Strategies used by midwives to support prenatal physical activity: A scoping review.

CONTEXT: Despite the well-known benefits of prenatal physical activity for the health of both the mother and her future child, and the existence of international Guidelines for prenatal physical activity, few pregnant women are sufficiently active. Prenatal health care providers, notably midwives, play an important role in promoting prenatal physical activity. Unfortunately, they face several challenges that hinder strategies used to support prenatal physical activity to their clients. The mode of communication used when giving advice and counselling is part of these strategies, as is the content of the information provided. However, little is known about how midwives communicate with their clients when it comes to recommendations about prenatal physical activity, whether it is general or specific recommendations, and about personal factors that may influence their recommendations. OBJECTIVE: To present a comprehensive analysis of the existing literature on strategies used by midwives to support prenatal physical activity to their clients, focusing on the mode of communication used, the content of the recommendation provided, as well as personal factors that can influence their recommendations. METHOD: A scoping review was conducted to retrieve original research articles on strategies used by midwives to support prenatal physical activity, published up to May 2023 and available in English and French. The search databases included CINAHL, MEDLINE, Cochrane, Scopus, PubMed, Psychology and behavioural Sciences Collection, and APA PsycINFO. Studies that fulfilled the eligibility criteria were selected for data extraction. The main findings were organized by the mode of communication used (unidirectional and bidirectional) and the type of recommendation provided (general versus specific). Midwives' knowledge, beliefs and attitudes towards prenatal physical activity were also extracted. RESULTS: A total of 1 307 articles were retrieved and 19 were included. The use of unidirectional mode of communication was identified in 64 %, 64 % and 14 % of the studies when it comes to provide general recommendations, specific recommendations and information on safety, respectively. The use of bidirectional mode of communication was identified in 43 %, 21 % and 7 % of the studies when it comes to provide general recommendations, specific recommendations and information on safety, respectively. Midwives had knowledge gaps about prenatal physical activity, their beliefs were not always aligned with the most recent recommendations, and they sometimes feel vulnerable in the way they support physical activity. However, they expressed the desire to improve the support they are providing. CONCLUSION: Results of this study highlight that when it comes to support prenatal physical activity, the unidirectional mode of communication is the most often used by midwives. Unfortunately, it is not considered effective as it does not allow discussing and explaining the information provided. Moreover, midwives exhibited some knowledge gaps about prenatal physical activity. Future work will be needed to better understand their challenges and needs in order to improve their initial training and clinical practice.

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

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

Health-Related Preconception Factors: Adherence to Guidelines and Associations with Weight Status.

BACKGROUND: Knowing the percentage of women planning a pregnancy who meet preconception dietary and physical activity (PA) guidelines and which health-related preconception factors are associated with body mass index (BMI) could help improve preconception care. OBJECTIVES: In a study conducted in women who were planning to conceive, the aims were to describe and compare eating and PA habits to current guidelines, as well as to identify the factors associated with BMI. DESIGN: This was a cross-sectional study. PARTICIPANTS/SETTING: From 2017 to 2020, women planning to conceive within the next year (n = 217) were recruited in the province of Québec (Canada) to participate in the Apports Nutritionnels durant la GrossessE - Cohorte Contrôle study. Among them, 184 (84.8%) were included in the analyses. MAIN OUTCOME MEASURES: Women completed three (90.2%) or two (9.8%) Web-based 24-hour dietary recalls and the International Physical Activity Questionnaire. Weight and height as well as the presence/absence of weight/body image concerns were self-reported. Eating and PA habits were compared with dietary reference intakes and Canadian guidelines, respectively. STATISTICAL ANALYSES: Descriptive statistics were used to describe the sample, eating and PA habits, as well as adherence to guidelines. A multivariable regression analysis was performed to identify the factors associated with BMI. RESULTS: On average, women were aged 30.8 ± 4.1 years and identified as White (94.0%). Most of them had weight/body image concerns (58.7%), 54.6% of whom had a normal body weight. Overall, 42.3% engaged in 150 minutes/week or more of moderate-to-vigorous intensity PA and 84.8% consumed <135 g alcoholic beverages per week. Mean dietary intake was below Dietary Reference Intakes for carbohydrates, vitamins D and E, and above Dietary Reference Intakes for total fat and folic acid. Factors associated with a higher BMI were weight/body image concerns (ß = 1.83; R2 = 13.0%), higher dietary protein intake (ß = .05; R2 = 4.0%), lower income (ß = .85; R2 = 2.9%), no folic acid supplementation (ß = .83; R2 = 2.5%), spending less time in moderate-to-vigorous intensity PA (ß = -.006; R2 = 2.4%), eating <2 snacks (ß = .75; R2 = 2.2%), and <3 meals (ß = 1.38; R2 = 1.5%) daily. CONCLUSION: Women planning to conceive do not have optimal eating and PA behaviors. Modifiable factors associated with BMI in preconception were identified.

Protocol of the Fit-For-Fertility study: a multicentre randomised controlled trial assessing a lifestyle programme targeting women with obesity and infertility.

INTRODUCTION: Women with obesity are at a higher risk of infertility as well as gestational and neonatal complications. Lifestyle changes are universally recommended for women with obesity seeking fertility treatments, but such intervention has only been assessed in very few robust studies. This study's objectives are therefore to assess the clinical outcomes and cost-effectiveness of an interdisciplinary lifestyle intervention (the Fit-For-Fertility Programme; FFFP) targeting women with obesity and subfertility in a diverse population. METHODS AND ANALYSIS: This pragmatic multicentre randomised controlled trial (RCT) will include 616 women with obesity (body mass index ≥30 kg/m2 or ≥27 kg/m2 with polycystic ovary syndrome or at-risk ethnicities) who are evaluated at a Canadian fertility clinic for subfertility. Women will be randomised either to (1) the FFFP (experimental arm) alone for 6 months, and then in combination with usual care for infertility if not pregnant; or (2) directly to usual fertility care (control arm). Women in the intervention group benefit from the programme up to 18 months or, if pregnant, up to 24 months or the end of the pregnancy (whichever comes first). Women from both groups are evaluated every 6 months for a maximum of 18 months. The primary outcome is live birth rate at 24 months. Secondary outcomes include fertility, pregnancy and neonatal outcomes; lifestyle and anthropometric measures; and cost-effectiveness. Qualitative data collected from focus groups of participants and professionals will also be analysed. ETHICS AND DISSEMINATION: This research study has been approved by the Research Ethics Board (REB) of Centre intégré universtaire de santé et des services sociaux de l'Estrie-CHUS (research coordinating centre) on 10 December 2018 and has been or will be approved successively by each participating centres' REB. This pragmatic RCT will inform decision-makers on improving care trajectories and policies regarding fertility treatments for women with obesity and subfertility. TRIAL REGISTRATION NUMBER: NCT03908099. PROTOCOL VERSION: 1.1, 13 April 2019.

Development of the Get Active Questionnaire for Pregnancy: breaking down barriers to prenatal exercise.

Evidence-based guidelines represent the highest level of scientific evidence to identify best practices for clinical/public health. However, the availability of guidelines do not guarantee their use, targeted knowledge translation strategies and tools are necessary to help promote uptake. Following publication of the 2019 Canadian Guideline for Physical Activity throughout Pregnancy, the Get Active Questionnaire for Pregnancy, and an associated Health Care Provider Consultation Form for Prenatal Physical Activity were developed to promote guideline adoption and use amongst pregnant individuals and health care providers. This paper describes the process of developing these tools. First, a survey was administered to qualified exercise professionals to identify the barriers and facilitators in using existing prenatal exercise screening tools. A Working Group of researchers and stakeholders then convened to develop an evidence-informed exercise pre-participation screening tool for pregnant individuals, building from previous tool and survey findings. Finally, end-user feedback was solicited through a survey and key informant interviews to ensure tools are feasible and acceptable to use in practice. The uptake and use of these documents by pregnant individuals, exercise, and health care professionals will be assessed in future studies. Novelty: Evidence supports the safety/benefits of exercise for most pregnant individuals; however, exercise is not recommended for a small number of individuals with specific medical conditions. The Get Active Questionnaire for Pregnancy and Health Care Provider Consultation Form for Physical Activity during Pregnancy identify individuals where prenatal exercise may pose a risk, while reducing barriers to physical activity participation for the majority of pregnant individuals.

Effects of a motor control exercise program on lumbopelvic pain recurrences and intensity in pregnant women with a history of lumbopelvic pain: a study protocol for a randomized controlled feasibility trial.

BACKGROUND: About 50% of women experience lumbopelvic pain (LBPP) during their pregnancy. LBPP has negative repercussions on sleep, social and sexual life, physical and work capacity, and psychological health and contributes to physical inactivity. The benefits of LBPP prevention or treatment in pregnant women through specific exercises should therefore be further investigated. This study protocol has been designed to establish the feasibility of implementing motor control exercise program with pregnant women presenting with a history of LBPP. METHODS/DESIGN: Forty pregnant women with a history of LBPP will be recruited and randomly allocated to a control (20 participants) or intervention (20 participants) group. The control group will receive standard prenatal care, including basic information on what to do when suffering from LBPP. The intervention group will participate in three 40-min exercise sessions per week from < 20 weeks until 34-36 weeks of gestation: one supervised group session via the Zoom platform (once a month, this session will take place at the Université du Québec à Trois-Rivières) and two unsupervised sessions at home. A motor control exercise program will be developed to target strengthening of the lumbo-pelvic-hip core muscles and improve spinal and pelvic stabilization. Participants of this group will also receive standard prenatal care. Women of the control group will receive after 6 weeks postpartum an exercise program designed to reduce LBPP they may have developed during pregnancy and that may persist after delivery. Primary outcomes will be participants' recruitment, retention and adherence rates, safety, and acceptability of the intervention. Secondary outcomes will include LBPP incidence, frequency, and intensity, as well as self-reported functional disability, physical activity levels, fear avoidance behavior, anxiety, and depression. DISCUSSION: This study will inform the feasibility of conducting a full-scale randomized controlled study to test the effectiveness of a motor control exercise program on the prevention and treatment of LBPP in women with a history of LBPP. Adequate prevention and treatment of pregnant women with a history of LBPP should help limit the recurrences of LBPP or the aggravation of its intensity during pregnancy. TRIAL REGISTRATION: US National Institutes of Health Clinical Trials registry NCT04253717 April 27, 2021.

Association Between Pregnancy-Related Hormones and Lumbopelvic Pain Characteristics in Pregnant Women: A Scoping Review.

OBJECTIVES: The objectives of this scoping review were (1) to document and quantify the potential associations between lumbopelvic pain characteristics and pregnancy-related hormones, and (2) to identify research approaches and assessment tools used to investigate lumbopelvic pain characteristics and pregnancy-related hormones. METHODS: The literature search was conducted in 6 databases (MEDLINE, Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature, SportDiscus, PsycINFO, and Cochrane) from inception up to March 2020 and completed using search terms relevant to pregnant women, pregnancy-related hormones, and lumbopelvic pain. The risk of bias was assessed using the characteristics recommended by Guyatt et al. for observational studies. RESULTS: The search yielded 1015 publications from which 9 met the inclusion criteria. Relaxin was the most studied pregnancy-related hormone. An association between relaxin levels and lumbopelvic pain presence or severity was found in 4 studies, while 5 studies did not report an association between them. One study reported an association between relaxin and lumbopelvic pain presence or severity while 2 studies reported no association and were considered as having a low risk of bias. One study reported measures of estrogen and progesterone levels. It showed that progesterone levels were found to be significantly higher in pregnant women with lumbopelvic pain compared to those without, while estrogen concentrations were similar in both groups. CONCLUSION: The literature showed conflicting evidence regarding the association between pregnancy-related hormones and lumbopelvic pain characteristics in pregnant women. The assessment tools used to investigate lumbopelvic pain characteristics and pregnancy-related hormones are heterogeneous across studies. Based on limited and conflicting evidence, and due to the heterogeneity of assessment tools and overall poor quality of the literature, the association between pregnancy-related hormones and lumbopelvic pain characteristics is unclear.

The use of manual lymphatic drainage on clinical presentation of musculoskeletal injuries: A systematic review.

The aim of this study was to provide a systematic review on the applicability of manual lymphatic drainage (MLD) in improving edema and clinical presentation postmusculoskeletal injuries. A review of the literature was performed in CINAHL, MANTIS, Medline, SPORTDiscus and Google Scholar, yielding a total of 8 articles. Half of the studies showed a strong quality assessment. Results from our work support the use of MLD for reducing edema reduction and pain as well as enhancing range of motion and patients' quality of life and satisfaction. Further research is needed to apply these findings to a broader range of musculoskeletal injuries and conditions.

Mechanisms Underlying Lumbopelvic Pain During Pregnancy: A Proposed Model.

Up to 86% of pregnant women will have lumbopelvic pain during the 3rd trimester of pregnancy and women with lumbopelvic pain experience lower health-related quality of life during pregnancy than women without lumbopelvic pain. Several risk factors for pregnancy-related lumbopelvic pain have been identified and include history of low back pain, previous trauma to the back or pelvis and previous pregnancy-related pelvic girdle pain. During pregnancy, women go through several hormonal and biomechanical changes as well as neuromuscular adaptations which could explain the development of lumbopelvic pain, but this remains unclear. The aim of this article is to review the potential pregnancy-related changes and adaptations (hormonal, biomechanical and neuromuscular) that may play a role in the development of lumbopelvic pain during pregnancy. This narrative review presents different mechanisms that may explain the development of lumbopelvic pain in pregnant women. A hypotheses-driven model on how these various physiological changes potentially interact in the development of lumbopelvic pain in pregnant women is also presented. Pregnancy-related hormonal changes, characterized by an increase in relaxin, estrogen and progesterone levels, are potentially linked to ligament hyperlaxity and joint instability, thus contributing to lumbopelvic pain. In addition, biomechanical changes induced by the growing fetus, can modify posture, load sharing and mechanical stress in the lumbar and pelvic structures. Finally, neuromuscular adaptations during pregnancy include an increase in the activation of lumbopelvic muscles and a decrease in endurance of the pelvic floor muscles. Whether or not a causal link between these changes and lumbopelvic pain exists remains to be determined. This model provides a better understanding of the mechanisms behind the development of lumbopelvic pain during pregnancy to guide future research. It should allow clinicians and researchers to consider the multifactorial nature of lumbopelvic pain while taking into account the various changes and adaptations during pregnancy.

Association Between Physical Activity, Weight Loss, Anxiety, and Lumbopelvic Pain in Postpartum Women.

OBJECTIVE: Lumbopelvic pain (LBPP) affects 45% to 81% of pregnant women, and 25% to 43% of these women report persistent LBPP beyond 3 months after giving birth. The objective of this study was to investigate the association of physical activity, weight status, anxiety, and evolution of LBPP symptoms in postpartum women. METHODS: This was a prospective observational cohort study with 3 time-point assessments: baseline (T0), 3 months (T3), and 6 months (T6). Women with persistent LBPP 3 to 12 months after delivery were recruited. At each time point, pain disability was assessed with the Pelvic Girdle Questionnaire and the Oswestry Disability Index (ODI), physical activity with Fitbit Flex monitors, and anxiety with the French-Canadian version of the State-Trait Anxiety Inventory. Weight was recorded using a standardized method. Pain intensity (numerical rating scale, 0-100) and frequency were assessed using a standardized text message on a weekly basis throughout the study. RESULTS: Thirty-two women were included (time postpartum: 6.6 ± 2.0 months; maternal age: 28.3 ± 3.8 years; body weight: 72.9 ± 19.1 kg), and 27 completed the T6 follow-up. Disability, pain intensity, and pain frequency improved at T6 (P < .001). Participants lost a mean of 1.9 ± 4.5 kg at T6, and this weight loss was correlated with reduction in LBPP intensity (r = 0.479, P = .011) and LBPP frequency (r = 0.386, P = .047), Pelvic Girdle Questionnaire score (r = 0.554, P = .003), and ODI score (r = 0.494, P = .009). Improvement in ODI score at T6 was correlated with the number of inactive minutes at T3 (r = -0.453, P = .026) and T6 (r = -0.457, P = .019), and with daily steps at T6 (r = 0.512, P = .006). CONCLUSION: Weight loss is associated with positive LBPP symptom evolution beyond 3 months postpartum, and physical activity is associated with reduction in pain disability.

Prenatal Exercise and Cardiorespiratory Health and Fitness: A Meta-analysis.

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.

Reproductive history, maternal anxiety and past physical activity practice predict physical activity levels throughout pregnancy.

We compared physical activity (PA) levels between pregnant women who conceived naturally (NC) or after fertility treatments (FT) and determined factors predicting prenatal moderate-to-vigorous intensity physical activity (MVPA). The study was conducted in Trois-Rivières (Canada) between October 2015 and July 2018. MVPA and anxiety levels were assessed at each trimester of pregnancy (TR1, TR2 and TR3) using an accelerometer and the State-Trait Anxiety Inventory, respectively. Sociodemographic and reproductive history data were self-reported or collected from medical files. Repeated measures analysis of variance and regression analyses were conducted. Ninety-six women were included in the analyses (58 NC and 38 FT). MVPA levels and daily step counts decreased significantly throughout pregnancy (time effect: F = 28.68, p < 0.0001 and F = 39.18, p < 0.0001, respectively), but NC and FT women presented similar MVPA and daily step counts (no group effect). The decline in PA practice throughout pregnancy was similar in both groups (no interaction effect). At TR1, State (ß = -0.272, p = 0.012) and Trait (ß = -0.349, p = 0.001) anxiety and past PA (ß = 0.483, p < 0.0001) were correlated with MVPA. Past MVPA was also correlated with MVPA at TR2 (ß = 0.595, p < 0.0001) and TR3 (ß = 0.654, p < 0.0001). Past PA was the strongest predictors of MVPA levels at TR1, TR2, and TR3, predicting 17% (p = 0.0002), 34% (p < 0.0001) and 42% (p < 0.0001), respectively. Overall, our findings suggest that MVPA practice throughout pregnancy is built on past PA practice. Therefore, to be effective at promoting PA throughout pregnancy, obstetric health care providers and fitness professionals should reinforce the importance of being active as early as possible during pregnancy.

Association between lifestyle habits and adiposity values among children exposed and unexposed to gestational diabetes mellitus in utero.

AIMS: The objectives of this study were to assess the profile of lifestyle habits among children exposed (GDM+) or unexposed (GDM-) to GDM and to assess whether a healthy lifestyle profile is associated with lower adiposity values among these children. METHODS: A total of 105 GDM+ and 38 GDM- children aged 2-14 years were included. Vegetables and fruit intakes were collected using two 24-h dietary recalls. Physical activity and sedentary time were measured with accelerometers. Screen and sleep time were assessed using questionnaires. Weight, height and waist circumference were measured. Body composition was assessed by absorptiometry. RESULTS: GDM+ children had lower moderate-to-vigorous physical activity practice (p = 0.043) and fruit intake (p = 0.020) than GDM- children. Among children with an unhealthy lifestyle (meeting 0-2 lifestyle recommendations), GDM+ children had greater percentage of fat mass (p = 0.021) and android fat mass (p = 0.020) than GDM- children. Moreover, among GDM+ children, children with a healthy lifestyle (meeting 3-4 lifestyle recommendations) tended to have lower percentage of fat mass (p = 0.053) and android fat mass (p = 0.071) than those with an unhealthy lifestyle. CONCLUSION: Improving lifestyle habits among GDM+ children could represent a promising approach to prevent deteriorated adiposity values.

Cross-Cultural Adaptation of the Cardiff Fertility Knowledge Scale and the Fertility Status Awareness Tool for the French-Canadian Population.

OBJECTIVE: The Cardiff Fertility Knowledge Scale (CFKS) and the Fertility Status Awareness Tool (FertiSTAT) are validated tools allowing the evaluation of fertility knowledge and raising awareness about risk indicators for reduced fertility. Their use by health care professionals practicing in the field of reproductive health might optimize fertility of the Canadian population. However, there currently is no version of these questionnaires for the French-Canadian population. The objective of this study was to translate and culturally adapt the CFKS and FertiSTAT to the French-Canadian population. METHODS: The translation and adaptation of the questionnaires was completed following a four-stage approach: (1) forward translation, (2) synthesis, (3) expert committee review, and (4) testing of the prefinal version of the questionnaires. The testing stage was conducted with a sample of 30 women and 10 men. RESULTS: During the translation process, linguistic difficulties were met for some items of both questionnaires but were resolved by consensus of the expert committee. Thirty women and 10 men tested the prefinal version of the CFKS-F and FertiSTAT-F. On a 5-point Likert scale, the global comprehension was 4.8 ± 0.5 and 4.6 ± 0.6, respectively. Based on the comments of the participants, the expert committee made minor modifications in the final version of the questionnaires to clarify the formulation of questions and adapt to one medical term. CONCLUSION: Tools to assess fertility knowledge and the presence of risk indicators for reduced fertility are now available for health care professionals practicing in the field of reproductive health.

Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta-analysis.

OBJECTIVE: The purpose of this review was to investigate the relationship between prenatal exercise, and low back (LBP), pelvic girdle (PGP) and lumbopelvic (LBPP) pain. 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 they were published in English, Spanish or French, and contained information on the population (pregnant women without contraindication to exercise), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone ["exercise-only"] or in combination with other intervention components [eg, dietary; "exercise + co-intervention"]), comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and outcome (prevalence and symptom severity of LBP, PGP and LBPP). RESULTS: The analyses included data from 32 studies (n=52 297 pregnant women). 'Very low' to 'moderate' quality evidence from 13 randomised controlled trials (RCTs) showed prenatal exercise did not reduce the odds of suffering from LBP, PGP and LBPP either in pregnancy or the postpartum period. However, 'very low' to 'moderate' quality evidence from 15 RCTs identified lower pain severity during pregnancy and the early postpartum period in women who exercised during pregnancy (standardised mean difference -1.03, 95% CI -1.58, -0.48) compared with those who did not exercise. These findings were supported by 'very low' quality evidence from other study designs. CONCLUSION: Compared with not exercising, prenatal exercise decreased the severity of LBP, PGP or LBPP during and following pregnancy but did not decrease the odds of any of these conditions at any time point.

Effects of prenatal exercise on fetal heart rate, umbilical and uterine blood flow: a systematic review and meta-analysis.

OBJECTIVE: To perform a systematic review and meta-analysis examining the influence of acute and chronic prenatal exercise on fetal heart rate (FHR) and umbilical and uterine blood flow metrics. 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 included (except case studies) if published in English, Spanish or French, and contained information on the population (pregnant women without contraindication to exercise), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone ["exercise-only"] or in combination with other intervention components [eg, dietary; "exercise + co-intervention"]), comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and outcomes (FHR, beats per minute (bpm); uterine and umbilical blood flow metrics (systolic:diastolic (S/D) ratio; Pulsatility Index (PI); Resistance Index (RI); blood flow, mL/min; and blood velocity, cm/s)). RESULTS: 'Very low' to 'moderate' quality evidence from 91 unique studies (n=4641 women) were included. Overall, FHR increased during (mean difference (MD)=6.35bpm; 95% CI 2.30 to 10.41, I2=95%, p=0.002) and following acute exercise (MD=4.05; 95% CI 2.98 to 5.12, I2=83%, p<0.00001). The incidence of fetal bradycardia was low at rest and unchanged with acute exercise. There were no significant changes in umbilical or uterine S/D, PI, RI, blood flow or blood velocity during or following acute exercise sessions. Chronic exercise decreased resting FHR and the umbilical artery S/D, PI and RI at rest. CONCLUSION: Acute and chronic prenatal exercise do not adversely impact FHR or uteroplacental blood flow metrics.

Prenatal exercise is not associated with fetal mortality: a systematic review and meta-analysis.

OBJECTIVE: To perform a systematic review of the relationship between prenatal exercise and fetal or newborn death. 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 included (except case studies) if they were published in English, Spanish or French and contained information on the population (pregnant women without contraindication to exercise), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone ["exercise-only"] or in combination with other intervention components [eg, dietary; "exercise + co-intervention"]), comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and outcome (miscarriage or perinatal mortality). RESULTS: Forty-six studies (n=2 66 778) were included. There was 'very low' quality evidence suggesting no increased odds of miscarriage (23 studies, n=7125 women; OR 0.88, 95% CI 0.63 to 1.21, I2=0%) or perinatal mortality (13 studies, n=6837 women, OR 0.86, 95% CI 0.49 to 1.52, I2=0%) in pregnant women who exercised compared with those who did not. Stratification by subgroups did not affect odds of miscarriage or perinatal mortality. The meta-regressions identified no associations between volume, intensity or frequency of exercise and fetal or newborn death. As the majority of included studies examined the impact of moderate intensity exercise to a maximum duration of 60 min, we cannot comment on the effect of longer periods of exercise. SUMMARY/CONCLUSIONS: Although the evidence in this field is of 'very low' quality, it suggests that prenatal exercise is not associated with increased odds of miscarriage or perinatal mortality. In plain terms, this suggests that generally speaking exercise is 'safe' with respect to miscarriage and perinatal mortality.