI = 0.02, 0.67, I2 = 76%, Pheterogeneity = 0.0004) and in physical self-perceived health status (z = 2.19, p = 0.03; SMD = 0.33, 95% CI = 0.03, 0.63, I2 = 71%, Pheterogeneity = 0.002) compared to control group pregnant women. Physical activity interventions could potentially increase mental and physical self-perception of quality of life during pregnancy.
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Affiliation(s)
- Miguel Sánchez-Polán
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Kristi Adamo
- School of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Cristina Silva-Jose
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Dingfeng Zhang
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Ignacio Refoyo
- Sports Department, Faculty of Physical Activity and Sports Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Rubén Barakat
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
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12
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Zhang D, Nagpal TS, Silva-José C, Sánchez-Polán M, Gil-Ares J, Barakat R. Influence of Physical Activity during Pregnancy on Birth Weight: Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2023; 12:5421. [PMID: 37629463 PMCID: PMC10455907 DOI: 10.3390/jcm12165421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Birth weight is a marker that is often referred to determine newborn health, potential growth trajectories and risk of future disease. Accordingly, interventions to promote appropriate and healthy birth weight have been extensively studied and implemented in pregnancy. In particular, physical activity in pregnancy is recommended to promote appropriate fetal development and newborn birth weight. This systematic review and meta-analyses aimed to summarize the effect of physical activity during pregnancy specifically from randomized controlled trials on the following outcomes: birth weight, macrosomia, low birth weight, being large for the gestational age, and being small for the gestational age (Registration No.: CRD42022370729). 63 studies (16,524 pregnant women) were included. There was a significant negative relationship between physical activity during pregnancy and macrosomia (z = 2.16; p = 0.03; RR = 0.79, 95% CI = 0.63, 0.98, I2 = 29%, Pheterogeneity = 0.09). No other significant relationships were found. Promoting physical activity during pregnancy may be an opportune time to reduce the risk of future chronic disease, such as obesity, through the prevention of macrosomia and the promotion of appropriate birth weights.
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Affiliation(s)
- Dingfeng Zhang
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (D.Z.); (C.S.-J.); (M.S.-P.); (R.B.)
| | - Taniya S. Nagpal
- Faculty of Kinesiology Sport and Recreation, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Cristina Silva-José
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (D.Z.); (C.S.-J.); (M.S.-P.); (R.B.)
| | - Miguel Sánchez-Polán
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (D.Z.); (C.S.-J.); (M.S.-P.); (R.B.)
| | - Javier Gil-Ares
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (D.Z.); (C.S.-J.); (M.S.-P.); (R.B.)
| | - Rubén Barakat
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (D.Z.); (C.S.-J.); (M.S.-P.); (R.B.)
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13
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Zhang D, Ruchat SM, Silva-Jose C, Gil-Ares J, Barakat R, Sánchez-Polán M. Influence of Physical Activity during Pregnancy on Type and Duration of Delivery, and Epidural Use: Systematic Review and Meta-Analysis. J Clin Med 2023; 12:5139. [PMID: 37568541 PMCID: PMC10419719 DOI: 10.3390/jcm12155139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
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.
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Affiliation(s)
- Dingfeng Zhang
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Stephanie-May Ruchat
- Department of Human Kinetics, Université du Québec à Trois, Trois-Rivières, QC G8T 0A1, Canada
| | - Cristina Silva-Jose
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Javier Gil-Ares
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Rubén Barakat
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Miguel Sánchez-Polán
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
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14
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Barakat R, Zhang D, Sánchez-Polán M, Silva-José C, Gil-Ares J, Franco E. Is Exercise during Pregnancy a Risk for Gestational Age and Preterm Delivery? Systematic Review and Meta-Analysis. J Clin Med 2023; 12:4915. [PMID: 37568315 PMCID: PMC10419377 DOI: 10.3390/jcm12154915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
Traditionally, one of the primary concerns regarding exercise during pregnancy has been the potential of reducing gestational age and increasing the likelihood of preterm delivery. The aim of this study was to perform a systematic review about the effects of physical activity (PA) during pregnancy on gestational age and preterm delivery. A systematic review and two meta-analyses were performed (Registration No. CRD42022370770). Data sources from online databases were searched up to November 2022. The review exclusively included studies involving pregnant populations and interventions consisting of PA implemented during pregnancy. The primary outcomes analysed were gestational age, measured in weeks, and the occurrence of preterm deliveries. A total of 57 studies were analysed through two independent meta-analyses for the first one, no association was found between moderate exercise during pregnancy and gestational age (Z = 0.45, p = 0.65, ES = 0.08, 95% CI = -0.06-0.04, I2 = 42%, P heterogeneity = 0.001), showing the exercise group had a higher gestational age. In addition, no differences were found between groups in terms of number of preterm deliveries (RR = 0.96, (95% CI = 0.77-1.21, Z = 0.33, p = 0.74; ES = 0.07; I2 = 31%, P heterogeneity = 0.05)). The findings of this study indicate that there is no association between exercise during pregnancy and reduced gestational age or increased risk of preterm delivery in healthy pregnancies.
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Affiliation(s)
- Rubén Barakat
- AFIPE Research Group, Faculty of PA and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (R.B.); (D.Z.); (M.S.-P.); (C.S.-J.)
| | - Dingfeng Zhang
- AFIPE Research Group, Faculty of PA and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (R.B.); (D.Z.); (M.S.-P.); (C.S.-J.)
| | - Miguel Sánchez-Polán
- AFIPE Research Group, Faculty of PA and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (R.B.); (D.Z.); (M.S.-P.); (C.S.-J.)
| | - Cristina Silva-José
- AFIPE Research Group, Faculty of PA and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (R.B.); (D.Z.); (M.S.-P.); (C.S.-J.)
| | - Javier Gil-Ares
- AFIPE Research Group, Faculty of PA and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (R.B.); (D.Z.); (M.S.-P.); (C.S.-J.)
| | - Evelia Franco
- Department of Education, Research and Evaluation Methods, Faculty of Social and Human Sciences, Universidad Pontificia de Comillas, 28049 Madrid, Spain;
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15
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Hawkins MS, Conlon RK, Donofry S, Buysse DJ, Venditti EM, Cheng Y, Levine MD. Sleep characteristics modify the associations of physical activity during pregnancy and gestational weight gain. Arch Gynecol Obstet 2023; 308:101-109. [PMID: 35870008 PMCID: PMC11186598 DOI: 10.1007/s00404-022-06677-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/14/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Excessive gestational weight gain (eGWG) is associated with adverse long-term maternal outcomes. Most lifestyle interventions that incorporate physical activity have been ineffective at reducing eGWG. The purpose of this study was to determine if sleep modified the relationships between physical activity change from the 2nd to 3rd trimester and the odds of excessive gestational weight gain (eGWG). METHODS This was a secondary data analysis of a prospective cohort study of pregnant birthing people with overweight or obesity (n = 105). We estimated physical activity energy expenditure (PAEE) in the 2nd and 3rd trimesters of pregnancy and sleep characteristics (i.e., sleep quality, daytime dysfunction, sleep efficiency, sleep duration) in the 2nd trimester of pregnancy with validated measures. We used regression models with sleep and PAEE change (increase/stable vs. decrease) interaction terms to examine the impact of sleep on PAEE change and eGWG. RESULTS Mean GWG was 37.02 ± 16.76 lbs. and 80% of participants experienced eGWG. Eighteen percent of participants increased their PAEE from the 2nd to the 3rd trimester. Increasing (vs. decreasing) PAEE was associated with lower log-odds of eGWG only among participants that slept at least 8 h/night (p = 0.06), had at least 85% sleep efficiency (p = 0.03), or reported less daytime dysfunction (p = 0.08). Sleep quality did not moderate the association between PAEE change and eGWG. CONCLUSIONS Weight management interventions in pregnancy should consider screening for and addressing poor sleep in the second trimester.
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Affiliation(s)
- Marquis S Hawkins
- Department of Epidemiology, University of Pittsburgh, 5138 Public Health, Pittsburgh, PA, 15261, USA.
| | - Rachel K Conlon
- Department of Psychiatry, University of Pittsburgh, 5138 Public Health, Pittsburgh, PA, 15261, USA
| | - Shannon Donofry
- Department of Psychology, University of Pittsburgh, 5138 Public Health, Pittsburgh, PA, 15261, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, 5138 Public Health, Pittsburgh, PA, 15261, USA
| | - Elizabeth M Venditti
- Department of Psychiatry, University of Pittsburgh, 5138 Public Health, Pittsburgh, PA, 15261, USA
| | - Yu Cheng
- Department of Statistics, University of Pittsburgh, 5138 Public Health, Pittsburgh, PA, 15261, USA
| | - Michele D Levine
- Department of Psychiatry, University of Pittsburgh, 5138 Public Health, Pittsburgh, PA, 15261, USA
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16
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Paulsen CP, Bandak E, Edemann-Callesen H, Juhl CB, Händel MN. The Effects of Exercise during Pregnancy on Gestational Diabetes Mellitus, Preeclampsia, and Spontaneous Abortion among Healthy Women-A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6069. [PMID: 37372656 DOI: 10.3390/ijerph20126069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
The aim was to compare the effects of different exercise modalities (aerobic, resistance, aerobic and resistance combined, or mind-body exercise) on gestational diabetes mellitus (GDM), preeclampsia, spontaneous abortion, withdrawal from the study, and adverse events in healthy pregnant women. A systematic search was conducted in February 2022 using MEDLINE, EMBASE, Cochrane library, and SPORT Discus to identify eligible randomized trials. The meta-analysis of 18 studies that examined exercise compared to no exercise showed a reduced risk of GDM (RR: 0.66 (95% CI: 0.50 to 0.86)). No subgroup differences were found regarding modality, intensity, or supervision. Exercise did not reduce the risk of preeclampsia (nine studies, RR: 0.65 (95% CI: 0.42 to 1.03)); however, in subgroup analyses, mind-body exercise and low-intensity exercise seemed to be effective in reduction of preeclampsia. There was no effect of exercise on withdrawal or adverse events found. No studies reported on spontaneous abortion, therefore, exercise during pregnancy is beneficial and safe. In the prevention of GDM, any modality and intensity seem equally effective. Subgroup analyses support an association between mind-body exercise and physical activity with low intensity and reduced risk of preeclampsia, but more high-quality randomized studies are needed. PROSPERO: CRD42022307053.
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Affiliation(s)
- Camilla Paludan Paulsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense, Denmark
| | - Elisabeth Bandak
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark
- Department of Biomedical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | | | - Carsten Bogh Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense, Denmark
- Department Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, 2100 Copenhagen, Denmark
| | - Mina Nicole Händel
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
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Harrison CL, Bahri Khomami M, Enticott J, Thangaratinam S, Rogozińska E, Teede HJ. Key Components of Antenatal Lifestyle Interventions to Optimize Gestational Weight Gain: Secondary Analysis of a Systematic Review. JAMA Netw Open 2023; 6:e2318031. [PMID: 37326994 PMCID: PMC10276313 DOI: 10.1001/jamanetworkopen.2023.18031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/27/2023] [Indexed: 06/17/2023] Open
Abstract
Importance Randomized clinical trials have found that antenatal lifestyle interventions optimize gestational weight gain (GWG) and pregnancy outcomes. However, key components of successful interventions for implementation have not been systematically identified. Objective To evaluate intervention components using the Template for Intervention Description and Replication (TIDieR) framework to inform implementation of antenatal lifestyle interventions in routine antenatal care. Data Sources Included studies were drawn from a recently published systematic review on the efficacy of antenatal lifestyle interventions for optimizing GWG. The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Health Technology Assessment Database, MEDLINE, and Embase were searched from January 1990 to May 2020. Study Selection Randomized clinical trials examining efficacy of antenatal lifestyle interventions in optimizing GWG were included. Data Extraction and Synthesis Random effects meta-analyses were used to evaluate the association of intervention characteristics with efficacy of antenatal lifestyle interventions in optimizing GWG. The results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Data extraction was performed by 2 independent reviewers. Main Outcomes and Measures The main outcome was mean GWG. Measures included characteristics of antenatal lifestyle interventions comprising domains related to theoretical framework, material, procedure, facilitator (allied health staff, medical staff, or researcher), delivery format (individual or group), mode, location, gestational age at commencement (<20 wk or ≥20 wk), number of sessions (low [1-5 sessions], moderate [6-20 sessions], and high [≥21 sessions]), duration (low [1-12 wk], moderate [13-20 wk], and high [≥21 wk]), tailoring, attrition, and adherence. For all mean differences (MDs), the reference group was the control group (ie, usual care). Results Overall, 99 studies with 34 546 pregnant individuals were included with differential effective intervention components found according to intervention type. Broadly, interventions delivered by an allied health professional were associated with a greater decrease in GWG compared with those delivered by other facilitators (MD, -1.36 kg; 95% CI, -1.71 to -1.02 kg; P < .001). Compared with corresponding subgroups, dietary interventions with an individual delivery format (MD, -3.91 kg; 95% CI -5.82 to -2.01 kg; P = .002) and moderate number of sessions (MD, -4.35 kg; 95% CI -5.80 to -2.89 kg; P < .001) were associated with the greatest decrease in GWG. Physical activity and mixed behavioral interventions had attenuated associations with GWG. These interventions may benefit from an earlier commencement and a longer duration for more effective optimization of GWG. Conclusions and Relevance These findings suggest that pragmatic research may be needed to test and evaluate effective intervention components to inform implementation of interventions in routine antenatal care for broad public health benefit.
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Affiliation(s)
- Cheryce L. Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Diabetes and Endocrine Unit, Monash Health, Melbourne, Victoria, Australia
| | - Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shakila Thangaratinam
- World Health Organization Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- Birmingham Women’s and Children’s National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Ewelina Rogozińska
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, London, United Kingdom
| | - Helena J. Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Diabetes and Endocrine Unit, Monash Health, Melbourne, Victoria, Australia
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18
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Roland CB, Knudsen SDP, Alomairah SA, Jessen AD, Jensen IKB, Brændstrup N, Molsted S, Jensen AK, Stallknecht B, Bendix JM, Clausen TD, Løkkegaard E. Effects of prenatal exercise on gestational weight gain, obstetric and neonatal outcomes: FitMum randomized controlled trial. BMC Pregnancy Childbirth 2023; 23:214. [PMID: 36991380 DOI: 10.1186/s12884-023-05507-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/07/2023] [Indexed: 03/31/2023] Open
Abstract
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.
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Affiliation(s)
- Caroline B Roland
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark.
| | - Signe dP Knudsen
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Saud A Alomairah
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- College of Health Sciences, Public Health Department, Saudi Electronic University, Riyadh, Saudi Arabia
| | - Anne D Jessen
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Ida K B Jensen
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Nina Brændstrup
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Stig Molsted
- Department of Clinical Research, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Andreas K Jensen
- Department of Clinical Research, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bente Stallknecht
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jane M Bendix
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Department of Clinical Research, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Tine D Clausen
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ellen Løkkegaard
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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19
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Zhu X, Chen W, Wang H. Effects of swimming before and during pregnancy on placental angiogenesis and perinatal outcome in high-fat diet-fed mice. PeerJ 2023; 11:e14562. [PMID: 36846460 PMCID: PMC9948747 DOI: 10.7717/peerj.14562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/22/2022] [Indexed: 02/22/2023] Open
Abstract
Background We explored the mechanism underlying exercise-mediated placental angiogenesis and perinatal outcome using mouse models. Methods Three-week-old C57BL/6 female mice were randomly divided into four experimental groups: standard-chow diet (SC), standard chow diet + exercise (SC-Ex), high-fat diet (HFD), and high-fat diet + exercise (HFD-Ex). After 13 weeks of exercise intervention, the male and female mice were caged. Approximately six to seven pregnant female mice from each experimental group were randomly selected for body composition, qRT-PCR, histological, and western blot analysis. The remaining mice were allowed to deliver naturally, and the perinatal outcome indexes were observed. Rusults The results showed that exercise intervention significantly improved the body composition and glucose tolerance in HFD-fed pregnant mice. The HFD group showed adipocyte infiltration, placental local hypoxia, and villous vascular thrombosis with a significant (p < 0.05) increase in the expression of VEGF and ANGPT1 proteins. Exercise intervention significantly elevated the expression of PPARγ, alleviated hypoxia and inflammation-related conditions, and inhibited angiogenesis. sFlt-1 mRNA in HFD group was significantly higher than that in SC group (p < 0.05). Furthermore, the HFD significantly reduced (p < 0.05) the fertility rate in mice. Conclusions Thus, HFD aggravates placental inflammation and the hypoxic environment and downregulates the expression of PPARγ and PPARα in the placenta. However, exercise intervention can significantly alleviate these conditions.
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Affiliation(s)
- Xiaofeng Zhu
- Child Development Research Institute of Jiaxing University, Jiaxing, China
| | - Weiwei Chen
- Child Development Research Institute of Jiaxing University, Jiaxing, China
| | - Haitang Wang
- Child Development Research Institute of Jiaxing University, Jiaxing, China
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20
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Rani V, Joshi S. Effectiveness of different behavioral interventions on gestational weight gain, post-partum weight retention and anthropometric measures in pregnancy: A randomized controlled trial. Health Promot Perspect 2022; 12:286-294. [PMID: 36686048 PMCID: PMC9808912 DOI: 10.34172/hpp.2022.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 07/15/2022] [Indexed: 01/15/2023] Open
Abstract
Background: The antenatal and postnatal periods are critical stages in a woman's reproductive life. Many physical changes occur during pregnancy, such as water retention and excessive weight gain. The aim of the present study is to find out the effectiveness of various behavioral interventions during pregnancy to prevent excessive gestational weight gain (GWG) and postpartum weight retention (PPWR). Methods: In this parallel-group randomized controlled trial, 150 pregnant women with singleton pregnancy, aged 20-30 years, body mass index (BMI)≥18.5 kg/m2 and gestational age of less than 16 weeks were randomly allocated into five groups (N=30 in each group): Group A: Control; Group B: Supervised exercise; Group C: Pedometer; Group D: Text message; and Group E: Pedometer plus text message group. Group B received four supervised exercise sessions per month up to delivery; Groups C and E were urged to increase their levels of physical activity, focusing on pedometer-measured step counts of at least 5000-7500 steps per day on seven consecutive days each month. Group E along with group D also received standard SMS messages about physical activity, diet, motivation, and educational-specific topics. Results: The between-group comparisons revealed a statistically significant reduction in PPWR but insignificant difference in GWG. The greatest reduction in PPWR was found in the supervised exercise group (MD=3.25 kg, 95% CI: [1.75, 4.75], P=0.0001 with effect size (η2 )=0.155). Conclusion: The study found that the supervised exercise can be seen as an effective way of improving the physical activity level and reducing excessive PPWR in pregnant women.
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21
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Knudsen SDP, Roland CB, Alomairah SA, Jessen AD, Molsted S, Clausen TD, Løkkegaard E, Stallknecht B, Bønnelycke J, Bendix JM, Maindal HT. Physical activity in pregnancy: a mixed methods process evaluation of the FitMum randomised controlled trial interventions. BMC Public Health 2022; 22:2283. [PMID: 36474181 PMCID: PMC9724308 DOI: 10.1186/s12889-022-14717-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- Signe de Place Knudsen
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark. .,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Caroline Borup Roland
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Saud Abdulaziz Alomairah
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
| | - Anne Dsane Jessen
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stig Molsted
- Department of Clinical Research, Copenhagen University Hospital - North Zealand, Hillerod, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tine D Clausen
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ellen Løkkegaard
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bente Stallknecht
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie Bønnelycke
- Department of Visual Culture and Performance Design, Roskilde University, Roskilde, Denmark
| | - Jane M Bendix
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark.,Department of Clinical Research, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
| | - Helle Terkildsen Maindal
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Steno Diabetes Center Copenhagen, Herlev, Denmark
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22
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Bahri Khomami M, Teede HJ, Enticott J, O’Reilly S, Bailey C, Harrison CL. Implementation of Antenatal Lifestyle Interventions Into Routine Care: Secondary Analysis of a Systematic Review. JAMA Netw Open 2022; 5:e2234870. [PMID: 36197663 PMCID: PMC9535535 DOI: 10.1001/jamanetworkopen.2022.34870] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Lifestyle interventions in pregnancy optimize gestational weight gain and improve pregnancy outcomes, with implementation recommended by the US Preventive Services Task Force. Yet, implementation research taking these efficacy trials into pragmatic translation remains limited. OBJECTIVE To evaluate success factors for implementing pregnancy lifestyle interventions into antenatal care settings in a meta-analysis, using the penetration, implementation, participation, and effectiveness (PIPE) impact metric. DATA SOURCES Data from a previous systematic review that searched across 9 databases, including MEDLINE, Embase, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Health Technology Assessment Database, were obtained, in 2 stages, up to May 6, 2020. STUDY SELECTION Randomized clinical trials reporting gestational weight gain in singleton pregnancies. DATA EXTRACTION AND SYNTHESIS The association of penetration, implementation, and participation with effectiveness of antenatal lifestyle interventions in optimizing gestational weight gain was estimated using random-effects meta-analyses. The Cochrane risk of bias tool, version 1.0, was used to assess risk of bias. MAIN OUTCOMES AND MEASURES Penetration (reach), implementation (fidelity), participation, and effectiveness of randomized clinical trials of lifestyle interventions in pregnancy. RESULTS Ninety-nine studies with 34 546 participants were included. Only 14 studies reported penetration of target populations. Overall, 38 studies (38.4%) had moderate fidelity, 25 (25.2%) had high fidelity, and 36 (36.4%) had unclear fidelity. Participation was reported in 84 studies (84.8%). Lifestyle interventions were associated with reducing gestational weight gain by 1.15 kg (95% CI, -1.40 to -0.91 kg). CONCLUSIONS AND RELEVANCE The findings of this systematic review and meta-analysis suggest that, despite the large body of evidence on efficacy of lifestyle interventions during pregnancy in optimizing gestational weight gain, little guidance is available to inform implementation of this evidence into practice. There is a need to better elucidate implementation outcomes in trial design alongside pragmatic implementation research to improve the health of women who are pregnant and the next generation.
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Affiliation(s)
- Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Helena J. Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Diabetes and Endocrine Unit, Monash Health, Melbourne, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sharleen O’Reilly
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin, Ireland
| | - Cate Bailey
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Cheryce L. Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Diabetes and Endocrine Unit, Monash Health, Melbourne, Australia
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23
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Zhu Z, Xie H, Liu S, Yang R, Yu J, Yan Y, Wang X, Zhang Z, Yan W. Effects of physical exercise on blood pressure during pregnancy. BMC Public Health 2022; 22:1733. [PMID: 36096756 PMCID: PMC9469521 DOI: 10.1186/s12889-022-14074-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/22/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Effect of physical exercise on pregnant women currently has become a hot topic in prenatal health care. In this study, A meta-analysis was conducted on account of Randomized Controlled Trial (RCT). It focused on evaluating the effect of physical exercise intervention on blood pressure so that could provide certain evidence for health care during pregnancy. Methods Results of relevant studies were retrieved from PubMed, Embase, Web of Science and the Cochrane Library, and all of these included studies were evaluated according to the Cochrane collaboration’s tool for assessing the risk of bias. Stata 15.1 was used for meta-analysis, and mean difference (MD) was used as statistic for pooled analysis. The effect values were combined by conventional meta-analysis and Bayesian meta-analysis respectively, and the consistency of pooled results was considered as well. Results A total of 18 RCT studies were included in the quantitative analysis. The conventional meta-analysis showed differences in blood pressure between intervention group and control group (P < 0.05). Systolic and diastolic blood pressures of intervention group were 3.19 mmHg (95% CI: -5.13, -1.25) and 2.14 mmHg (95% CI: -4.26, -0.03) lower than that of control group, respectively. Bayesian meta-analysis showed that both systolic and diastolic pressure among intervention group decreased by 3.34 mmHg (95% CrI: -5.15, -1.56) and 2.14 mmHg (95% CrI: -3.79, − 0.50), respectively. Subgroup analysis supported that as long as healthy pregnant women participated in exercises, their blood pressure could be slightly regulated, while hypertension susceptible pregnant women significantly lowered blood pressure. Conclusion Exercise intervention during pregnancy is beneficial to lower or normalize blood pressure, and this research provides clues for follow-up studies.
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Affiliation(s)
- Zhu Zhu
- Jiangsu Vocational Institute of Commerce, Nanjing, 211168, China
| | - Hang Xie
- Office of Clinical Research Center, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Shiping Liu
- Department of Orthopedics, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Ruizhe Yang
- Department of Public Health, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Juan Yu
- Department of Medicine, Gansu University of Chinese Medicine, Dingxi, 743000, China
| | - Yiping Yan
- College of Mathematics and Statistics, Northwest Normal University, Lanzhou, 730070, China
| | - Xu Wang
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Zhihua Zhang
- Yunyang People's Hospital of Danyang, Danyang, 212300, China.
| | - Wu Yan
- Department of Children Health Care, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
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24
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Corso M, Miarka B, Figueiredo T, Bragazzi N, Carvalho D, Dias I. Effects of aerobic, strength, and combined training during pregnancy in the blood pressure: A systematic review and meta-analysis. Front Physiol 2022; 13:916724. [PMID: 36111150 PMCID: PMC9468920 DOI: 10.3389/fphys.2022.916724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022] Open
Abstract
Gestational hypertension can lead to fetal complications, and, if untreated, high blood pressure during pregnancy may cause eclampsia and even death in the mother and fetus. Exercise is a strategy for preventing blood pressure disorders. There is little knowledge about the physiological impacts of different physical types of training on blood pressure during pregnancy. For that, this meta-analysis aimed to compare the effects of different physical exercise modalities (i.e., aerobic training—AT, strength training—ST, and combined training—AT + ST) on systolic blood pressure (SBP) and diastolic blood pressure (DBP) of pregnant women. A search was performed on PUBMED, LILACS, CINAHL, Sport discus, EMBASE, SCOPUS, and Cochrane Central Register of Controlled Trials to identify researchers. From 3,450 studies, 20 and 19 were included in the qualitative and quantitative analyses. AT studies presented a medium effect size (ES) on SBP [−0.29 (−2.95 to 2.36) p = 0.83], with substantial heterogeneity (I2 = 64%), and had a large impact on DBP [−1.34 (−2.98 to 0.30) p = 0.11], with moderate heterogeneity (I2 = 30%). ST researchers showed a large ES on SBP [−1.09 (−3.66 to 1.49) p = 0.41], with a reduced heterogeneity (I2 = 0%), and a medium ES on DBP [−0.26 (−2.77 to 2.19) p = 0.83] with moderate heterogeneity (I2 = 38%). AT + ST studies had a large ES on SBP [−1.69 (−3.88 to 0.49) p = 0.13] and DBP [−01.29 (−2.26 to 0.31) p = 0.01] with considerable (I2 = 83%) and moderate heterogeneity (I2 = 47%), respectively. These findings are essential for developing new research protocols to avoid gestational hypertension and preeclampsia. AT + ST had a large impact on the SBP and DBP reduction; however, there is a need for more similar procedures to reduce heterogeneity between studies, promoting consensual results. Systematic Review Registration: [PROSPERO], identifier [CRD42021256509].
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Affiliation(s)
- Marcelo Corso
- Physical Education Postgraduate Program, School of Physical Education and Sports, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bianca Miarka
- Physical Education Postgraduate Program, School of Physical Education and Sports, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- *Correspondence: Bianca Miarka,
| | - Tiago Figueiredo
- Physical Education Program, Estácio de Sá University, Rio de Janeiro, Brazil
| | - Nicola Bragazzi
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Danilo Carvalho
- Physical Education Postgraduate Program, School of Physical Education and Sports, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ingrid Dias
- Physical Education Postgraduate Program, School of Physical Education and Sports, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Xie E, Tao H, Liu M, Li C, Zhao Q. The effect of exercise on the prevention of gestational hypertension in obese and overweight pregnant women: An updated meta-analysis. Front Public Health 2022; 10:923161. [PMID: 36045739 PMCID: PMC9420989 DOI: 10.3389/fpubh.2022.923161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/25/2022] [Indexed: 01/22/2023] Open
Abstract
Background Gestational hypertension (GH) is a common disease that seriously threatens the safety and health of pregnant women and their newborns. Physical exercise (PE) is widely recognized as a health maintenance method and it has numerous benefits. Studies on the association between PE and the risk of GH in obese and overweight pregnant women have generated controversial findings. This updated meta-analysis was performed to reassess the effects of PE on GH. Methods The articles from inception to April 2022, presenting studies investigating exercise intervention and pregnancy outcomes were explored across several online databases. Heterogeneity among the included studies was estimated and tested by Q test and I 2 statistic. Risk ratios (RRs) and 95% confidence intervals (CI) were calculated through either random-effect or fixed-effect models. Subgroup analyses, sensitivity analyses, and publication bias diagnoses were also conducted. Results Twelve with 1,649 subjects were included. PE was associated with a reduced risk of GH in obese and overweight pregnant women (Pooled RR = 0.58, 95% CI = 0.42-0.81, P = 0.001; I 2 = 24.3%). Subgroup analysis found significant trends amongst Eastern countries (RR = 0.59, 95% CI = 0.36-0.96, P = 0.033). Sensitivity analysis suggested the results were stable. No publication bias was detected based on Begg's test and Egger's test. Conclusion PE was associated with reduced risk of GH in obese and overweight pregnant women, especially in Eastern countries. More well-designed studies are still needed to further elaborate on these associations. Systematic review registration CRD42022326183.
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Affiliation(s)
- Enli Xie
- Department of Sports Training, Nanjing Sport Institute, Nanjing, China,*Correspondence: Enli Xie
| | - Huimin Tao
- Department of Sports Training, Nanjing Sport Institute, Nanjing, China
| | - Mengqing Liu
- Department of Chaohu Clinical Medicine, Anhui Medical University, Hefei, China
| | - Changchun Li
- School of Physical Education, Spots Institute of Jingdezhen University, Jingdezhen, China,Changchun Li
| | - Qi Zhao
- Department of Sports Training, Nanjing Sport Institute, Nanjing, China,Qi Zhao
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Tsironikos GI, Perivoliotis K, Bargiota A, Zintzaras E, Doxani C, Tatsioni A. Effectiveness of exercise intervention during pregnancy on high-risk women for gestational diabetes mellitus prevention: A meta-analysis of published RCTs. PLoS One 2022; 17:e0272711. [PMID: 35930592 PMCID: PMC9355219 DOI: 10.1371/journal.pone.0272711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/26/2022] [Indexed: 11/19/2022] Open
Abstract
Objective We aimed at investigating the preventive role of exercise intervention during pregnancy, in high-risk women for gestational diabetes mellitus (GDM). Materials and methods We searched PubMed, CENTRAL, and Scopus for randomized controlled trials (RCTs) that evaluated exercise interventions during pregnancy on women at high risk for GDM. Data were combined with random effects models. Between study heterogeneity (Cochran’s Q statistic) and the extent of study effects variability [I2 with 95% confidence interval (CI)] were estimated. Sensitivity analyses examined the effect of population, intervention, and study characteristics. We also evaluated the potential for publication bias. Results Among the 1,508 high-risk women who were analyzed in 9 RCTs, 374 (24.8%) [160 (21.4%) in intervention, and 214 (28.1%) in control group] developed GDM. Women who received exercise intervention during pregnancy were less likely to develop GDM compared to those who followed the standard prenatal care (OR 0.70, 95%CI 0.52, 0.93; P-value 0.02) [Q 10.08, P-value 0.26; I2 21% (95%CI 0, 62%]. Studies with low attrition bias also showed a similar result (OR 0.70, 95%CI 0.51, 0.97; P-value 0.03). A protective effect was also supported when analysis was limited to studies including women with low education level (OR 0.55; 95%CI 0.40, 0.74; P-value 0.0001); studies with exercise intervention duration more than 20 weeks (OR 0.54; 95%CI 0.40, 0.74; P-value 0.0007); and studies with a motivation component in the intervention (OR 0.69, 95%CI 0.50, 0.96; P-value 0.03). We could not exclude large variability in study effects because the upper limit of I2 confidence interval was higher than 50% for all analyses. There was no conclusive evidence for small study effects (P-value 0.31). Conclusions Our study might support a protective effect of exercise intervention during pregnancy for high-risk women to prevent GDM. The protective result should be corroborated by large, high quality RCTs.
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Affiliation(s)
| | | | - Alexandra Bargiota
- Department of Internal Medicine-Endocrinology, University Hospital of Larissa, Larissa, Greece
| | - Elias Zintzaras
- Department of Biomathematics, University of Thessaly, Larissa, Greece
| | - Chrysoula Doxani
- Department of Biomathematics, University of Thessaly, Larissa, Greece
| | - Athina Tatsioni
- Department of Research Unit for General Medicine and Primary Health Care, University of Ioannina, Ioannina, Greece
- * E-mail:
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Boutib A, Chergaoui S, Marfak A, Hilali A, Youlyouz-Marfak I. Quality of Life During Pregnancy from 2011 to 2021: Systematic Review. Int J Womens Health 2022; 14:975-1005. [PMID: 35941917 PMCID: PMC9356752 DOI: 10.2147/ijwh.s361643] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Health-related quality of life (HRQoL) has emerged as a key concern in patient care. It has become one of the major objectives of clinical trials. Our study aims to describe the quality of life (QoL) during uncomplicated pregnancy and to assess its associated factors. Patients and Methods The search of articles was carried out using the online database of PUBMED and Web of Science with a limit of time between 2011 and 2021. Data were retrieved by two independent reviewers. Results 721 publications responding to keywords were identified, of which 73 articles on the topic were selected. The main countries that have published on this subject are Australia (n = 10) and China (n = 7). Twenty-three articles deal with QoL for pathological pregnancies. All the pathologies studied have a negative impact on the HRQoL of pregnant women, and its improvement depends on the type of treatment. Obesity, low back, and pelvic girdle pain, and hyperemesis gravidarum were the frequent pathologies during pregnancy. Socio-demographic characteristics related to improved well-being (favorable economic status, social support). Similarly, better sleep quality and moderate physical exercise were linked to an increased QoL. Physical and psychological factors were associated with a lower QoL. Conclusion The HRQoL refers to patients’ subjective evaluation of physical, mental, and social components of well-being. Optimizing the QoL during pregnancy necessitates a deeper understanding of their issues as well as counseling which provides support wherever needed.
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Affiliation(s)
- Amal Boutib
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
| | - Samia Chergaoui
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
| | - Abdelghafour Marfak
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
- National School of Public Health, Rabat, Morocco
| | - Abderraouf Hilali
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
| | - Ibtissam Youlyouz-Marfak
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
- Correspondence: Ibtissam Youlyouz-Marfak, Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, 26000, Morocco, Tel +212 6 61 60 43 58, Fax +212 5 23 40 01 87, Email
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Programming by maternal obesity: a pathway to poor cardiometabolic health in the offspring. Proc Nutr Soc 2022; 81:227-242. [DOI: 10.1017/s0029665122001914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is an ever increasing prevalence of maternal obesity worldwide such that in many populations over half of women enter pregnancy either overweight or obese. This review aims to summarise the impact of maternal obesity on offspring cardiometabolic outcomes. Maternal obesity is associated with increased risk of adverse maternal and pregnancy outcomes. However, beyond this exposure to maternal obesity during development also increases the risk of her offspring developing long-term adverse cardiometabolic outcomes throughout their adult life. Both human studies and those in experimental animal models have shown that maternal obesity can programme increased risk of offspring developing obesity and adipose tissue dysfunction; type 2 diabetes with peripheral insulin resistance and β-cell dysfunction; CVD with impaired cardiac structure and function and hypertension via impaired vascular and kidney function. As female offspring themselves are therefore likely to enter pregnancy with poor cardiometabolic health this can lead to an inter-generational cycle perpetuating the transmission of poor cardiometabolic health across generations. Maternal exercise interventions have the potential to mitigate some of the adverse effects of maternal obesity on offspring health, although further studies into long-term outcomes and how these translate to a clinical context are still required.
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Knudsen SDP, Alomairah SA, Roland CB, Jessen AD, Hergel IM, Clausen TD, Larsen JE, van Hall G, Jensen AK, Molsted S, Bendix JM, Løkkegaard E, Stallknecht B. Effects of Structured Supervised Exercise Training or Motivational Counseling on Pregnant Women's Physical Activity Level: FitMum - Randomized Controlled Trial. J Med Internet Res 2022; 24:e37699. [PMID: 35857356 PMCID: PMC9350815 DOI: 10.2196/37699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/18/2022] [Accepted: 05/31/2022] [Indexed: 02/06/2023] Open
Abstract
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
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Affiliation(s)
- Signe de Place Knudsen
- Department of Gynecology and Obstetrics, Copenhagen University Hospital-North Zealand, Hillerod, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Saud Abdulaziz Alomairah
- Department of Gynecology and Obstetrics, Copenhagen University Hospital-North Zealand, Hillerod, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.,Public Health Department, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
| | - Caroline Borup Roland
- Department of Gynecology and Obstetrics, Copenhagen University Hospital-North Zealand, Hillerod, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Dsane Jessen
- Department of Gynecology and Obstetrics, Copenhagen University Hospital-North Zealand, Hillerod, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ida-Marie Hergel
- Department of Gynecology and Obstetrics, Copenhagen University Hospital-North Zealand, Hillerod, Denmark
| | - Tine D Clausen
- Department of Gynecology and Obstetrics, Copenhagen University Hospital-North Zealand, Hillerod, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Eg Larsen
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Gerrit van Hall
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.,Clinical Biochemistry, Clinical Metabolomics Core Facility, Rigshospitalet, Copenhagen, Denmark
| | - Andreas Kryger Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Research, Copenhagen University Hospital-North Zealand, Hillerod, Denmark
| | - Stig Molsted
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Research, Copenhagen University Hospital-North Zealand, Hillerod, Denmark
| | - Jane M Bendix
- Department of Gynecology and Obstetrics, Copenhagen University Hospital-North Zealand, Hillerod, Denmark.,Department of Clinical Research, Copenhagen University Hospital-North Zealand, Hillerod, Denmark
| | - Ellen Løkkegaard
- Department of Gynecology and Obstetrics, Copenhagen University Hospital-North Zealand, Hillerod, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bente Stallknecht
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Seneviratne SN, Rajindrajith S. Fetal programming of obesity and type 2 diabetes. World J Diabetes 2022; 13:482-497. [PMID: 36051425 PMCID: PMC9329845 DOI: 10.4239/wjd.v13.i7.482] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/18/2021] [Accepted: 06/03/2022] [Indexed: 02/06/2023] Open
Abstract
The prevalence of obesity and type 2 diabetes mellitus has increased rapidly over the past few decades, and prevention efforts have not been successful. Fetal programming involves the earliest stage of obesity development, and provides a novel concept to complement other strategies for lifelong prevention of obesity and type 2 diabetes mellitus. The World Health Organization now advocates a life-course approach to prevent/control obesity, starting with pre-conceptional and antenatal maternal health. Maternal overnutrition, gestational diabetes mellitus and excessive gestational weight gain lead to fetal overgrowth, and “programs” the offspring with an increased risk of obesity and type 2 diabetes mellitus in childhood and adulthood. This review summarizes current data on fetal programming of obesity and type 2 diabetes mellitus including potential causative factors, mechanisms and interventions to reduce its impact.
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Affiliation(s)
| | - Shaman Rajindrajith
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
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Altemani AH, Alzaheb RA. The prevention of gestational diabetes mellitus (The role of lifestyle): a meta-analysis. Diabetol Metab Syndr 2022; 14:83. [PMID: 35706048 PMCID: PMC9199329 DOI: 10.1186/s13098-022-00854-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/05/2022] [Indexed: 11/11/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is the most common complication of pregnancy. The disease is on the rise worldwide with deleterious consequences on the fetus, mother, and children. The study aimed to review the role of lifestyle in the prevention of GDM. We searched PubMed, SCOPUS, Web of Science, Cochrane Library, EBSCO, and Google Scholar from the first published article up to December 2021; articles were eligible if they were controlled trials, prospective cohorts, and case-control. Out of 5559 articles retrieved, 66 full texts were screened, and 19 studies were included in the meta-analysis. (6 studies assessed the effects of diet, and 13 were on exercise). The dietary intervention showed significant positive effect on GDM, odd ratio = 0.69, 95% CI, 0.56-84, P-value for overall effect = 0.002. The DASH diet was better than Mediterranean Diet (odd ratio, 0.71, 95% CI, 68-74, P-value < 0.001). Regarding exercise, no significant prevention was evident on GDM, odd ratio, 0.77, 95% CI, 0.55-1.06, P-value = 0.11. However, a significant prevention of gestational diabetes was found when the exercise was mild-moderate (odd ratio = 0.65, 95% CI, 0.53-80, P < 0.0001) and started in the first trimester (odd ratio, 0.57, 95% CI, 0.43-0.75, P < 0.0001. No significant effect was found when the exercise was vigorous (odd ratio = 1.09, 95% CI, 0.50-2.38, P = 0.83) and started during the second trimester of pregnancy (odd ratio, 1.08, 95% CI, 0.65-1.80, P = 0.77. Diet and early mild-moderate exercise were effective in GDM prevention. Exercise during the second trimester and moderate-vigorous were not. Further studies assessing the type, duration, and frequency of physical activity are needed.
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Affiliation(s)
- Abdullah H Altemani
- Department of Family and Community Medicine, Faculty of Medicine, University of Tabuk, Tabuk, 71491, Saudi Arabia.
| | - Riyadh A Alzaheb
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia
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Physical Activity during Pregnancy and Newborn Body Composition: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127127. [PMID: 35742376 PMCID: PMC9222359 DOI: 10.3390/ijerph19127127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022]
Abstract
The current literature demonstrates that not only is exercise during pregnancy safe, but it has substantial maternal and infant benefits and appears to influence infant growth/size throughout pregnancy and at birth. However, many existing studies have investigated only the effects of prenatal exercise on birth weight. The purpose of this review was to determine the impact or association of maternal physical activity during pregnancy on neonatal body composition assessed between birth and two weeks of age. Electronic database searches were conducted on 29 July 2019 for randomized control trials and cohort studies, with an updated search completed on 8 January 2021. A total of 32 articles that met eligibility criteria were selected for review. Overall, prenatal exercise was not associated with infant body composition at birth. Yet, five of the studies identified suggest that infant body composition could be influenced by higher volumes of mid-to-late term prenatal physical activity. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (Registration No. CRD42020160138).
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Tang Q, Zhong Y, Xu C, Li W, Wang H, Hou Y. Effectiveness of five interventions used for prevention of gestational diabetes: A network meta-analysis. Medicine (Baltimore) 2022; 101:e29126. [PMID: 35475799 PMCID: PMC9276162 DOI: 10.1097/md.0000000000029126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/03/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with short- and long-term health issues for mother and child; preventing these complications is crucially important. This study aimed to perform a systematic review and network meta-analysis of the relationships among 5 interventions used to prevent GDM. MATERIALS AND METHODS A comprehensive literature search was performed to pool evidence from inception to June 30, 2020. The type of studies was confined to randomized control trials and quasi-randomized control trials published in English investigating the interventions for preventing GDM, including physical activity, dietary intervention, probiotic intervention, mixed intervention, and inositol supplementation. The data were pooled together to report the odds ratio (OR) of GDM with a corresponding 95% credible interval (CrI) and generate a network plot, the surface under the cumulative ranking curve plot, and contribution plot. In addition, loop inconsistency was examined, and a funnel plot combined with Egger test was used to measure heterogeneity. RESULTS The network meta-analysis included 46 randomized control trials involving 16,545 patients. Compared with placebo, physical activity (OR: 0.64, 95% CrI: 0.46-0.88) and probiotic intervention (OR: 0.57, 95% CrI: 0.34-0.96) reduced the incidence of GDM significantly. However, dietary intervention, a combination of physical activity and diet intervention, and inositol supplementation did not significantly alter GDM risk. CONCLUSIONS Physical activity and probiotic intervention are more effective than placebo in reducing the risk of developing GDM. Future work should focus on the type, duration, frequency, and timing of physical activity and probiotic intervention.
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Affiliation(s)
- Qiongyao Tang
- Operating Theatre, Haikou Maternal, and Child Health Hospital, Haikou, Hainan, China
| | - Ying Zhong
- Operating Theatre, Haikou Maternal, and Child Health Hospital, Haikou, Hainan, China
| | - Chenyun Xu
- Longhua Outpatient Department, Hainan General Hospital, Haikou, Hainan, China
| | - Wangya Li
- Operating Theatre, Haikou Maternal, and Child Health Hospital, Haikou, Hainan, China
| | - Haiyan Wang
- Operating Theatre, Haikou Maternal, and Child Health Hospital, Haikou, Hainan, China
| | - Yu Hou
- Department of Critical Care Medicine, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, Hainan, China
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Hanley SJ, Sibbick E, Varley I, Sale C, Elliott‐Sale KJ. Exercise Interventions for Weight Management During Pregnancy and up to 1 year Postpartum Among Normal Weight Women and Women with Overweight and Obesity: An Updated Systematic Review. Obes Sci Pract 2022; 8:531-544. [PMID: 36238219 PMCID: PMC9535668 DOI: 10.1002/osp4.597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/20/2022] [Accepted: 01/30/2022] [Indexed: 11/06/2022] Open
Abstract
Background Given the increased occurrence of pre‐gravid obesity in recent years, and the implications of maternal obesity for maternal and offspring health, it is evident that there is a continued need to investigate antenatal and postnatal weight management strategies and to provide evidence‐based advice for exercise‐based interventions. Given the small number of studies (n = 5) included in an original systematic review by our group in 2015, it was important to add to the dataset by assessing data published since 2015, in order to provide a more in‐depth view of current knowledge. Objective To provide an updated systematic review on studies employing exercise interventions for weight management in pregnant and postpartum women. Methods A systematic review of randomised controlled trials evaluating the effects of an exercise intervention on gestational weight gain and postpartum weight management in normal weight women, and women with overweight and obesity was conducted. PubMed, Scopus, Central Register of Controlled Trials and Web of Science were searched for studies published between September 2013 and June 2021. No restrictions were set on type, intensity, duration, or frequency of exercise intervention. Only studies that targeted body weight or mass as a primary outcome were included. Results Thirteen studies were included in this review: 11 during and two following pregnancy. Exercise significantly reduced gestational weight gain in five of the pregnancy studies and induced significant weight loss in one of the postpartum studies. Across studies, there were large disparities in exercise modality, frequency, and duration, although moderate intensity exercise was consistently employed. Conclusions Some studies showed positive effects of exercise on weight management during and following pregnancy. While there is still no consensus on effective exercise intervention approaches, it is crucial that physical activity, of any safe form, is recommended to encourage healthy weight management during this time.
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Affiliation(s)
- Stephanie J. Hanley
- Sport Health and Performance Enhancement Research Centre Nottingham Trent University School of Science and Technology Clifton Campus Clifton LaneNottingham NG11 8NS
| | - Elise Sibbick
- Sport Health and Performance Enhancement Research Centre Nottingham Trent University School of Science and Technology Clifton Campus Clifton LaneNottingham NG11 8NS
| | - Ian Varley
- Sport Health and Performance Enhancement Research Centre Nottingham Trent University School of Science and Technology Clifton Campus Clifton LaneNottingham NG11 8NS
| | - Craig Sale
- Sport Health and Performance Enhancement Research Centre Nottingham Trent University School of Science and Technology Clifton Campus Clifton LaneNottingham NG11 8NS
| | - Kirsty J. Elliott‐Sale
- Sport Health and Performance Enhancement Research Centre Nottingham Trent University School of Science and Technology Clifton Campus Clifton LaneNottingham NG11 8NS
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Effect of aerobic exercise on frequency of vaginal birth: A meta-analysis. VOJNOSANIT PREGL 2022. [DOI: 10.2298/vsp200311080b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. Pregnancy is a state where different morphological and physiological changes occur in a pregnant woman's body. There are many factors that have an effect on maintaining a healthy pregnancy. Physical activity is one of the possible factors that can have an impact on the quality of life during pregnancy. Healthy pregnant women, without medical or obstetric complications, are advised to exercise in a moderate and proper manner. The aim of this meta-analysis was to evaluate the impact of continuous aerobic exercise on the frequency of vaginal birth in healthy pregnant women with normal body mass index (BMI) values. Methods. This meta-analysis was based on a systematic review and selection of randomized clinical trials. The affect of physical exercise was assessed using the "RStudio" programming language and environment. Heterogeneity of studies was assessed by Q statistics. Possible publication bias of studies was identified. The primary outcome analysis was related to the frequency of vaginal birth, while the secondary outcome analysis was related to BMI in the first measurement and total weight gain after the second measurement. The suitability of 10 individual studies is shown by graphical and statistical analysis of the extracted data. Results. Physically active pregnant women who exercised with light to moderate intensity 3 times a week (35?60 minutes), had a more frequent vaginal birth than sedentary pregnant women (67.4% vs. 60.5; relative risk (RR) 1.11, 95% confidence interval (CI), 1.04?1.18). RR was statistically significantly different from unit (p = 0.002). All pregnant women had optimal BMI values in the first measurement before intervention. Also, all pregnant women gained the recommended number of kilograms during pregnancy. Conclusion. Analysis of selected individual studies showed that continuous aerobic physical exercise during the second and third trimesters does not have a negative effect on measured outcome of pregnancy. Physically active pregnant women were more likely to give birth vaginally than sedentary pregnant women.
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Mohsenzadeh-Ledari F, Taghizadeh Z, Motaghi Z, Keramat A, Moosazadeh M, Yazdani S, Najafi A, Ghorbani M. Effect of caring intervention on preeclampsia in pregnant women with metabolic syndrome: A randomized controlled trial. JOURNAL OF NURSING AND MIDWIFERY SCIENCES 2022. [DOI: 10.4103/jnms.jnms_49_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Pascual-Morena C, Cavero-Redondo I, Álvarez-Bueno C, Martínez-Hortelano JA, Reina-Gutiérrez S, Saz-Lara A, Núñez de Arenas-Arroyo S, Martínez-Vizcaíno V. Physical Exercise vs. Metformin to Improve Delivery- and Newborn-Related Outcomes Among Pregnant Women With Overweight: A Network Meta-Analysis. Front Med (Lausanne) 2021; 8:796009. [PMID: 34957166 PMCID: PMC8696129 DOI: 10.3389/fmed.2021.796009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Overweight/obesity is associated with the risk of delivery- and newborn-related complications in pregnancy. Interventions such as exercise or metformin could reduce the risk of these complications. Objective: To estimate and compare the effects of different types of exercise interventions (i.e., aerobic, resistance, combined exercise) and metformin on delivery- and newborn-related outcomes among pregnant women with overweight/obesity. Methods: MEDLINE, Scopus, Web of Science, Cochrane Library databases and the gray literature were searched from inception to September 2021. This systematic review was registered in PROSPERO (CDR: 42019121715). Randomized controlled trials (RCTs) of metformin or an exercise intervention aimed at preventing cesarean section, preterm birth, macrosomia, or birth weight among pregnant women with overweight/obesity were included. Random effects meta-analyses and frequentist network meta-analyses (NMA) were conducted for each outcome. Results: Fifteen RCTs were included. In the NMA, metformin reduced the risk of cesarean section (RR = 0.66, 95% CI: 0.46, 0.95), combined exercise reduced the risk of macrosomia (RR = 0.37, 95% CI: 0.14, 0.95), and aerobic exercise reduced birth weight (mean difference = -96.66 g, 95% CI: -192.45, -0.88). In the subgroup among pregnant women with obesity, metformin reduced the risk of cesarean section (RR = 0.66, 95% CI: 0.45, 0.97). Conclusions: Combined exercise could reduce the risk of macrosomia in pregnant women with overweight, whereas metformin could reduce the risk of cesarean section in pregnant women with obesity. However, previous evidence suggests a larger effect of physical exercise in other outcomes for this population group. Therefore, the medicalization of healthy pregnant women with obesity is not justified by the current evidence. Systematic Review Registration: PROSPERO: CRD42019121715; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019121715.
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Affiliation(s)
| | - Iván Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla—La Mancha, Cuenca, Spain
- Rehabilitation in Health Research Center (CIRES), Universidad de las Américas, Santiago, Chile
| | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla—La Mancha, Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | - José Alberto Martínez-Hortelano
- Health and Social Research Center, Universidad de Castilla—La Mancha, Cuenca, Spain
- Guadalajara University Hospital, Health Service of Castilla-La Mancha (SESCAM), Guadalajara, Spain
| | - Sara Reina-Gutiérrez
- Health and Social Research Center, Universidad de Castilla—La Mancha, Cuenca, Spain
| | - Alicia Saz-Lara
- Health and Social Research Center, Universidad de Castilla—La Mancha, Cuenca, Spain
| | | | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla—La Mancha, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
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Harris RG, Batterham M, Neale EP, Ferreira I. Impact of missing outcome data in meta-analyses of lifestyle interventions during pregnancy to reduce postpartum weight retention: An overview of systematic reviews with meta-analyses and additional sensitivity analyses. Obes Rev 2021; 22:e13318. [PMID: 34477276 DOI: 10.1111/obr.13318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/20/2021] [Accepted: 06/22/2021] [Indexed: 12/01/2022]
Abstract
High risk of bias associated with missing outcome data (MOD) in meta-analyses (MAs) of the effects of lifestyle interventions during pregnancy on postpartum weight retention (PPWR) casts doubt on whether such interventions can be relied upon as truly effective. This systematic overview of three MAs (19 RCTs), each with high MOD rates in the subset of RCTs included, examined how MOD were addressed in the estimation of summary intervention effects. All MAs reported beneficial and statistically significant intervention effects estimated based on complete case analyses, deemed valid if MOD was missing at random (MAR). Therefore, we conducted sensitivity analyses using pattern mixture models and informative missingness parameters (describing how the outcome in the missing participants may be related to the outcome in the completers), to ascertain the robustness of the estimates to reasonable deviations from the MAR assumption. In plausible scenarios where the response in intervention group participants with versus without MOD was worse (by just 0.5 kg), effect estimates were attenuated in all MAs and no longer statistically significant in two MAs. Statistical significance was retained when all 19 RCTs identified across MAs were examined together in a broader meta-analysis: -0.63 kg (95%CI -0.17, -0.08), but the clinical relevancy of effects of this magnitude remains unclear.
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Affiliation(s)
- Rebecca G Harris
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Marijka Batterham
- School of Mathematics and Applied Statistics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Elizabeth P Neale
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Isabel Ferreira
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Public Health Department, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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Kubler JM, Clifton VL, Moholdt T, Beetham KS. The effects of exercise during pregnancy on placental composition: A systematic review and meta-analysis. Placenta 2021; 117:39-46. [PMID: 34768167 DOI: 10.1016/j.placenta.2021.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/14/2021] [Accepted: 10/13/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Morphological changes to the placenta occur as the demands of the foetus increase throughout gestation. Physical activity during pregnancy is known to benefit both the mother and infant, however the impact of antenatal exercise training on placental development is less known. The aim of this systematic review and meta-analysis was to investigate the effects of exercise training during pregnancy on measures of placental composition. METHODS Six electronic databases were searched from inception to June 2021 for studies comparing regular antenatal exercise with either usual maternal care or no exercise for its effect on measures of placental morphological composition. Meta-analyses were performed for placental weight and the placental weight to birthweight (PWBW) ratio. RESULTS Seven randomised controlled trials and two cohort studies were included in the systematic review and meta-analysis (n = 9). There was no significant difference in placental weight (mean difference (MD) = -9.07g, p = 0.42) or the PWBW ratio (MD = 0.00, p = 0.32) between exercise and control groups. Parenchymal tissue volume was higher, represented by an increase in villous tissue, and non-parenchymal volume was lower in women who exercised regularly compared to those that were not exercising during pregnancy. DISCUSSION Exercise training during pregnancy may not alter placental weight or the PWBW ratio. However, findings from this review indicate that antenatal exercise training can promote advantageous morphological changes to placental tissues.
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Affiliation(s)
- Jade M Kubler
- Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Vicki L Clifton
- Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Women's Clinic, St. Olavs University Hospital, Trondheim, Norway
| | - Kassia S Beetham
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Australia.
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Pascual-Morena C, Cavero-Redondo I, Álvarez-Bueno C, Lucerón-Lucas-Torres M, Sanabria-Martínez G, Poyatos-León R, Rodríguez-Martín B, Martínez-Vizcaíno V. Exercise versus Metformin to Improve Pregnancy Outcomes among Overweight Pregnant Women: A Systematic Review and Network Meta-Analysis. J Clin Med 2021; 10:jcm10163490. [PMID: 34441786 PMCID: PMC8397096 DOI: 10.3390/jcm10163490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/16/2022] Open
Abstract
Being overweight is associated with pregnancy-related disorders such as gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), and excessive maternal weight gain (MWG). Exercise and metformin reduce the risk of these disorders. This network meta-analysis (NMA) aims to compare the effect of metformin and different types of exercise (aerobic, resistance and combined) on the risk of GDM, HDP, and MWG among overweight/obese pregnant women. Medline, EMBASE, Web of Science and Cochrane Library were searched from inception to June 2021. Meta-analyses and NMAs were performed. Sixteen randomized controlled trials were included. In the NMA, aerobic exercise showed an effect on GDM (RR = 0.51, 95% CI = 0.26, 0.97), and metformin a reduction in MWG (MWG = -2.93 kg, 95% CI = -4.98, -0.87). No intervention showed any effect on the reduction of HDP. Our study suggests that aerobic exercise may have the greatest effect in reducing the risk of GDM, and perhaps, the MWG. Strategies should be developed to increase adherence to this type of intervention among overweight women without contraindications. Although metformin could reduce MWG, medicalization of pregnancy in healthy women is not justified with the present results. More research is needed on the effect of the intensity and frequency of exercise sessions and the length of interventions.
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Affiliation(s)
- Carlos Pascual-Morena
- Health and Social Research Center, Universidad de Castilla—La Mancha, 16071 Cuenca, Spain; (C.P.-M.); (C.Á.-B.); (M.L.-L.-T.); (G.S.-M.); (R.P.-L.); (B.R.-M.); (V.M.-V.)
| | - Iván Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla—La Mancha, 16071 Cuenca, Spain; (C.P.-M.); (C.Á.-B.); (M.L.-L.-T.); (G.S.-M.); (R.P.-L.); (B.R.-M.); (V.M.-V.)
- Rehabilitation in Health Research Center (CIRES), Universidad de las Américas, Santiago 72819, Chile
- Correspondence:
| | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla—La Mancha, 16071 Cuenca, Spain; (C.P.-M.); (C.Á.-B.); (M.L.-L.-T.); (G.S.-M.); (R.P.-L.); (B.R.-M.); (V.M.-V.)
- Universidad Politécnica y Artística del Paraguay, Asunción 001518, Paraguay
| | - Maribel Lucerón-Lucas-Torres
- Health and Social Research Center, Universidad de Castilla—La Mancha, 16071 Cuenca, Spain; (C.P.-M.); (C.Á.-B.); (M.L.-L.-T.); (G.S.-M.); (R.P.-L.); (B.R.-M.); (V.M.-V.)
| | - Gema Sanabria-Martínez
- Health and Social Research Center, Universidad de Castilla—La Mancha, 16071 Cuenca, Spain; (C.P.-M.); (C.Á.-B.); (M.L.-L.-T.); (G.S.-M.); (R.P.-L.); (B.R.-M.); (V.M.-V.)
| | - Raquel Poyatos-León
- Health and Social Research Center, Universidad de Castilla—La Mancha, 16071 Cuenca, Spain; (C.P.-M.); (C.Á.-B.); (M.L.-L.-T.); (G.S.-M.); (R.P.-L.); (B.R.-M.); (V.M.-V.)
| | - Beatriz Rodríguez-Martín
- Health and Social Research Center, Universidad de Castilla—La Mancha, 16071 Cuenca, Spain; (C.P.-M.); (C.Á.-B.); (M.L.-L.-T.); (G.S.-M.); (R.P.-L.); (B.R.-M.); (V.M.-V.)
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla—La Mancha, 16071 Cuenca, Spain; (C.P.-M.); (C.Á.-B.); (M.L.-L.-T.); (G.S.-M.); (R.P.-L.); (B.R.-M.); (V.M.-V.)
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca 3460000, Chile
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Fazzi C, Denison FC, Saunders DH, Norman JE, Reynolds RM. Options in Pregnancy to Increase ActiveLy Sitting (OPALS) Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5673. [PMID: 34073151 PMCID: PMC8197813 DOI: 10.3390/ijerph18115673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND A negative association between obesity and pregnancy outcomes has been described, as well as between time sedentary and pregnancy outcomes. Most interventions based on physical activity involving obese pregnant women have failed in improving pregnancy outcomes. Exchanging time spent in sedentary activities with time spent in light-intensity activities, performed in a home-based setting, might help morbidly obese pregnant women. We aimed to assess the feasibility of an exercise intervention. METHODS An exercise intervention for morbidly obese pregnant women was designed involving morbidly obese pregnant women. Pregnant women with BMI ≥ 40 kg/m² with 20 or less weeks of gestation were invited to take part in the OPALS Feasibility Study. A home-based approach was employed. Participants were asked to perform the intervention for at least 12 weeks, and to register their performance in an activity diary. After the intervention, participants were asked to return the activity diary and answer a feasibility questionnaire. RESULTS In the intervention, 28 participants took part. Six women completed the intervention for 12 weeks or more. All declared they intended to keep on doing the intervention. All women reported that the exercises made them feel better. CONCLUSION Empowering, and involving morbidly obese pregnant women in taking care of themselves and giving them realistic tasks to do on their own and around their environment helps to increase commitment, as does avoiding the effect of their own weight whilst exercising. A 20% of compliance was observed in this study, which might be explained by the difficulties that pregnancy and excess weight mean. Thus, for future studies, we suggest adding a supervision plan to increase that number.
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Affiliation(s)
- Caterina Fazzi
- Tommy’s Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK; (C.F.); (F.C.D.)
- Department of Physical Education, Sports and Recreation, Metropolitan University of Educational Sciences, Santiago 7760197, Chile
| | - Fiona C. Denison
- Tommy’s Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK; (C.F.); (F.C.D.)
| | - David H. Saunders
- Physical Activity for Health Research Centre (PAHRC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh EH8 8AQ, UK;
| | - Jane E. Norman
- Health Sciences Faculty Office, University of Bristol, Bristol BS8 1UD, UK;
| | - Rebecca M. Reynolds
- Tommy’s Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK; (C.F.); (F.C.D.)
- The British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH8 8AQ, UK
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Cantor AG, Jungbauer RM, McDonagh M, Blazina I, Marshall NE, Weeks C, Fu R, LeBlanc ES, Chou R. Counseling and Behavioral Interventions for Healthy Weight and Weight Gain in Pregnancy: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2021; 325:2094-2109. [PMID: 34032824 DOI: 10.1001/jama.2021.4230] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Counseling and active behavioral interventions to limit excess gestational weight gain (GWG) during pregnancy may improve health outcomes for women and infants. The 2009 National Academy of Medicine (NAM; formerly the Institute of Medicine) recommendations for healthy GWG vary according to prepregnancy weight category. OBJECTIVE To review and synthesize the evidence on benefits and harms of behavioral interventions to promote healthy weight gain during pregnancy to inform the US Preventive Services Task Force recommendation. DATA SOURCES Ovid MEDLINE and the Cochrane Library to March 2020, with surveillance through February 2021. STUDY SELECTION Randomized clinical trials and nonrandomized controlled intervention studies focused on diet, exercise, and/or behavioral counseling interventions on GWG. DATA EXTRACTION AND SYNTHESIS Independent data abstraction and study quality rating with dual review. MAIN OUTCOMES AND MEASURES Gestational weight-related outcomes; maternal and infant morbidity and mortality; harms. RESULTS Sixty-eight studies (N = 25 789) were included. Sixty-seven studies evaluated interventions during pregnancy, and 1 evaluated an intervention prior to pregnancy. GWG interventions were associated with reductions in risk of gestational diabetes (43 trials, n = 19 752; relative risk [RR], 0.87 [95% CI, 0.79 to 0.95]; absolute risk difference [ARD], -1.6%) and emergency cesarean delivery (14 trials, n = 7520; RR, 0.85 [95% CI, 0.74 to 0.96]; ARD, -2.4%). There was no significant association between GWG interventions and risk of gestational hypertension, cesarean delivery, or preeclampsia. GWG interventions were associated with decreased risk of macrosomia (25 trials, n = 13 990; RR, 0.77 [95% CI, 0.65 to 0.92]; ARD, -1.9%) and large for gestational age (26 trials, n = 13 000; RR, 0.89 [95% CI, 0.80 to 0.99]; ARD, -1.3%) but were not associated with preterm birth. Intervention participants experienced reduced weight gain across all prepregnancy weight categories (55 trials, n = 20 090; pooled mean difference, -1.02 kg [95% CI, -1.30 to -0.75]) and demonstrated lower likelihood of GWG in excess of NAM recommendations (39 trials, n = 14 271; RR, 0.83 [95% CI, 0.77 to 0.89]; ARD, -7.6%). GWG interventions were associated with reduced postpartum weight retention at 12 months (10 trials, n = 3957; mean difference, -0.63 kg [95% CI, -1.44 to -0.01]). Data on harms were limited. CONCLUSIONS AND RELEVANCE Counseling and active behavioral interventions to limit GWG were associated with decreased risk of gestational diabetes, emergency cesarean delivery, macrosomia, and large for gestational age. GWG interventions were also associated with modest reductions in mean GWG and decreased likelihood of exceeding NAM recommendations for GWG.
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Affiliation(s)
- Amy G Cantor
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
- Department of Family Medicine, Oregon Health & Science University, Portland
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Rebecca M Jungbauer
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Marian McDonagh
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Ian Blazina
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Nicole E Marshall
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Chandler Weeks
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Rongwei Fu
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
- School of Public Health, Oregon Health & Science University-Portland State University
| | - Erin S LeBlanc
- Kaiser Permanente, Center for Health Research, Portland, Oregon
| | - Roger Chou
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
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Díaz-Burrueco JR, Cano-Ibáñez N, Martín-Peláez S, Khan KS, Amezcua-Prieto C. Effects on the maternal-fetal health outcomes of various physical activity types in healthy pregnant women. A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 262:203-215. [PMID: 34058612 DOI: 10.1016/j.ejogrb.2021.05.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 05/11/2021] [Accepted: 05/16/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Physical activity (PA) promotes health in pregnancy. OBJECTIVE To collate the recent randomized controlled trial (RCT) on the effects of various types of PA during pregnancy on maternal-fetal health outcomes, among healthy mothers, and to report the variability in the outcomes reported. SEARCH STRATEGY Registered in PROSPERO (CRD42019143522). Systematic search conducted in EMBASE, CENTRAL, MEDLINE and CINAHL, from 2015-2020. SELECTION CRITERIA RCT examining PA interventions and maternal-fetal outcomes. DATA COLLECTION AND ANALYSIS Were independently extracted by two reviewers. Quality of studies was assessed with Cochrane Collaboration's risk of bias tool. RESULTS 37 studies (6857 women) were included. PA had a protective effect on gestational weight gain (overall SMD -0.32, 95 % CI -0.46, -0.17, I2 77 %; supervised exercise SMD -0.15, 95 % CI -0.28, -0.02, I2 51 %; static cycling SMD -0.32, 95 % CI -0.59, -0.05; I2 49 %), gestational diabetes (overall OR 0.65, 95 % CI: 0.43, 0.98, I2 48 %), and hypertensive disorders (overall OR 0.51, 95 % CI: 0.31, 0.83, I2 0%). CONCLUSIONS PA in pregnancy had a preventive effect on weight gain, gestational diabetes, and hypertensive disorders. Supervised exercise and static cycling had a protective effect on gestational weight gain. Variation in outcomes reported suggest establishing a core outcome set.
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Affiliation(s)
- Javier Ramón Díaz-Burrueco
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain
| | - Naomi Cano-Ibáñez
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain; CIBER de Epidemiología y Salud Pública, (CIBERESP), Granada, Spain; Instituto de Investigación Biosanitaria ibs, GRANADA, Granada, Spain.
| | - Sandra Martín-Peláez
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria ibs, GRANADA, Granada, Spain
| | - Khalid S Khan
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain; CIBER de Epidemiología y Salud Pública, (CIBERESP), Granada, Spain
| | - Carmen Amezcua-Prieto
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain; CIBER de Epidemiología y Salud Pública, (CIBERESP), Granada, Spain; Instituto de Investigación Biosanitaria ibs, GRANADA, Granada, Spain
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Aung W, Saw L, Sweet L. An integrative review of interventions for limiting gestational weight gain in pregnant women who are overweight or obese. Women Birth 2021; 35:108-126. [PMID: 33958291 DOI: 10.1016/j.wombi.2021.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
PROBLEM Excessive gestational weight gain in women who are overweight or obese puts them at risk of poor short- and long-term outcomes for maternal and neonatal health. Several interventions have been trialled to encourage women who are overweight or obese to limit gestational weight gain during pregnancy. AIM The aim of this review was to analyse the evidence on interventions to limit gestational weight gain in pregnant women who are overweight or obese. METHOD An integrative review guided by the Joanna Briggs Institute approach was conducted. An unlabeled search query of pregnancy, weight, and obesity was conducted in Medline, Scopus and CINAHL, limited to English language, 2010-2020 publications, and primary research on humans. Unlabeled search query of "((pregnancy outcome) OR (prenatal care) OR (pregnancy complications)) AND ((weight loss) OR (weight gain) OR (weight management)) AND (obesity) was used. Additional 9 records were identified through reference lists. Following a critical appraisal, 21 primary research articles were included in this review. A thematic synthesis was undertaken. FINDINGS Four major themes were identified. These are (1) mixed findings of lifestyle interventions for weight management, (2) ineffectiveness of probiotics or metformin for weight management, (3) psycho-behavioural interventions for weight management, and (4) midwifery role as an integral component in multidisciplinary intervention for weight management. CONCLUSION The literature suggests a need for longer duration of behavioural lifestyle intervention sessions led by the same midwife trained in motivational interviewing to limit weight gain in pregnant women who are overweight or obese.
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Affiliation(s)
- Wintnie Aung
- College of Medicine and Public Health, Flinders University, Australia
| | - Lauren Saw
- College of Medicine and Public Health, Flinders University, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University, Australia; Centre for Quality and Patient Safety Research, Western Health Partnership, Australia.
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Muhammad HFL, Pramono A, Rahman MN. The safety and efficacy of supervised exercise on pregnant women with overweight/obesity: A systematic review and meta-analysis of randomized controlled trials. Clin Obes 2021; 11:e12428. [PMID: 33167074 DOI: 10.1111/cob.12428] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/13/2020] [Accepted: 10/25/2020] [Indexed: 11/26/2022]
Abstract
Behavioural modification through physical activity and dietary counselling has been shown to have beneficial effects on pregnant women with overweight/obesity. Whether exercise alone with supervision (ie, supervised exercise) may also benefit for pregnant women with overweight/obesity is still unknown. This systematic review and meta-analysis aimed to determine the safety and efficacy of supervised exercise on pregnant women with overweight/obesity. PubMed, Cochrane library, Embase (Ovid), CINAHL (EBSCO), and Web of Science were used to search publications using a combination of main keywords "obesity", "exercise", "pregnant women", and "randomised controlled trial". From a total of 740 publications, 11 randomized controlled trials were included. All studies reported no adverse effects of supervised exercise on pregnant women with overweight/obesity. Of interest, this meta-analysis showed gestational weight gain (GWG) was lower in the supervised exercise group as compared to control (Mean difference 0.88 kg, 95%CI -1.73 to -0.03, P = .04). There was a significant effect of supervised exercise on post-prandial blood glucose (MD: -0.24, 95%CI -0.47 to -0.01, P = .04) and insulin resistance (HOMA-IR) (MD: -0.18, 95%CI -0.30 to -0.05, P = .005). There were no differences in risk of gestational diabetes mellitus, pre-eclampsia/gestational hypertension, and newborn outcomes (eg, infants birth weight, preterm birth incident, and gestational age) (all P > .05). This meta-analysis might suggest beneficial effects of supervised exercise on pregnant women with overweight/obesity to prevent excessive GWG, attenuates insulin resistance, and the post-prandial blood glucose level.
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Affiliation(s)
| | - Adriyan Pramono
- Department of Nutrition Science, Faculty of Medicine, Universitas Diponegoro, Central Java, Semarang, Indonesia
| | - Muhammad Nurhadi Rahman
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Roland CB, Knudsen SDP, Alomairah SA, Andersen AD, Bendix J, Clausen TD, Molsted S, Jensen AK, Teilmann G, Jespersen AP, Larsen JE, Hall GV, Andersen E, Barrès R, Mortensen OH, Maindal HT, Tarnow L, Løkkegaard ECL, Stallknecht B. Structured supervised exercise training or motivational counselling during pregnancy on physical activity level and health of mother and offspring: FitMum study protocol. BMJ Open 2021; 11:e043671. [PMID: 33741668 PMCID: PMC7986889 DOI: 10.1136/bmjopen-2020-043671] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/30/2020] [Accepted: 02/25/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION A physically active lifestyle during pregnancy improves maternal and offspring health but can be difficult to follow. In Denmark, less than 40% of pregnant women meet physical activity (PA) recommendations. The FitMum study aims to explore strategies to increase PA during pregnancy among women with low PA and assess the health effects of PA. This paper presents the FitMum protocol, which evaluates the effects of structured supervised exercise training or motivational counselling supported by health technology during pregnancy on PA level and health of mother and offspring. METHODS AND ANALYSIS A single-site three-arm randomised controlled trial that aims to recruit 220 healthy, pregnant women with gestational age (GA) no later than week 15 and whose PA level does not exceed one hour/week. Participants are randomised to one of three groups: structured supervised exercise training consisting of three weekly exercise sessions, motivational counselling supported by health technology or a control group receiving standard care. The interventions take place from randomisation until delivery. The primary outcome is min/week of moderate-to-vigorous intensity PA (MVPA) as determined by a commercial activity tracker, collected from randomisation until GA of 28 weeks and 0-6 days, and the secondary outcome is gestational weight gain (GWG). Additional outcomes are complementary measures of PA; clinical and psychological health parameters in participant, partner and offspring; analyses of blood, placenta and breastmilk samples; process evaluation of interventions; and personal understandings of PA. ETHICS AND DISSEMINATION The study is approved by the Danish National Committee on Health Research Ethics (# H-18011067) and the Danish Data Protection Agency (# P-2019-512). Findings will be disseminated via peer-reviewed publications, at conferences, and to health professionals via science theatre performances. TRIAL REGISTRATION NUMBER NCT03679130. PROTOCOL VERSION This paper was written per the study protocol version 8 dated 28 August 2019.
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Affiliation(s)
- Caroline Borup Roland
- Department of Biomedical Sciences, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
| | - Signe de Place Knudsen
- Department of Biomedical Sciences, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
| | - Saud Abdulaziz Alomairah
- Department of Biomedical Sciences, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Public Health, Saudi Electronic University, Riyadh, Saudi Arabia
| | - Anne Dsane Andersen
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
| | - Jane Bendix
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
| | - Tine D Clausen
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Stig Molsted
- Department of Clinical Research, Nordsjaellands Hospital, Hillerod, Denmark
| | - Andreas Kryger Jensen
- Department of Clinical Research, Nordsjaellands Hospital, Hillerod, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Grete Teilmann
- Department of Paediatrics, Nordsjaellands Hospital, Hillerod, Denmark
| | - Astrid Pernille Jespersen
- The Saxo Institute, University of Copenhagen, Centre for Health Research in the Humanities, Copenhagen, Denmark
| | - Jakob Eg Larsen
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark
| | - Gerrit van Hall
- Department of Biomedical Sciences, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Clinical Metabolomics Core Facility, Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Emil Andersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Romain Barrès
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Ole Hartvig Mortensen
- Department of Biomedical Sciences, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Helle Terkildsen Maindal
- Department of Public Health, Aarhus Universitet, Aarhus, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Lise Tarnow
- Steno Diabetes Center Copenhagen, Holbaek, Denmark
| | - Ellen Christine Leth Løkkegaard
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Bente Stallknecht
- Department of Biomedical Sciences, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
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Maternal Physical Activity During Pregnancy and the Effect on the Mother and Newborn: A Systematic Review. J Phys Act Health 2020; 18:130-147. [PMID: 33361475 DOI: 10.1123/jpah.2019-0348] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/29/2020] [Accepted: 10/16/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The practice of physical exercise during pregnancy has benefits for both the mother and baby. Currently, there is scientific evidence that supports the inclusion of a monitored physical activity program in the daily activities of pregnant women. The objective of this study is to provide an overview of the current status of the association between physical activity during pregnancy and the effects on the mother and the newborn. METHODS A systematic review of the literature, assessing each study using the Scottish Intercollegiate Guidelines Network, from different databases PubMed, Embase, or ScienceDirect, on the association between maternal physical activity and its effects on the mother and the newborn published from 2010 until 2018 was conducted. RESULTS About 25 studies were identified and divided into categories according to the health problems affecting the mother or newborn. It was found that 8% of all the studies received a grade B, 68% obtained a grade C, and the remaining 24% obtained less than a grade C. Improved cardiovascular function, decreased risk of gestational diabetes mellitus, hypertension, and the limitation of weight gain are among the benefits to the mother with lower percentage of body fat, increased gestational age, and potentially improved neurodevelopment as benefits for the child. CONCLUSIONS The realization of physical activity during pregnancy is supported by most of the studies reviewed. However, given the vulnerability of the studied populations, more studies on the association between physical activity and pregnancy are necessary.
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Cai C, Ruchat SM, Sivak A, Davenport MH. Prenatal Exercise and Cardiorespiratory Health and Fitness: A Meta-analysis. Med Sci Sports Exerc 2020; 52:1538-1548. [PMID: 31977635 DOI: 10.1249/mss.0000000000002279] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE This study aimed to examine the influence of prenatal exercise on maternal cardiorespiratory health and fitness during pregnancy. METHODS Online databases were searched up to February 25, 2019. Studies of randomized controlled trials (RCTs) were eligible, which contained information on the relevant population (pregnant women), intervention (subjective or objective measures of frequency, intensity, duration, volume, or type of exercise), comparator (no exercise intervention), and outcomes (maternal cardiorespiratory fitness, including V˙O2max, submaximal V˙O2, V˙O2 at anaerobic threshold, and cardiorespiratory health, including resting heart rate, and resting systolic and diastolic blood pressures during pregnancy). RESULTS From 2699 unique citations, 26 RCTs (N = 2292 women) were included. Of these, one study reported measured V˙O2max, seven reported predicted V˙O2max, three reported submaximal V˙O2, and two studies reported VO2AT. "Low"- to "high"-certainty evidence revealed that exercise was associated with improved predicted/measured V˙O2max (5 RCTs, n = 430; mean difference [MD], 2.77 mL·kg·min; 95% confidence interval [CI], 0.32 to 5.21 mL·kg·min; I = 69%), reduced resting heart rate (9 RCTs, n = 637; MD, -1.71 bpm; 95% CI, -3.24 to -0.19 bpm; I = 13%), resting systolic blood pressure (16 RCTs, n = 1672; MD, -2.11 mm Hg; 95% CI, -3.71 to -0.51 mm Hg; I = 69%), and diastolic blood pressure (15 RCTs, n = 1624; MD, -1.77 mm Hg; 95% CI, -2.90 to -0.64 mm Hg; I = 60%). CONCLUSION Prenatal exercise interventions improve maternal predicted/measured V˙O2max and reduce resting heart rate and blood pressure. This review highlights the need for additional high-quality studies of cardiorespiratory fitness (namely, V˙O2max and V˙O2 peak) in pregnancy.PROSPERO registration number: CRD42019131249.
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Affiliation(s)
| | - Stephanie-May Ruchat
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, CANADA
| | - Allison Sivak
- H.T. Coutts Education and Physical Education Library, University of Alberta, Edmonton, Alberta, CANADA
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Doi SAR, Furuya-Kanamori L, Toft E, Musa OAH, Mohamed AM, Clark J, Thalib L. Physical activity in pregnancy prevents gestational diabetes: A meta-analysis. Diabetes Res Clin Pract 2020; 168:108371. [PMID: 32827593 DOI: 10.1016/j.diabres.2020.108371] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/15/2020] [Accepted: 08/10/2020] [Indexed: 01/30/2023]
Abstract
AIMS The effectiveness of physical activity (PA) programs for prevention of gestational diabetes (GDM) lacks conclusive evidence. The aim of this study was to generate clear evidence regarding the effectiveness of physical activity programs in GDM prevention to guide clinical practice. METHODS PubMed/Medline, ISI Web of Science, Scopus, and EMBASE were searched to identify the randomized trials (RCTs) published until June 2019. Randomised controlled trials enrolling women at high risk before the 20th week of gestation comparing the effect of PA interventions with usual care for prevention of GDM were retrieved. Data obtained were synthesised using a bias-adjusted model of meta-analysis. RESULTS A total of 1467 adult women in 11 eligible trials were included. The risk of GDM was significantly lower with PA, but only when it was delivered in the healthcare facility (RR 0.53; 95% CI 0.38-0.74). The number needed to treat with PA in pregnancy (compared to usual care) to prevent one GDM event was 18 (95% CI 14 - 29). The overall effect of PA interventions regardless of location of the intervention was RR 0.69 (95% CI 0.51 - 0.94). CONCLUSIONS This study provides evidence that in-facility physical activity programs started before the 20th week of gestation can significantly decrease the incidence of GDM among women at high risk.
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Affiliation(s)
- Suhail A R Doi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar.
| | - Luis Furuya-Kanamori
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar; Research School of Population Health, Australian National University, Canberra, Australia
| | - Egon Toft
- Deans Office, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Omran A H Musa
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Aisha M Mohamed
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Justin Clark
- The Centre for Research into Evidence Based Practice, Bond University, Gold Coast, Australia
| | - Lukman Thalib
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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Moholdt T, Hawley JA. Maternal Lifestyle Interventions: Targeting Preconception Health. Trends Endocrinol Metab 2020; 31:561-569. [PMID: 32284283 DOI: 10.1016/j.tem.2020.03.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/17/2020] [Accepted: 03/06/2020] [Indexed: 12/13/2022]
Abstract
About one-third of women of reproductive age are obese, predisposing both mother and baby to unfavourable pregnancy outcomes and initiating an intergenerational cycle of chronic metabolic disorders. Here we summarise recent research on the influence of maternal metabolic health on offspring susceptibility to future cardiometabolic diseases. Current primary lifestyle approaches (i.e., diet and exercise interventions) to halt the succession of inherited and epigenetic metabolic abnormalities have met with limited success due to late implementation, poor adherence, and/or generic guidelines. In our opinion, such interventions must commence prior to conception to improve both maternal and child health outcomes, with new approaches urgently needed to increase adherence to primary lifestyle changes among reproductive-age women.
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Affiliation(s)
- Trine Moholdt
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Department of Gynaecology and Obstetrics, St Olav's Hospital, Trondheim, Norway.
| | - John A Hawley
- Exercise and Nutrition Research Programme, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia
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