The effect of maternal exercise on fetal aortic blood flow

Impact of maternal physical activity during an uncomplicated pregnancy on fetal and neonatal well-being parameters: a systematic review of the literature

We carried a thorough systematic review of the contemporary literature regarding the impact of maternal physical activity during pregnancy on the fetal and neonatal well-being parameters. We searched systematically publications indexed in PubMed and ScienceDirect, according to the PRISMA protocol. Studies examining following fetal and neonatal well-being parameters were included: fetal heart rate, active fetal movements, Doppler assessment of the placental and fetal circulations, amniotic fluid index, Apgar score, and umbilical cord blood acid-basis analysis at delivery. Altogether, 73 studies were identified (pooled sample size n = 7867). Out of these, 42 pertained to acute and 31 pertained to chronic exposure to maternal physical activity. The majority of the identified studies reported a positive or neutral effect of maternal physical activity on the fetal heart rate, Doppler-derived umbilical and cerebral blood flow parameters, and Apgar score. The literature regarding uterine arteries Doppler assessment, fetal active movements, amniotic fluid index, and umbilical cord blood acid-base analysis at delivery is sparse and does not allow us to generalize the inferences. Maternal physical activity during physiological pregnancy is safe for fetal and neonatal well-being when practiced according to recommendations. There is a need for better quality studies concerning the subject.

Umbilical artery flow velocity waveforms following maternal exercise

The effect of acute exercise on pregnant women in the last trimester of pregnancy and the changes in fetal umbilical artery flow velocity waveforms were studied. One hundred and forty-three healthy pregnant women underwent an acute exercise test. The exercise was performed on an upright bicycle ergometer for 5 minutes, followed by 30 minutes of recovery. The baseline control values of umbilical artery velocity waveforms were compared with those after exercise. The mean exercise intensity achieved was 67.4% (55-90%) of submaximal exercise. Maternal heart rate rose significantly from a mean of 89 (68-120) beats per minute at rest to a mean of 144 (116-200) beats per minute after exercise (P<0.001). Maternal blood pressure rose significantly after exercise from a mean systolic of 112 (80-150) mmHg to a mean of 147 (120-200) mmHg (P<0.001), and from a mean diastolic of 67 (40-85) mmHg to a mean of 84 (70-100) mm Hg (P<0.001). The mean fetal umbilical pulsatility index (PI) was shown to decrease significantly following exercise at 2 and 4 minutes of recovery. It is concluded that (1) an acute exercise test of this intensity causes a significant decrease in PI index after 2 and 4 minutes of recovery; (2) an exercise intensity between 55 and 75% causes a decrease in the PI after exercise while exercise of 76-90% of submaximal exercise causes a rebound increase after an initial decrease at 2 minutes; (3) it may be possible to use this pattern of exercise as an exercise test to differentiate between low- and high-risk pregnancies. Studies on high-risk pregnancies are being prepared for publication.

The effect of maternal exercise on fetal heart rate

One hundred and ninety-three women with uncomplicated pregnancies and 44 with high-risk pregnancies participated in a 5-minute exercise stress test on a bicycle ergometer. All women were in the third trimester of pregnancy. Measurements of fetal heart rate were made at intervals of 2, 4, 6, 8, 10, 12, 16, 20, 25 and 30 minutes. Fetal heart rate was then compared in terms of maternal age, parity, consumption of cigarettes, exercise intensity, history of activity, cardiotocography score, maternal heart rate at rest, maternal heart rate after exercise, fetal sex and birth weight. In low-risk pregnancies an increase in fetal heart rate from 143 (124-171) beats per minute (bpm) to 148 (116-191) bpm was noted after exercise while, in the high-risk pregnancy group, a transient decrease from 148 (115-170) bpm to 141 (70-180) bpm was observed. There were also 10 cases of significant bradycardia in the high-risk pregnancy group. We conclude that the effect of maternal exercise on fetal heart rate is dependent on many variables. A fetal bradycardia following exercise is more likely to occur in high-risk pregnancies. The use of fetal heart rate variation with exercise could be a useful prognostic factor in pregnancy.

Intrauterine therapy for parvovirus B19 infected symptomatic fetus using B19 IgG-rich high titer gammaglobulin

Parvovirus B19-infected hydrops fetalis was treated using gammaglobulin injection into the peritoneal cavity (GIFPeC) with B19-IgG-rich immunoglobulin. Fetal anemia and hydrops resolved, and B19-DNA in fetal ascites decreased despite no change in maternal B19-IgG or B19-DNA. Gammaglobulin injection into the peritoneal cavity is thus useful for treating hydrops fetalis while avoiding intrauterine blood-transfusion risks.