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Impact of prenatal exercise on neonatal and childhood outcomes: a systematic review and meta-analysis
  1. Margie H Davenport1,
  2. Victoria L Meah1,
  3. Stephanie-May Ruchat2,
  4. Gregory A Davies3,
  5. Rachel J Skow1,
  6. Nick Barrowman4,
  7. Kristi B Adamo5,
  8. Veronica J Poitras6,
  9. Casey E Gray7,
  10. Alejandra Jaramillo Garcia6,
  11. Frances Sobierajski1,
  12. Laurel Riske1,
  13. Marina James1,
  14. Amariah J Kathol1,
  15. Megan Nuspl8,
  16. Andree-Anne Marchand9,
  17. Taniya S Nagpal10,
  18. Linda G Slater11,
  19. Ashley Weeks12,
  20. Ruben Barakat13,
  21. Michelle F Mottola10
  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 Department of Obstetrics and Gynecology, Queen’s University, Kingston, Ontario, Canada
  4. 4 Clinical Research Unit, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
  5. 5 School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
  6. 6 Independent Researcher, Ottawa, Ontario, Canada
  7. 7 Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
  8. 8 Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
  9. 9 Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
  10. 10 R Samuel McLaughlin Foundation - Exercise and Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, Children’s Health Research Institute, The University of Western Ontario, London, Ontario, Canada
  11. 11 John W Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
  12. 12 School of Interdisciplinary Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
  13. 13 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 2R3, Canada; mdavenpo{at}


Objective We aimed to identify the relationship between maternal prenatal exercise and birth complications, and neonatal and childhood morphometric, metabolic and developmental outcomes.

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 published in English, Spanish or French, and contained information on the relevant population (pregnant women without contraindication to exercise), intervention (subjective/objective measures of frequency, intensity, duration, volume or type of exercise, alone (‘exercise-only’) or in combination with other intervention components (eg, dietary; ‘exercise+cointervention’)), comparator (no exercise or different frequency, intensity, duration, volume, type or trimester of exercise) and outcomes (preterm birth, gestational age at delivery, birth weight, low birth weight (<2500 g), high birth weight (>4000 g), small for gestational age, large for gestational age, intrauterine growth restriction, neonatal hypoglycaemia, metabolic acidosis (cord blood pH, base excess), hyperbilirubinaemia, Apgar scores, neonatal intensive care unit admittance, shoulder dystocia, brachial plexus injury, neonatal body composition (per cent body fat, body weight, body mass index (BMI), ponderal index), childhood obesity (per cent body fat, body weight, BMI) and developmental milestones (including cognitive, psychosocial, motor skills)).

Results A total of 135 studies (n=166 094) were included. There was ‘high’ quality evidence from exercise-only randomised controlled trials (RCTs) showing a 39% reduction in the odds of having a baby >4000 g (macrosomia: 15 RCTs, n=3670; OR 0.61, 95% CI 0.41 to 0.92) in women who exercised compared with women who did not exercise, without affecting the odds of growth-restricted, preterm or low birth weight babies. Prenatal exercise was not associated with the other neonatal or infant outcomes that were examined.

Conclusions Prenatal exercise is safe and beneficial for the fetus. Maternal exercise was associated with reduced odds of macrosomia (abnormally large babies) and was not associated with neonatal complications or adverse childhood outcomes.

  • exercise
  • pregnancy

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  • Contributors MHD, S-MR, MFM, GAD, KBA contributed to the conception of the study. MHD, S-MR, MFM, GAD, KBA, AJG, NB, VJP, CEG, LGS, RB contributed to the design of the study and development of the search strategy. LGS conducted the systematic search. VLM, RS, FS, LR, MJ, AJK, A-AM, TSN, AW completed the acquisition of data. MHD, NB, MN performed the data analysis. All authors assisted with the interpretation. MHD, VLM were the principal writers of the manuscript. All authors contributed to the drafting and revision of the final article. All authors approved the final submitted version of the manuscript.

  • Funding This was funded by a Canadian Institutes of Health Research Knowledge Synthesis Grant (140995). 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 (0033140). RS is funded by a Canadian Institutes of Health Research Doctoral Research Award (146252). A-AM is funded by a Fonds de Recherche en Santé du Québec Doctoral Research Award (34399).

  • Competing interests None declared.

  • Patient consent Not required.

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