How does a lifestyle intervention during pregnancy influence perceived barriers to leisure-time physical activity? The Norwegian fit for delivery study, a randomized controlled trial

A review of the behaviour change techniques used in physical activity promotion or maintenance interventions in pregnant women

BACKGROUND

The proportion of women meeting the recommended physical activity requirement is low. Evidence suggests behaviour change techniques (BCTs) can be effective in initiating and maintaining behaviour change and improving physical activity.

PURPOSE

To synthesise the evidence related to the attributes of BCT-based physical activity interventions targeted at pregnant women.

METHODS

A systematic search of studies was made. Randomised controlled trials aiming to improve or maintain physical activity in pregnant women were included. Trials were categorised into 'very promising', 'quite promising', or 'non-promising' according to the intervention effectiveness. One-way analysis of variance was used to determine the difference in mean BCTs implemented in promising/ non-promising studies.

FINDINGS

A total of 18,966 studies were identified and 10 studies were included. 'Problem solving', 'social support (unspecified)', 'graded tasks', 'goal setting (behaviour)', 'instruction on how to perform a behaviour', 'self-monitoring of behaviour', 'demonstration of the behaviour', and 'action planning' were rated as promising BCTs.

DISCUSSION

Specific types of BCTs might be associated with physical activity promotion or maintenance during pregnancy. More high-quality randomised controlled trials investigating the effectiveness of individual or combinations of BCTs on physical activity in pregnant women are needed.

Physical activity and pregnancy outcomes: an expert review

This expert review aimed to assess current literature on the effect and tracking of physical activity during pregnancy and associated outcomes. Self-reported physical activity may be inaccurate given the subjective nature of the questionnaires. The accelerometer ActiGraph is considered the "gold standard" to objectively measure physical activity. However, other more user-friendly wearable devices are now widely available and may accurately track physical activity. Conclusive data from both validated activity questionnaires and accelerometers indicate that physical activity is safe during pregnancy. In addition, studies of physical activity during pregnancy that evaluate pregnancy outcomes have found reduced risks of preterm birth, preeclampsia, and gestational diabetes mellitus and improved mental health among individuals who regularly engage in physical activity. In the United States, approximately 48% of pregnant individuals gain more than the recommended amount of weight during pregnancy; excessive gestational weight gain is associated with an increased risk of maternal and fetal complications, including preterm birth, preeclampsia, and gestational diabetes mellitus, and corresponding higher adverse short- and long-term maternal and offspring health outcomes. Although physical activity is safe during pregnancy and may reduce excessive gestational weight gain and resultant pregnancy complications, further research is needed to determine the frequency and duration of specific types of physical activity during pregnancy. Providers should encourage physical activity before and during pregnancy and educate patients regarding the benefits and safety of physical activity.

Physical activity during pregnancy and its effects on neonatal outcomes

INTRODUCTION

Despite the acknowledgement that physical activity is beneficial during pregnancy and may result in positive health outcomes for the newborn child few studies have examined this issue. This research was deemed necessary with the primary objective of identifying possible associations between adherence to American College of Sports Medicine recommendations on neonatal outcome variables at birth.

METHODS

An observational, longitudinal and prospective study focused on a sample of 70 pregnant women (the power score achieved was estimated to be 0.3). Data was collected in three stages (1st and 2nd trimester of pregnancy and 48 h after delivery). The variables analyzed included the physical activity measurement (with accelerometry), neonatal outcomes at birth and the mother's anxiety, dietary intake, anthropometric measures and socio-demographic and lifestyle.

RESULTS

21.4% women were active according to physical activity recommendations. There were no significant differences in neonatal outcomes at birth when comparing adherence to physical activity recommendations and the overall activity levels of the mothers. There were also no statistically significant differences in the birth weights of babies born to active and inactive mothers. Mother's anxiety level, weight gained and dietary intake were not statistically different according to compliance with physical activity behaviour or recommendations.

DISCUSSION

There is no relationship between adherence to physical activity recommendations on neonatal outcome variables at birth. There were also no significant associations with sociodemographic and lifestyle variables. There is a need to identify attitudes associated with negative physical activity behavior to reduce the incidence of comorbidities associated with sedentary lifestyles during pregnancy.

Three short postmeal walks as an alternate therapy to continuous walking for women with gestational diabetes

The purpose of this study was to determine whether postmeal walking (breaking up exercise into short bouts after meals) is an effective and feasible alternate to continuous walking for the management of gestational diabetes. Forty-one women with gestational diabetes were randomised between wk 28-30 gestation to either standard-care (30-min continuous exercise) or standard-care with postmeal walking (10-min of walking after breakfast, lunch and dinner). Continuous glucose and activity monitors were worn to measure glycaemic control and adherence during three-days of standard-care (baseline) followed by three-days of postmeal or continuous walking. A linear mixed model analysed the changes from baseline between postmeal and continuous walking, as an average of the three-day periods. Thirty-two women (postmeal walking n=17: control n=15, 33±5 y, body mass index 25±4 kg.m2) completed the trial. Postprandial and overnight glucose concentrations were similar between postmeal walking and control, both interventions improved from baseline. There was no difference in adherence between groups, however postmeal walking completed more minutes of prescribed physical activity across baseline and intervention days compared to the continuous walking standard-care group. Preliminary findings from this proof-of-concept study suggest postmeal walking could be a promising alternative to, and work interchangeably with, traditional advice to perform continuous moderate-intensity physical activity, in women with gestational diabetes. Novelty bullets -Three ten-minute postmeal walks may be comparable to thirty minutes continuous walking for glucose control in women with gestational diabetes - Accumulating activity in short bouts after meals is a feasible alternate to continuous exercise for women with gestational diabetes.

'Beyond the Bump': an online wellbeing and lifestyle pilot program during COVID-19 for first year postpartum mothers: a research article

Background

Establishing a healthy lifestyle post-delivery is pivotal to reduce the incidence of chronic diseases. Due to COVID-19 restrictions, access to postpartum health programs has been increasingly difficult. The aim of this study was to inform, develop and evaluate Beyond the Bump (BtB); an online program to improve access to health and wellbeing education and support for physical activity in the postpartum.

Methods

A three-phase mixed-methods design of a 10-week Australia-wide online pilot program during COVID-19 with women less than 1 year postpartum and their primary care health professionals was utilised. Phase-one: needs assessment focus groups and interviews. Phase-two: BtB program implementation pre-post health measures survey, attendance and engagement with the program. Phase-three: program evaluation with feedback surveys and interviews.

Results

Women (n = 12) and health professionals (n = 16) expressed strong need for a postpartum program with access to education from experts on exercise, pelvic floor, sleep and baby nutrition. Despite BtB being developed from women’s suggestions (including time-of-day ‘morning’), attendance to all ten sessions was poor (of 162 registrations; 23% participated in the first session and 5% in the last session). Barriers to attendance included ‘too busy’,‘ forgot’ and ‘topic not relevant for age of child’. 88% of women reported the education as the most enjoyable component of the program. 100% (n = 26) of women interviewed would recommend the program to a friend.

Conclusions

There is a continuing need for postpartum support. Online programs with access to expert education and exercise were reported to be of significant interest and value. However, more research is needed to improve the uptake and value placed on mothers’ wellbeing and physical activity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04913-7.

To Be Active or to Stop? A Cross-Sectional Retrospective Study Exploring Provider Advice and Patient Fears Surrounding Physical Activity in Pregnancies Complicated by Fetal Growth Restriction

Exercise guidance for women with pregnancies complicated by fetal growth restriction (FGR) is vague, despite the fact that physical activity during pregnancy improves placental development, placental blood flow, and encourages healthy fetal growth. The goal of this study is to test the hypothesis that women with pregnancies complicated by FGR are fearful of physical activity and are being given unclear or limited advice from healthcare providers. Participants (N = 78) (women who delivered an infant diagnosed with FGR within the past 5 years) took an electronic survey including demographic information, pregnancy information, provider advice recall, and other health-related information relevant to growth-restricted pregnancies. Quantitative and qualitative (post-positivism paradigm) methods were employed to analyze the data. When asked specifically about how the FGR diagnosis impacted their activity levels, nearly 50% of participants said the diagnosis led them to decrease their activity levels. Participants reported that healthcare providers who do discuss activity with pregnant patients with FGR suggest low-intensity activities or ceasing activity, although the majority of providers did not discuss activity at all. More fears surrounding physical activity were reported post-FGR diagnosis, including worrying about fetal growth and development and causing fetal harm when engaging in physical activity.

Coping with Covid-19: stress, control and coping among pregnant women in Ireland during the Covid-19 pandemic

Background

The aim of the current study is to investigate the relationship between perceived control, coping and psychological distress among pregnant women in Ireland during the Covid-19 pandemic. It is hypothesised that lower levels of perceived control, greater use of avoidant coping and greater Covid-19 related pregnancy concern will be associated with psychological distress. In addition, it is hypothesised that the relationship between Covid-19 related pregnancy concern and psychological distress will be moderated by perceived control and avoidant coping.

Method

The study is cross-sectional, utilizing an online questionnaire, which was completed by 761 women in January 2021. The questionnaire includes measures of perceived control, coping style, perceived stress, anxiety and depression.

Results

Correlation analyses found that lower levels of perceived control were associated with higher levels of avoidant coping and psychological distress. There was also a significant positive relationship between avoidant coping and psychological distress. Using multiple regression, perceived control, avoidant coping and Covid-19 related pregnancy concern were found to predict 51% of the variance in psychological distress. However, in the moderation analysis, perceived control and avoidant coping were not found to moderate the relationship between Covid-19 related pregnancy concern and psychological distress.

Conclusion

The results from this study suggest that pregnant women in Ireland are experiencing increased levels of psychological distress during the Covid-19 pandemic. The findings also suggest that perceptions of control and avoidant coping are associated with psychological distress in this group and could be used as intervention targets.

Uncovering Barriers to Prenatal Physical Activity and Exercise Among South African Pregnant Women: A Cross-Sectional, Mixed-Method Analysis

Background

The barriers to prenatal physical activity and exercise have been widely reported in the literature, highlighting context-specific challenges. However, generally, research on prenatal physical activity and exercise among pregnant women in South Africa is rare; and particularly concerning the barriers to their prenatal physical activity practice. This study assessed the barriers to physical activity participation among pregnant women in the Eastern Cape, South Africa.

Methods

This was a sequential explanatory mixed method, predominantly quantitative study involving 1,082 pregnant women. A structured self-administered questionnaire on perceived barriers to physical participation was applied to collect quantitative data; while a subset of 15 pregnant women participated in individual in-depth semi-structured interviews to augment quantitative data. Quantitative and qualitative data were analyzed using descriptive statistics and thematic analysis, respectively.

Results

The results of the quantitative analysis presented major barriers: lack of advice on prenatal physical activity and inadequate or conflicting information about prenatal physical activity; tiredness; work commitments; discomfort; lack of time; low energy; non-accessibility to physical activity; lack of financial resources, and safety concerns for the mother and the baby. Qualitatively, the barriers identified relate to four main themes: individual, lack of information, lack of resources, and environmental barriers.

Conclusion

The major barriers cited by the women were tiredness, lack of time, discomfort, and low energy. They also include lack of support, advice and information about prenatal physical activity. The multiple constraining factors responsible for low or non-prenatal physical activity of pregnant women in this setting highlight the need to tailor interventions to address their individual uniquely perceived barriers.

Physical Activity in High-Risk Pregnancies

It is known that physical activity before and during pregnancy is associated with health benefits for both the mother and fetus. The WHO recommends a minimum of 150 min per week of moderate-intensity aerobic physical activity for pregnant women. However, the majority of pregnant woman seem not to be physically active in pregnancy as recommended. In addition, the WHO recommendations do not include information on physical activity (PA) for specific target groups. This might be particularly problematic in women with assisted reproduction technologies (ART) or those who have received the fetal diagnosis of congenital heart defects (CHD). The aim of our study was to elaborate on whether assisted reproduction technologies (ART) and/or the diagnosis of fetal congenital heart defects (CHD) influence the level of PA in pregnant women, and to determine if there is a difference between PA behavior before and during pregnancy. In addition, we will evaluate whether high-risk pregnant women also reach the WHO recommendations. A non-interventional, cross-sectional, monocentric study based on two standardized questionnaires on physical activity was conducted. In total, n = 158 pregnant women were included. All of the participants were recruited from the outpatient clinics of the German Heart Center, Munich, and the Klinikverbund Kempten-Oberallgäu, Germany. Pregnant women after ART (n = 18), with fetal CHD (n = 25) and with both ART and CHD (n = 8) could be included. A total of 107 pregnant women served as healthy controls. Women, after ART, showed a significantly reduced level of physical activity (p = 0.014) during pregnancy compared to women who became pregnant naturally. Additionally, less (p < 0.001) and lighter (p = 0.002) physical activity was observed in all groups during pregnancy compared to those before pregnancy. An increase in maternal age increases the likelihood of CHD (p < 0.001) and decreases the level of physical activity before pregnancy (p = 0.012). The overall level of physical activity decreased in healthy and high-risk pregnancies, and only a quarter (26.49%) of all pregnant women reached the WHO recommendations. Further research for the specific target groups is highly recommended in order to promote and increase physical activity in ART and CHD pregnancies.

The role of midwives and obstetrical nurses in the promotion of healthy lifestyle during pregnancy

Women with maternal obesity, an unhealthy lifestyle before and during pregnancy and excess gestational weight gain have an increased risk of adverse pregnancy and birth outcomes that can also increase the risk of long-term poor health for them and their children. Pregnant women have frequent medical appointments and are highly receptive to health advice. Healthcare professionals who interact with women during pregnancy are in a privileged position to support women to make lasting healthy lifestyle changes that can improve gestational weight gain and pregnancy outcomes and halt the intergenerational nature of obesity. Midwives and obstetrical nurses are key healthcare professionals responsible for providing antenatal care in most countries. Therefore, it is crucial for them to build and enhance their ability to promote healthy lifestyles in pregnant women. Undergraduate midwifery curricula usually lack sufficient lifestyle content to provide emerging midwives and obstetrical nurses with the knowledge, skills, and confidence to effectively assess and support healthy lifestyle behaviours in pregnant women. Consequently, registered midwives and obstetrical nurses may not recognise their role in healthy lifestyle promotion specific to healthy eating and physical activity in practice. In addition, practising midwives and obstetrical nurses do not consistently have access to healthy lifestyle promotion training in the workplace. Therefore, many midwives and obstetrical nurses may not have the confidence and/or skills to support pregnant women to improve their lifestyles. This narrative review summarises the role of midwives and obstetrical nurses in the promotion of healthy lifestyles relating to healthy eating and physical activity and optimising weight in pregnancy, the barriers that they face to deliver optimal care and an overview of what we know works when supporting midwives and obstetrical nurses in their role to support women in achieving a healthy lifestyle.

Level of exercise and physical activity among pregnant women in Saudi Arabia: A systematic review

The current study aimed to clarify the health benefits of physical activity on the mother and fetus in the Saudi women population. Besides, it is intended to provide recommendation based on the literature and results of studies from Saudi Arabia for exercise in pregnancy to improve the general health of women in Saudi Arabia. Prenatal physical exercise enhances physical and mental health of pregnant women. It can also reduce the risk of multiple pregnancy-related complications such as; lower back pain, fluid retention and risk of gestational diabetes. All these factors can affect fetal development and life later. Multiple studies showed that prenatal exercise could reduce the risk of fetal macrosomia with no effect on other perinatal or postnatal complications. The study followed the systematic literature review approach where it included multiple medical search Databases using PICOS eligibility criteria up to January 2019. The review was based on the following keywords: pregnancy, gestational, or prenatal) and (physical exercise, exercise, or physical activity. There are only two studies that dealt with physical exercises among Saudi women. The results indicated a relation between prenatal physical exercise on improving or decreasing risks on the mother and child during pregnancy.

Barriers and facilitators to a healthy lifestyle in postpartum women: A systematic review of qualitative and quantitative studies in postpartum women and healthcare providers

A healthy postpartum lifestyle is vital for the promotion of optimal maternal health, return to pre-pregnancy weight and prevention of postpartum weight retention, but barriers exist. We performed a systematic review that aimed to describe the barriers and facilitators to a healthy lifestyle in the first 2 years postpartum from the perspectives of women and healthcare providers. Databases were searched for eligible studies published up to 26 August 2019. Following thematic analysis, identified themes were mapped to the Theoretical Domains Framework and the Capability, Opportunity, Motivation and Behaviour model. We included 28 qualitative and quantitative studies after screening 15,643 citations and 246 full texts. We identified barriers and facilitators relating to capability (e.g., lack of knowledge regarding benefits of lifestyle behaviours; limitations in healthcare providers' skills in providing lifestyle support), opportunity (e.g., social support from partners, family, friends and healthcare providers; childcare needs) and motivation (e.g., identifying benefits of exercise and perception of personal health; enjoyment of the activity or food). We suggest intervention components to include in lifestyle interventions for postpartum women based on the identified themes. Our findings provide evidence to inform the development of interventions to support postpartum women in adopting and maintaining a healthy lifestyle.

Prenatal Counseling throughout Pregnancy: Effects on Physical Activity Level, Perceived Barriers, and Perinatal Health Outcomes: A Quasi-Experimental Study

Physical activity during pregnancy has many health benefits. However, the physical activity level is insufficient throughout pregnancy and women report perceived barriers to physical activity. This study assessed the impact of a counseling intervention offered in addition to routine pregnancy care on physical activity patterns, perceived barriers, and perinatal health outcomes. A quasi-experimental trial was conducted in the Maternity Unit of a hospital in Guadeloupe (a French department). Ninety-six pregnant women were allocated to a control or intervention group. Regular physical activity counseling was dispensed to the women in the intervention group by trained healthcare providers. The physical activity level and the perceived barriers were assessed in each trimester. Outcomes for the perinatal health of the mother and child were measured throughout pregnancy and after delivery. The perceived barriers, such as a lack of information about the health benefits and risks over the two trimesters (all p < 0.05) and insecurity related to practice throughout pregnancy (all p < 0.05), were different in favor of the intervention group. There were no significant between-group differences for the major indices of physical activity, whether measured or reported. The intervention women reported significantly more sedentary activity compared with the control group in the third trimester, 64.7 (36.4–78.7) vs. 22.7 (9.4–49.8) MET-hours/week, respectively (p < 0.001). The perinatal health outcomes for the mother and child showed no significant differences. The intervention was unable to limit the decline in physical activity or improve health outcomes. However, it was associated with an improvement in the perception of barriers. Future research should focus on interventions that have a sufficient quantitative impact on perceived barriers in order to limit physical activity decline.

The impact of a randomized controlled trial of a lifestyle intervention on postpartum physical activity among at-risk hispanic women: Estudio PARTO

AIMS

To assess the impact of a culturally modified, motivationally targeted, individually-tailored intervention on postpartum physical activity (PA) and PA self-efficacy among Hispanic women.

METHODS

Estudio PARTO was a randomized controlled trial conducted in Western Massachusetts from 2013-17. Hispanic women who screened positive for gestational diabetes mellitus were randomized to a Lifestyle Intervention (LI, n = 100) or to a comparison Health and Wellness (HW, n = 104) group during late pregnancy. Exercise goals in LI were to meet American College of Obstetrician & Gynecologists guidelines for postpartum PA. The Pregnancy Physical Activity Questionnaire (PPAQ) and the Self-Efficacy for Physical Activity Questionnaire were administered at 6 weeks, 6 months, and 1 year postpartum.

RESULTS

Compared to baseline levels, both groups had significant increases in moderate-to-vigorous PA at 6 months and one year postpartum (i.e., LI: mean change = 30.9 MET-hrs/wk, p = 0.05; HW: 27.6 MET-hrs/wk, p = 0.01), with only LI group experiencing significant increases in vigorous PA (mean change = 1.3 MET-hrs/wk, p = 0.03). Based on an intent-to-treat analysis using mixed effects models, we observed no differences in pattern of change in PA intensity and type over time between intervention groups (all p > 0.10). However, there was the suggestion of a greater decrease in sedentary activity in the LI group compared to the HW group (β = -3.56, p = 0.09).

CONCLUSIONS

In this randomized trial among high-risk Hispanic women, both groups benefitted from participation in a postpartum intervention.

Exploring Beliefs About Exercise Among Pregnant Women in Rural Communities

INTRODUCTION

Women who are pregnant in rural communities are disproportionally impacted by obesity and sedentary behavior, and this could be related to having negative beliefs about exercise during pregnancy, leading to inactivity. The purpose of this study was to identify self-reported beliefs about exercise among pregnant women in a rural community.

METHODS

Pregnant participants (N = 70) between 8 and 16 weeks' gestation were recruited from an obstetric clinic serving a rural population. An open-ended questionnaire addressing beliefs about exercise and based on the constructs of the theory of planned behavior was administered. Descriptive survey results were analyzed by calculating means and frequencies. Open-ended responses were assessed by inductive content analysis.

RESULTS

Commonly reported advantages of exercise during pregnancy included improved perinatal health outcomes and weight management. Commonly reported disadvantages included an increase in fatigue and concerns for maternal and fetal safety. Common facilitators of exercise included access to resources, free time or a decrease in demands from work, and support systems including family and friends. Common barriers to exercise included a lack of time, physical changes including feelings of nausea and fatigue, and lack of access to resources.

DISCUSSION

This study was the first to report beliefs about exercise during pregnancy in a rural setting. Responses in the current study suggest potential gaps in knowledge of evidence-based information regarding physical activity during pregnancy. Beliefs as well as reported barriers and facilitators of physical activity during pregnancy were similar those reported in other populations. In addition, access to resources (or lack of) appears to be an important facilitator (or barrier) among women in rural settings; thus, developing strategies designed to overcome this barrier, specifically in rural areas, is critically important. Future intervention strategies need to be tailored specifically to the needs of women living in rural areas.

Effectiveness of Physical Activity Interventions on Pregnancy-Related Outcomes among Pregnant Women: A Systematic Review

Regular physical activity has been demonstrated to contribute to physical and psychological health. Nevertheless, pregnant women generally exhibit low levels of physical activity. Implementation of interventions that enhance the self-efficacy of pregnant women on increasing physical activity is required. This paper provides an in-depth review of studies reporting the effect of various physical activity interventions dedicated for pregnant women on pregnancy-related issues, including gestational weight gain, pain and depression, physical activity level, and quality of life among these individuals. Five databases were used in searching the literature. Findings of the included studies were presented narratively, and appraisal of their methodological quality was conducted using the quality assessment tool developed by Effective Public Health Practice Project. Review findings demonstrated that physical activity interventions are effective in enhancing physical activity levels of pregnant women. Further, they are potentially useful in alleviating pregnancy-related pain and psychological symptoms, reducing gestational weight gain, and increasing self-efficacy in enhancing physical activity levels among these individuals. Nevertheless, inconsistencies in findings between studies hamper the drawing of firm conclusions on these latter outcomes. Overall, studies demonstrated a positive effect of physical activity interventions on the well-being and physical and psychological health of pregnant women.

Impact of prenatal exercise on neonatal and childhood outcomes: a systematic review and meta-analysis

Objective

We aimed to identify the relationship between maternal prenatal exercise and birth complications, and neonatal and childhood morphometric, metabolic and developmental outcomes.

Design

Systematic review with random-effects meta-analysis and meta-regression.

Data sources

Online databases were searched up to 6 January 2017.

Study eligibility criteria

Studies of all designs were eligible (except case studies and reviews) if published in English, Spanish or French, and contained information on the relevant population (pregnant women without contraindication to exercise), intervention (subjective/objective measures of frequency, intensity, duration, volume or type of exercise, alone (‘exercise-only’) or in combination with other intervention components (eg, dietary; ‘exercise+cointervention’)), comparator (no exercise or different frequency, intensity, duration, volume, type or trimester of exercise) and outcomes (preterm birth, gestational age at delivery, birth weight, low birth weight (<2500 g), high birth weight (>4000 g), small for gestational age, large for gestational age, intrauterine growth restriction, neonatal hypoglycaemia, metabolic acidosis (cord blood pH, base excess), hyperbilirubinaemia, Apgar scores, neonatal intensive care unit admittance, shoulder dystocia, brachial plexus injury, neonatal body composition (per cent body fat, body weight, body mass index (BMI), ponderal index), childhood obesity (per cent body fat, body weight, BMI) and developmental milestones (including cognitive, psychosocial, motor skills)).

Results

A total of 135 studies (n=166 094) were included. There was ‘high’ quality evidence from exercise-only randomised controlled trials (RCTs) showing a 39% reduction in the odds of having a baby >4000 g (macrosomia: 15 RCTs, n=3670; OR 0.61, 95% CI 0.41 to 0.92) in women who exercised compared with women who did not exercise, without affecting the odds of growth-restricted, preterm or low birth weight babies. Prenatal exercise was not associated with the other neonatal or infant outcomes that were examined.

Conclusions

Prenatal exercise is safe and beneficial for the fetus. Maternal exercise was associated with reduced odds of macrosomia (abnormally large babies) and was not associated with neonatal complications or adverse childhood outcomes.