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Prenatal Exercise and Pre-gestational Diseases: A Systematic Review and Meta-analysis

  • Deborah Adesegun
    Affiliations
    Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, AB
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  • Chenxi Cai
    Affiliations
    Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB

    Women and Children's Health Research Institute, University of Alberta, Edmonton, AB

    Alberta Diabetes Institute, University of Alberta, Edmonton, AB
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  • Allison Sivak
    Affiliations
    Coutts Education Library, University of Alberta, Edmonton, AB
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  • Radha Chari
    Affiliations
    Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, AB
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  • Margie H. Davenport
    Correspondence
    Corresponding author: Dr. Margie Davenport, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB.
    Affiliations
    Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB

    Women and Children's Health Research Institute, University of Alberta, Edmonton, AB

    Alberta Diabetes Institute, University of Alberta, Edmonton, AB
    Search for articles by this author
Published:December 28, 2018DOI:https://doi.org/10.1016/j.jogc.2018.10.007

      Abstract

      Objective

      This study sought to examine the effect of prenatal exercise on birth outcomes in women with pre-gestational diseases, including chronic hypertension, type 1 diabetes, and type 2 diabetes.

      Methods

      A structured search of online databases up to June 8, 2018 was conducted. Studies of all designs and languages were included if they contained information on the population (pregnant women with pre-gestational diseases), intervention (subjective or objective measures of frequency, intensity, duration, volume, or type of exercise), comparator (no exercise or different frequency, intensity, duration, volume, or type of exercise), and outcome (birth weight, macrosomia [birth weight >4000 g], large for gestational age, low birth weight [<2500 g], small for gestational age [<10th percentile], Apgar score, preterm birth [<37 weeks], Caesarean section (CS), preeclampsia, and glycemic control).

      Results

      A total of five studies (n = 221 women) were included. Canadian Task Classification was designated as level I. “Low” to “very low” quality evidence revealed that prenatal exercise reduced the odds of CS by 55% in women with type 1 diabetes and chronic hypertension (OR 0.45; 95% CI 0.22–0.95, I2 = 0%). The odds of low (<2500 g) or high (>4000 g) birth weight, Apgar score at 1 and 5 minutes, preeclampsia, and preterm birth were not different between women who exercised and those who did not.

      Conclusion

      Prenatal exercise reduced the odds of CS and did not increase the risk of adverse maternal or neonatal outcomes in mothers with pre-gestational medical conditions. Findings are based on limited evidence, thus suggesting a need for high-quality investigations on exercise in this population of women.

      Résumé

      Objectif

      Cette étude avait pour but d'examiner les effets de l'exercice prénatal sur les issues de grossesse de femmes présentant déjà des affections avant la grossesse, dont l'hypertension chronique et le diabète, de type 1 ou de type 2.

      Méthodologie

      Les auteures ont effectué une recherche structurée dans des bases de données en ligne jusqu’au 8 juin 2018. Les études étaient sélectionnées - sans restrictions de modèle ou de langue - si elles contenaient de l'information sur la population (femmes enceintes présentant des affections avant la grossesse), l'intervention (mesures subjectives ou objectives de la fréquence, de l'intensité, de la durée, du volume ou du type d'exercice), le point de comparaison (aucun exercice ou différences dans l'intensité, la durée, le volume ou le type d'exercice) et les issues (poids à la naissance, macrosomie [poids à la naissance > 4000 g], GAG, poids insuffisant à la naissance [< 2500 g], PAG [< 10e percentile], indice d'Apgar, accouchement prématuré [< 37 semaines], césarienne, prééclampsie, et régulation glycémique).

      Résultats

      Au total, cinq études (n = 221 femmes) ont été sélectionnées (classification I du Groupe d'étude canadien). Des données probantes de qualité ≪ faible ≫ et ≪ très faible ≫ ont révélé que l'exercice prénatal permettrait de réduire le risque de césarienne de 55 % chez les femmes présentant un diabète de type 1 ou une hypertension chronique (RC : 0,45; IC à 95 % : 0,22 à 0,95, I2 = 0 %). Le risque de faible poids (< 2500 g) ou de poids élevé (> 4000 g) à la naissance, l'indice d'Apgar à une et à cinq minutes et l'incidence de prééclampsie et d'accouchements prématurés n'étaient associés à aucune différence entre les femmes qui avaient fait de l'exercice et les autres.

      Conclusion

      L'exercice prénatal a réduit le risque de césarienne sans faire augmenter le risque d'issues maternelles ou néonatales indésirables chez les femmes présentant des affections avant la grossesse. Les résultats étant fondés sur des données probantes limitées, des études de haute qualité sur l'exercice dans cette population sont donc requises.

      Key Words

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