Objective To perform a systematic review and meta-analysis examining the influence of acute and chronic prenatal exercise on fetal heart rate (FHR) and umbilical and uterine blood flow metrics.
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 [eg, dietary; “exercise + co-intervention”]), comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and outcomes (FHR, beats per minute (bpm); uterine and umbilical blood flow metrics (systolic:diastolic (S/D) ratio; Pulsatility Index (PI); Resistance Index (RI); blood flow, mL/min; and blood velocity, cm/s)).
Results ‘Very low’ to ‘moderate’ quality evidence from 91 unique studies (n=4641 women) were included. Overall, FHR increased during (mean difference (MD)=6.35bpm; 95% CI 2.30 to 10.41, I2=95%, p=0.002) and following acute exercise (MD=4.05; 95% CI 2.98 to 5.12, I2=83%, p<0.00001). The incidence of fetal bradycardia was low at rest and unchanged with acute exercise. There were no significant changes in umbilical or uterine S/D, PI, RI, blood flow or blood velocity during or following acute exercise sessions. Chronic exercise decreased resting FHR and the umbilical artery S/D, PI and RI at rest.
Conclusion Acute and chronic prenatal exercise do not adversely impact FHR or uteroplacental blood flow metrics.
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Contributors MHD, S-MR, MFM, GAD and KBA contributed to the conception of the study. MHD, S-MR, MFM, GAD, KBA, AJG, NB, VJP, CEG, LGS and RB contributed to the design of the study and development of the search strategy. LGS conducted the systematic search. RS and VLM completed the acquisition of data. RS, MHD and NB performed the data analysis. All authors assisted with the interpretation. RS and MHD 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 Canadian Institute of Health Research Knowledge Synthesis Grant (grant number 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 (grant number RES0033140). RS is funded by a Canadian Institutes for Health Research Doctoral Research Award (grant number GSD-146252).
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.