Exercise during pregnancy for preventing gestational diabetes mellitus and hypertensive disorders: An umbrella review of randomised controlled trials and an updated meta-analysis.

OBJECTIVE: This study aimed to provide, through an umbrella review, an overview of the effect of single exercise interventions during pregnancy on gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP). Also, to update the current evidence through an updated meta-analysis. DESIGN: Umbrella review. SETTING: PubMed, EMBASE, Web of Science, Cochrane database of systematic reviews, Epistemonikos, SPORTDiscus, Clinicaltrials.gov, and PROSPERO register were searched from the database inception until August 2021. POPULATION: Peer-reviewed systematic reviews and meta-analyses of randomised controlled trials (RCTs) and RCTs samples. METHODS: Random-effects model was used to calculate relative risk with 95% confidence interval in the updated meta-analysis. The reference category was the groups that received usual prenatal care. AMSTAR 2 and the Cochrane Collaboration tool were used to assess the quality and GRADE approach was used to assess the overall certainly of evidence. MAIN OUTCOME MEASURES: GDM and HDP relative risk. RESULTS: Twenty-three systematic reviews and meta-analyses; and 63 RCTs were included. Single exercise interventions reduced the incidence of GDM and HDP in most systematic reviews and meta-analyses. Moreover, exercise interventions during pregnancy decrease the incidence of developing GDM and GH, particularly when they are supervised, have a low to moderate intensity level, and are initiated during the first trimester of pregnancy. CONCLUSION: Based on the findings, obstetric and physical exercise professionals could recommend exercise interventions during pregnancy as an effective strategy to improve maternal outcomes.

Effects of exercise-based interventions on postpartum depression: A meta-analysis of randomized controlled trials.

BACKGROUND: There is inconsistent evidence about the effect of physical activity on the prevention and treatment of depression during the postnatal period. The aim of this meta-analysis was to determine the effect of physical activity interventions during pregnancy and the postpartum period for controlling postpartum depressive symptoms. METHODS: We systematically searched Cochrane Library Plus, Science Direct, EMBASE, CINAHL, PubMed, Web of Science, and Scopus, from January 1990 to May 2016, for randomized or nonrandomized controlled trials addressing the effect of physical activity on postpartum depression. The inverse variance-weighted method was used to compute pooled estimates of effect size and respective 95% confidence intervals (95% CI) for physical activity intervention on postpartum depression. Subgroup analyses were performed comparing women with and without postpartum depressive symptoms according to specific scales measuring this construct. Meta-regression and sensitivity analysis were computed to evaluate heterogeneity. RESULTS: Twelve studies were included in the meta-analysis. Effect size for the relationship between physical activity interventions during pregnancy and the postpartum period on postpartum depressive symptoms was 0.41 (95% CI 0.28-0.54). Heterogeneity was I2  = 33.1% (P = .117). When subgroup analyses were done, pooled effect sizes were 0.67 (95% CI 0.44-0.90) for mothers who met postpartum depressive symptoms criteria at baseline based on specific scales, and 0.29 (95% CI 0.14-0.45) for mothers who did not meet those depressive symptoms criteria at baseline. CONCLUSION: Physical exercise during pregnancy and the postpartum period is a safe strategy to achieve better psychological well-being and to reduce postpartum depressive symptoms.

A follow-up study to assess the determinants and consequences of physical activity in pregnant women of Cuenca, Spain.

BACKGROUND: In recent years, the influence of physical exercise on pregnancy outcomes has been widely debated. Despite the numerous studies addressing the relationship between maternal physical activity and pregnancy outcomes, the evidence for consistent and significant impact of regular exercise during pregnancy on fetal growth remains lacking. The aims of this study were, first, to assess the level of physical activity performed throughout the pregnancy by objective (accelerometer) and self-reported (questionnaire) measurements, and, second, to ascertain pre-pregnancy physical activity levels, to estimate the relationship between levels of physical activity and some pregnancy and neonatal outcomes. METHODS/DESIGN: This was a prospective cohort study. Participants were pregnant women (n = 194) aged 18 to 40 years who attended for three quarterly appointments for pregnancy ultrasound scans at the Virgen de la Luz Hospital in Cuenca, Spain. All participants provided written informed consents to participate in the study. Physical activity during the pregnancy follow-up was assessed by a self-reported Pregnancy Physical Activity Questionnaire and sleep log; also objectively by a GT3X accelerometer (ActiGraph). Furthermore, pregnancy symptoms inventory, nutritional behavioural assessment, socio-demographic characteristics, and anthropometry and body composition were measured. At the end of the follow up, the following main outcomes were determined: pregnancy outcomes (incidence of gestational diabetes mellitus, pre-eclampsia, pregnancy-induced hypertension, weight gain during pregnancy, type of delivery, and neonatal outcomes (gestational age, birth weight, gender, Apgar score 1 min/5 min, type of resuscitation (I/II/III/IV), and pH of umbilical cord blood). Descriptive statistics for cross-sectional data, linear mixed regression models for absolute differences in changes baseline-final measurements were used as statistical analyses. DISCUSSION: Although the effectiveness of physical activity programmes on improving maternal and neonatal outcomes has heretofore been studied, the impact of free time physical activity during pregnancy has not been assessed using objective measures. This paper reports the design of a prospective cohort study that aims to assess the physical activity levels of pregnant women, and to estimate the relationship between those physical activity levels with maternal and neonatal outcomes. This study could contribute to providing evidence for the formulation of recommendations for physical activity for pregnant women.

Effects of exercise during pregnancy on mode of delivery: a meta-analysis.

INTRODUCTION: We conducted a systematic review and meta-analysis to examine the influence of physical exercise interventions on the mode of delivery of healthy pregnant women with low to moderate levels of physical activity. MATERIAL AND METHODS: Key words were used to conduct a computerized search for articles on the topic in six databases: Cochrane Library Plus, Science Direct, EMBASE, PubMed, Web of Science and ClinicalTrials.gov. Ten randomized controlled trials were identified and included in the meta-analysis. Main outcome measures were mode of delivery (normal, instrumental vaginal, or cesarean delivery) and physical activity. RESULTS: Relative risk reductions and their 95% confidence interval were calculated for each study, and the heterogeneity of the studies was estimated using Cochran's Q statistic. The evidence suggests that physical exercise during pregnancy may increase the likelihood of normal delivery (relative risk = 1.12, 95% confidence interval 1.01-1.24; p = 0.041), in particular when exercise takes place during the second and third trimesters (relative risk = 1.14, 95% confidence interval 1.01-1.32; p = 0.048), even reducing the risk of cesarean delivery (relative risk = 0.66, 95% confidence interval 0.46-0.96; p = 0.028). CONCLUSIONS: Regular exercise during pregnancy appears to modestly increase the chance for normal delivery among healthy pregnant women. This applies to women with low to moderate levels of physical activity, but studies are needed to understand better the effect of physical exercise of moderate to vigorous intensity in the different trimesters.

Exercise versus Metformin to Improve Pregnancy Outcomes among Overweight Pregnant Women: A Systematic Review and Network Meta-Analysis.

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.

Interpregnancy Weight Change and Hypertension During Pregnancy: A Systematic Review and Meta-analysis.

OBJECTIVE: To synthesize evidence regarding the association between interpregnancy weight change and hypertensive disorders of pregnancy. DATA SOURCES: MEDLINE, EMBASE, Cochrane Library, Web of Science, and ClinicalTrials.gov databases were systematically searched from the databases' interception until April 2019. Search strategy included the terms: "interpregnancy," "intergestational," "hypertension" and "hypertensive disorders." METHODS OF STUDY SELECTION: Studies that assessed the relationship between interpregnancy weight change and hypertensive disorders of pregnancy were included. Twelve studies and 415,605 women were included in this systematic review and meta-analysis. We used Mendeley reference manager during the review process. Odds ratios (ORs) for the most adjusted models reported by the included articles and the corresponding 95% CIs were calculated. The no weight change category defined by each study was used as the reference category. TABULATION, INTEGRATION, AND RESULTS: Overall, there was an increased risk of hypertensive disorders of pregnancy associated with interpregnancy weight gain (OR 1.37; 95% CI 1.21-1.53; I=62.1%; P<.001). Additionally, interpregnancy weight loss was associated with lower risk of developing hypertensive disorders of pregnancy (OR 0.87; 95% CI 0.75-0.99; I=54.9%; P=.01), Finally, meta-regression showed that interpregnancy weight gain was associated with a graded increase in the risk of hypertensive disorders of pregnancy. CONCLUSION: This systematic review and meta-analysis provides evidence that interpregnancy weight gain is associated with an increased risk of hypertensive disorders of pregnancy, gestational hypertension, and preeclampsia. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42018103002.

Interpregnancy weight change and perinatal outcomes: A protocol for a systematic review and meta-analysis.

BACKGROUND: Growing evidence suggests that interpregnancy weight change (IPWC) is a risk factor for perinatal outcomes, since it may increase the probability of gestational complications including gestational diabetes or cesarean delivery. Additionally, IPWC may affect neonatal outcomes increasing the prevalence of newborns small for gestational age or preterm birth. However, the association between IPWC and perinatal outcomes has not systematically synthesized thus far. This study protocol aims to provide a clear, transparent and standardized procedure for systematically reviewing the association between IPWC and perinatal outcomes. METHODS AND ANALYSIS: This systematic review and meta-analyses protocol is based on the preferred reporting items for systematic review and meta-analysis protocols and the Cochrane Collaboration Handbook. MEDLINE, EMBASE, the Cochrane Library, and Web of Science will be systematically searched from their inception. No limits will be defined by study design, as such different tools to assess risk of bias will be used:Odd ratios and their corresponding 95% confidence intervals will be reported to evaluate associations between IPWC and perinatal outcomes. RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSION: This systematic review and meta-analysis will systematically synthesize the evidence regarding the association between IPWC and perinatal outcomes. Data will be extracted from published articles and findings will be published in peer-reviewed journals. Ethical approval and informed consent will not be required due to the nature of the study. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018100449.

Effects of physical exercise during pregnancy on mothers' and neonates' health: a protocol for an umbrella review of systematic reviews and meta-analysis of randomised controlled trials.

INTRODUCTION: A growing interest has emerged on the effects of exercise during gestation. Several systematic reviews and meta-analyses have shown that prenatal exercise could reduce the mothers' risk for some disorders. Despite this, evidence regarding the risk of caesarean section, birth weight or Apgar score at delivery is still controversial. Furthermore, practitioners are reluctant to recommend exercise to pregnant women suffering from some disorders, such as hypertension, pre-eclampsia or pregnant women with obesity. Moreover, the scarcity of studies addressing the risks and benefits of exercise at higher intensity prevent practitioners from recommending it at higher dosages. Umbrella reviews represent an appropriate design to elucidate the reasons behind the contradictory findings of previous systematic reviews. METHODS: This protocol was developed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols and the Cochrane Collaboration Handbook. Medline, EMBASE, Web of Science, Cochrane database of systematic reviews, Epistemonikos, Prospero register and SPORTDiscuss databases will be searched to identify systematic reviews, meta-analyses and randomised controlled trials that examine the effect of exercise on pregnancy outcomes from inception to August 2019. Searches will be conducted from September to November 2019. STATISTICAL ANALYSIS: Methodological quality will be evaluated using the AMSTAR 2 tool. The certainty of evidence and strength of recommendations for meta-analyses will be assessed by the Grading of Recommendations Assessment, Development and Evaluation framework. The summary effect sizes will be calculated through the use of random-effects and fixed-effects models. Heterogeneity among studies will be assessed using the I2 statistic, and evidence of excess significance bias and evidence of small study effects will also be evaluated. ETHICS AND DISSEMINATION: Ethical approval will not be needed for this review protocol. The results will be disseminated to academic audiences by peer-reviewed publications. Furthermore, results will be disseminated to clinical audiences through professionals' associations and social networks, and may influence guidelines developers in order to improve outcomes in mothers and offspring. PROSPERO REGISTRATION NUMBER: CRD42019123410.

Effects of Exercise-Based Interventions on Neonatal Outcomes: A Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE: The aim of this study was to conduct a systematic review and meta-analysis of randomized controlled clinical trials (RCTs) assessing the influence of physical exercise interventions during pregnancy on some neonatal outcomes. DATA SOURCE: Key words were used to conduct a computerized search in six databases: Cochrane Library Plus, Science Direct, EMBASE, PubMed, Web of Science, and ClinicalTrials.gov. STUDY INCLUSION AND EXCLUSION CRITERIA: RCTs that included an exercise program for healthy pregnant women who were sedentary or had low levels of physical activity were selected. DATA EXTRACTION: Two independent reviewers extracted data and assessed the quality of the studies included. Of 4296 articles retrieved, 14 RCTs (3044 pregnant women) met the inclusion criteria. DATA SYNTHESIS: Pooled effect sizes (ESs) were calculated using a fixed model. RESULTS: Overall, physical exercise programs during pregnancy produced a small reduction in neonatal birth weight (ES = -.10; p = .04). The Apgar score at 1 minute was also weakly increased with combined exercise (aerobic, strength, and flexibility) (ES = .09; p = .048) and no differences between groups were observed in gestational age at delivery and Apgar score at 5 minutes. CONCLUSION: Structured physical exercise programs during pregnancy appear to be safe for the neonate, mainly favoring a lower birth weight within normal range. However, more studies are needed to establish recommendations.