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Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis
  1. Margie H Davenport1,
  2. Stephanie-May Ruchat2,
  3. Veronica J Poitras3,
  4. Alejandra Jaramillo Garcia3,
  5. Casey E Gray4,
  6. Nick Barrowman5,
  7. Rachel J Skow1,
  8. Victoria L Meah6,
  9. Laurel Riske1,
  10. Frances Sobierajski1,
  11. Marina James1,
  12. Amariah J Kathol1,
  13. Megan Nuspl7,
  14. Andree-Anne Marchand8,
  15. Taniya S Nagpal9,
  16. Linda G Slater10,
  17. Ashley Weeks11,
  18. Kristi B Adamo12,
  19. Gregory A Davies13,
  20. Ruben Barakat14,
  21. Michelle F Mottola9
  1. 1 Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children’s Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
  2. 2 Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
  3. 3 Independent researcher, Ottawa, Ontario, Canada
  4. 4 Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
  5. 5 Clinical Research Unit, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
  6. 6 Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
  7. 7 Faculty of Medicine and Dentistry, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
  8. 8 Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
  9. 9 R Samuel McLaughlin Foundation–Exercise and Pregnancy Laboratory, Department of Anatomy and Cell Biology, Faculty of Health Sciences, School of Kinesiology, Schulich School of Medicine and Dentistry, Children’s Health Research Institute, The University of Western Ontario, London, Ontario, Canada
  10. 10 John W Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
  11. 11 School of Interdisciplinary Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
  12. 12 Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
  13. 13 Department of Obstetrics and Gynecology, Queen’s University, Kingston, Ontario, Canada
  14. 14 Facultad de Ciencias de la Actividad Física y del Deporte–INEF, Universidad Politécnica de Madrid, Madrid, Spain
  1. Correspondence to Dr Margie H Davenport, Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, T6G 2E1, Canada; mdavenpo{at}ualberta.ca

Abstract

Objective Gestational diabetes mellitus (GDM), gestational hypertension (GH) and pre-eclampsia (PE) are associated with short and long-term health issues for mother and child; prevention of these complications is critically important. This study aimed to perform a systematic review and meta-analysis of the relationships between prenatal exercise and GDM, GH and PE.

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 [e.g., dietary; “exercise + co-intervention”]), Comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and Outcomes (GDM, GH, PE).

Results A total of 106 studies (n=273 182) were included. ‘Moderate’ to ‘high’-quality evidence from randomised controlled trials revealed that exercise-only interventions, but not exercise+cointerventions, reduced odds of GDM (n=6934; OR 0.62, 95% CI 0.52 to 0.75), GH (n=5316; OR 0.61, 95% CI 0.43 to 0.85) and PE (n=3322; OR 0.59, 95% CI 0.37 to 0.9) compared with no exercise. To achieve at least a 25% reduction in the odds of developing GDM, PE and GH, pregnant women need to accumulate at least 600 MET-min/week of moderate-intensity exercise (eg, 140 min of brisk walking, water aerobics, stationary cycling or resistance training).

Summary/conclusions In conclusion, exercise-only interventions were effective at lowering the odds of developing GDM, GH and PE.

  • exercise
  • pregnancy
  • diabetes
  • evidence-based review
  • meta-analysis

https://doi.org/10.1136/bjsports-2018-099355

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    Footnotes

    • MHD and S-MR contributed equally.

    • Contributors MHD, SMR, MFM, GAD and KBA conceived the study. MHD, SMR, MFM, VJP, AJG, CEG, NB and LS wrote the study protocol. MHD, SMR, RJS, VLM, LR, FS, MJ, AJK, AAM and TSN selected the studies. RJS, VLM, LR, FS, MJ, AJK, AAM, TSN, AW and NB extracted and analysed the data. MHD, SMR and MFM checked the extracted data. SMR and MHD wrote the first draft of the manuscript and all authors contributed to the writing of the final version.

    • Funding This study was funded by the Canadian Institute of Health Research Knowledge Synthesis Grant. MHD is funded by an Advancing Women’s Heart Health Initiative New Investigator Award supported by Health Canada and the Heart and Stroke Foundation of Canada. RJS is funded by a Canadian Institutes for Health Research Doctoral Research Award. AAM is funded by a Fonds de Recherche en Santé du Québec Doctoral Research Award.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.