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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Article info
Publication history
Published online: December 28, 2018
Footnotes
Competing interests: The authors declare that they have no competing interests.
Each author has indicated that they meet the journal's requirements for authorship.
Identification
Copyright
© 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
