Population characteristics associated with adherence to prenatal group-based exercise programs.

Community-based supervised group exercise may be an effective option to increase activity levels throughout pregnancy. Previous studies that have explored predictors of low adherence to exercise during pregnancy have not examined group-based settings. We analysed an international cohort of 347 pregnant women who participated in group-based prenatal exercise interventions (from <20 weeks to 34-36 weeks pregnant). Probable adherence predictors informed by previous literature that were assessed included: pre-pregnancy physical activity level and body mass index (BMI) classification, age, number of previous pregnancies, and education level. Adherence was measured by attendance. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated to explore the relationship between the selected predictors and high adherence (≥70%). Post-secondary education level versus only secondary (aOR 5.28; CI 1.67; 16.72) or primary level (aOR 13.82; CI 4.30; 44.45) presented greater likelihood to have high adherence to the exercise intervention than low adherence. Future research and public health initiatives should consider implementing strategies to overcome education-related barriers to improve accessibility to prenatal exercise.

Obesity can offset the cardiometabolic benefits of gestational exercise.

Pregnancy exercise can prevent excessive gestational weight gain (EGWG), gestational diabetes mellitus (GDM) and hypertension (GH), but inter-individual variability has not been explored. We aimed to analyze the prevalence--and potential sociodemographic and medical predictors of--non-responsiveness to gestational exercise, and the association of non-responsiveness with adverse pregnancy outcomes. Among 688 women who completed a supervised light-to-moderate intensity exercise program (three ~1-h sessions/week including aerobic, resistance, and pelvic floor muscle training) until near-term, those who showed EGWG, GDM or GH were considered 'non-responders'. A low prevalence of non-responders was observed for GDM (3.6%) and GH (3.4%), but not for EGWG (24.2%). Pre-pregnancy obesity was the strongest predictor of non-responsiveness for GH (odds ratio 8.40 [95% confidence interval 3.10-22.78] and EGWG (5.37 [2.78-10.39]), whereas having a highest education level attenuated the risk of being non-responder for GDM (0.10 [0.02-0.49]). Non-responsiveness for EGWG was associated with a higher risk of prolonged labor length, instrumental/cesarean delivery, and macrosomia, and of lower Apgar scores. No association with negative delivery outcomes was found for GDM/GH. In summary, women with pre-pregnancy obesity might require from additional interventions beyond light-to-moderate intensity gestational exercise (e.g., diet and/or higher exercise loads) to ensure cardiometabolic benefits.

Gestational Exercise and Maternal and Child Health: Effects until Delivery and at Post-Natal Follow-up.

We studied the influence of pregnancy exercise on maternal/offspring cardiometabolic health until delivery and at follow-up. We pooled data from two randomized controlled trials from our group that were performed following the same methodology (one unpublished). We also collected follow-up data de novo from the participants of both trials and their offspring. In total, 1348 women with uncomplicated, singleton gestations were assigned to an intervention (n = 688, performing a supervised, moderate-intensity exercise program (three sessions/week)) or control group (n = 660). Maternal outcomes were excessive gestational weight gain (EGWG), gestational hypertension/diabetes and, at follow-up, return to pre-pregnancy weight within six months, hypertension, overweight/obesity, and other cardiometabolic conditions. Offspring outcomes were macrosomia and low-birthweight and, at follow-up, overweight/obesity, low-weight, and cardiometabolic conditions. Adherence to the intervention, which proved safe, was > 95%. Pregnancy exercise reduced the risk of EGWG, gestational hypertension, and diabetes (adjusted odds ratio (OR) and 95% confidence interval: 0.60 (0.46-0.79), 0.39 (0.23-0.67), and 0.48 (0.28-0.84)), and it was associated with a greater likelihood of returning to pre-pregnancy weight (2.37 (1.26-4.54)) and a lower risk of maternal cardiometabolic conditions (0.27 (0.08-0.95)) at the end of follow-up (median 6.1 years (interquartile range 1.8)). Pregnancy exercise also reduced the risk of macrosomia (0.36 (0.20-0.63)) and of childhood overweight/obesity during the first year (0.20 (0.06-0.63)). Our findings suggest that pregnancy exercise might protect maternal/offspring health.

Influence of Land or Water Exercise in Pregnancy on Outcomes: A Cross-sectional Study.

PURPOSE: This study aimed to compare the cross-sectional results from three experimental studies conducted on land, in water, and in mixed form (land + water) during pregnancy on maternal and newborn outcomes. METHODS: A cross-sectional design was used to analyze the results of three randomized clinical trials in healthy pregnant women from Madrid (Spain) and Buenos Aires (Argentina). Five hundred and sixty-eight pregnant women were recruited. For each of the studies, the number of women in the exercise group totaled 107 for study 1 (land), 49 women for study 2 (water), and 101 women for study 3 (land + water). A total of 311 women represented the control group (CG) (pooled together from all three studies). RESULTS: Total maternal weight gain was different between study 1 and CG (11.7 vs 13.4 kg, P = 0.001, Cohen's d = 0.38) as well as the percentage of pregnant women with excessive weight gain (20.6%, n = 22, vs 37.9%, n = 118, respectively, P = 0.005, χ = 16.6, OR = 0.42, 95% confidence interval = 0.25-0.71). The number of pregnant women with gestational diabetes in CG was significantly higher than that in studies 2 and 3 (CG n = 22/7.1%; study 2, n = 0/0%; and study 3, n = 1/1%; P = 0.03, χ = 8.9). CONCLUSION: Exercise performed on land is more effective than aquatic activities in preventing excessive maternal weight gain, whereas combined programs (land + aquatic) or water exercise programs may be more effective in preventing gestational diabetes.

Exercise during pregnancy protects against hypertension and macrosomia: randomized clinical trial.

BACKGROUND: The prevalence of all pregnancies with some form of hypertension can be up to 10%, with the rates of diagnosis varying according to the country and population studied and the criteria used to establish the diagnosis. Prepregnancy obesity and excessive gestational weight gain (GWG) of all body mass index (BMI) categories have been associated with maternal hypertensive disorders and linked to macrosomia (>4000 g) and low birthweight (<2500 g). No large randomized controlled trial with high adherence to an exercise program has examined pregnancy-induced hypertension and these associated issues. We investigated whether women adherent (≥80% attendance) to an exercise program initiated early showed a reduction in pregnancy-induced hypertension and excessive GWG in all prepregnancy BMI categories, and determined if maternal exercise protected against macrosomia and low birthweight. OBJECTIVE: We sought to examine the impact of a program of supervised exercise throughout pregnancy on the incidence of pregnancy-induced hypertension. STUDY DESIGN: A randomized controlled trial was used. Women were randomized into an exercise group (N = 382) or a control group (N = 383) receiving standard care. The exercise group trained 3 d/wk (50-55 min/session) from gestational weeks 9-11 until weeks 38-39. The 85 training sessions involved aerobic exercise, muscular strength, and flexibility. RESULTS: High attendance to the exercise program regardless of BMI showed that pregnant women who did not exercise are 3 times more likely to develop hypertension (odds ratio [OR], 2.96; 95% confidence interval [CI], 1.29-6.81, P = .01) and are 1.5 times more likely to gain excessive weight if they do not exercise (OR, 1.47; 95% CI, 1.06-2.03, P = .02). Pregnant women who do not exercise are also 2.5 times more likely to give birth to a macrosomic infant (OR, 2.53; 95% CI, 1.03-6.20, P = .04). CONCLUSION: Maternal exercise may be a preventative tool for hypertension and excessive GWG, and may control offspring size at birth while reducing comorbidities related to chronic disease risk.

Exercise and depression in overweight and obese pregnant women: a randomised controlled trial / Ejercicio y depresión en mujeres embarazadas con sobrepeso y obesidad: ensayo clínico aleatorio

Objective: To assess the effectiveness of a regular physical exercise program on the prevention of depression in overweight and obese pregnant women. Material and method: A randomised controlled trial was conducted at Hospital Universitario de Fuenlabrada in Madrid. A total of 106 overweight and obese healthy pregnant women (32.70±3.90 years), with uncomplicated and singleton gestation were analyzed (52 to the exercise group (EG) and 54 to the control group (CG)). Women from EG participated in a physical conditioning program throughout pregnancy, which included a total of 55- to 60-minute weekly sessions, 3 days per week. The main outcome measure was the patients’ depression level, assessed by the Center for Epidemiological Studies Depression scale (CES-D). Other pregnancy outcomes were measured. Results: A smaller percentage of depressed women were identified in the EG compared to the CG in the third trimester: entire group EG: 17.8% vs. CG: 47.2% p=0.002, overweight EG: 16.2% vs. CG: 47.7% p=0.003 and adequate weight gain EG: 8.7% vs. CG: 62.5% p=0.000. Comparations within EG showed a significantly reduce of the percentage of depressed women in the third trimester in comparison with the first one: entire group 25% vs. 15.9% p=0.000; overweight 24.32% vs. 16.2% p=0.003; excessive weight gain 31.57% vs. 26.31% p=0.007 and adequate weight gain: 21.73% vs. 8.7% p=0.005. Whereas this percentage tended to increase significantly within the CG. Conclusion: An adapted exercise program designed for overweight and obese pregnant women may reduce the prevalence of depression in late pregnancy, and turn out in a longer gestational age at labour among depressive active pregnant women (AU)

Objetivo: Evaluar la eficacia de un programa de ejercicio físico regular en la prevención de la depresión en mujeres gestantes con sobrepeso y obesidad. Material y método: Se llevó a cabo un ensayo clínico aleatorio en el Hospital Universitario de Fuenlabrada en Madrid. Un total de 106 mujeres gestantes sanas con sobrepeso y obesidad (32,70±3,90 años), sin complicaciones y con gestación simple fueron analizadas (52 en el grupo de ejercicio (GE) y 54 en el grupo de control (GC)). Las mujeres del GE participaron en un programa de acondicionamiento físico durante el embarazo, incluyendo sesiones semanales de 55 a 60 minutos, 3 días a la semana. La variable principal de estudio fue el nivel de depresión de las pacientes, evaluado a través de 'Center for Epidemiological Studies Depression scale (CES-D)'. Otros resultados del embarazo fueron medidos. Resultados: Se identificó un menor porcentaje de mujeres con depresión en el GE en comparación con el GC en el tercer trimestre de embarazo: grupo entero GE: 17,8% vs. GC: 47,2% p=0,002, sobrepeso GE: 16,2% vs. GC: 47,7% p=0,003 y ganancia de peso adecuada GE: 8,7% vs. GC: 62,5% p=0,000. Las comparaciones dentro del GE mostraron una reducción significativa del porcentaje de mujeres con depresión en el tercer trimestre de embarazo en comparación con el primer trimestre: grupo entero 25% vs. 15,9% p=0,000; sobrepeso 24,32% vs. 16,2% p=0,003; ganancia de peso excesiva 31,57% vs. 26,31% p=0,007 y ganancia de peso adecuada: 21,73% vs. 8,7% p=0,005. Mientras que este porcentaje tendió a incrementarse significativamente dentro del GC. Conclusión: Un programa adaptado de ejercicio físico diseñado para mujeres con sobrepeso y obesidad puede reducir la prevalencia de depresión al final del embarazo, y resultar en una edad gestacional más prolongada en el momento del parto entre las gestantes deprimidas físicamente activas (AU)

Exercise Is Associated with a Reduction in Gestational Diabetes Mellitus.

PURPOSE: The objective of this study is to assess the effectiveness of a maternal exercise program (land/aquatic activities, both aerobic and muscular conditioning) in preventing gestational diabetes mellitus (GDM). METHODS: Three hundred and forty-two pregnant women from Spain (age, 33.24 ± 4.3 yr) without obstetric contraindications were recruited for a clinical randomized controlled trial. The intervention group (IG, n = 101) exercised for 60 and 50 min on land and in water, respectively, three times per week. The control group (n = 156) received usual standard care. RESULTS: The prevalence of GDM was reduced in the IG group (IG, 1%, n = 1, vs control group, 8.8%, n = 13 (χ1 = 6.84, P = 0.009)) with a significant risk estimate (odds ratio = 0.103; 95% confidence interval, 0.013-0.803). CONCLUSION: The exercise program performed during pregnancy reduced the prevalence of GDM by preserving glucose tolerance.

Exercise during pregnancy improves maternal glucose screen at 24-28 weeks: a randomised controlled trial.

OBJECTIVE: The influence of an exercise programme performed by healthy pregnant women on maternal glucose tolerance was studied. STUDY DESIGN: A physical activity (PA, land/aquatic activities) programme during the entire pregnancy (three sessions per week) was conducted by a qualified instructor. 83 healthy pregnant women were randomly assigned to either an exercise group (EG, n=40) or a control (CG, n=43) group. 50 g maternal glucose screen (MGS), maternal weight gain and several pregnancy outcomes were recorded. RESULTS: Significant differences were found between study groups on the 50 g MGS. Values corresponding to the EG (103.8 ± 20.4 mg/dl) were better than those of the CG (126.9 ± 29.5 mg/dl), p=0.000. In addition, no differences in maternal weight gain and no cases of gestational diabetes in EG versus 3 in CG (7%) (p>0.05) were found. CONCLUSION: A moderate PA programme performed during pregnancy improves levels of maternal glucose tolerance.