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Prenatal exercise is not associated with fetal mortality: a systematic review and meta-analysis
  1. Margie H Davenport1,
  2. Amariah J Kathol1,
  3. Michelle F Mottola2,
  4. Rachel J Skow1,
  5. Victoria L Meah3,
  6. Veronica J Poitras4,
  7. Alejandra Jaramillo Garcia4,
  8. Casey E Gray5,
  9. Nick Barrowman6,
  10. Laurel Riske1,
  11. Frances Sobierajski1,
  12. Marina James1,
  13. Taniya Nagpal2,
  14. Andree-Anne Marchand7,
  15. Linda G Slater8,
  16. Kristi B Adamo9,
  17. Gregory A Davies10,
  18. Ruben Barakat11,
  19. Stephanie-May Ruchat12
  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 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 and Dentistry, Children’s Health Research Institute, The University of Western Ontario, London, Ontario, Canada
  3. 3 Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
  4. 4 Independent Researcher, Ottawa, Ontario, Canada
  5. 5 Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
  6. 6 Clinical Research Unit, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
  7. 7 Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
  8. 8 John W Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
  9. 9 Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
  10. 10 Department of Obstetrics and Gynecology, Queen’s University, Kingston, Ontario, Canada
  11. 11 Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Madrid, Spain
  12. 12 Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
  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 To perform a systematic review of the relationship between prenatal exercise and fetal or newborn death.

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 they were 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 outcome (miscarriage or perinatal mortality).

Results Forty-six studies (n=2 66 778) were included. There was ‘very low’ quality evidence suggesting no increased odds of miscarriage (23 studies, n=7125 women; OR 0.88, 95% CI 0.63 to 1.21, I2=0%) or perinatal mortality (13 studies, n=6837 women, OR 0.86, 95% CI 0.49 to 1.52, I2=0%) in pregnant women who exercised compared with those who did not. Stratification by subgroups did not affect odds of miscarriage or perinatal mortality. The meta-regressions identified no associations between volume, intensity or frequency of exercise and fetal or newborn death. As the majority of included studies examined the impact of moderate intensity exercise to a maximum duration of 60 min, we cannot comment on the effect of longer periods of exercise.

Summary/conclusions Although the evidence in this field is of ‘very low’ quality, it suggests that prenatal exercise is not associated with increased odds of miscarriage or perinatal mortality. In plain terms, this suggests that generally speaking exercise is ‘safe’ with respect to miscarriage and perinatal mortality.

  • exercise
  • pregnancy
  • miscarriage
  • stillbirth
  • perinatal mortality

https://doi.org/10.1136/bjsports-2018-099773

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    Footnotes

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

    • Funding This project was funded by a 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. RS 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.