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Impact of prenatal exercise on maternal harms, labour and delivery outcomes: a systematic review and meta-analysis
  1. Margie H Davenport1,
  2. Stephanie-May Ruchat2,
  3. Frances Sobierajski1,
  4. Veronica J Poitras3,
  5. Casey E Gray4,
  6. Courtney Yoo1,
  7. Rachel J Skow1,
  8. Alejandra Jaramillo Garcia3,
  9. Nick Barrowman5,
  10. Victoria L Meah6,
  11. Taniya S Nagpal7,
  12. Laurel Riske1,
  13. Marina James1,
  14. Megan Nuspl8,
  15. Ashley Weeks9,
  16. Andree-Anne Marchand10,
  17. Linda G Slater11,
  18. Kristi B Adamo12,
  19. Gregory A Davies13,
  20. Ruben Barakat14,
  21. Michelle F Mottola7
  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 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
  8. 8 Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
  9. 9 Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
  10. 10 Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
  11. 11 John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
  12. 12 School of Human Kinetics, Faculty of Health Sciences, 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, T6G 2E1, Canada; mdavenpo{at}ualberta.ca

Abstract

Objective To perform a systematic review of the relationships between prenatal exercise and maternal harms including labour/delivery outcomes.

Design Systematic review with random effects meta-analysis and meta-regression.

Datasources 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), comparator (no exercise or different frequency, intensity, duration, volume and type of exercise, alone [“exercise-only”] or in combination with other intervention components [e.g., dietary; “exercise + co-intervention”]) and outcome (preterm/prelabour rupture of membranes, caesarean section, instrumental delivery, induction of labour, length of labour, vaginal tears, fatigue, injury, musculoskeletal trauma, maternal harms (author defined) and diastasis recti).

Results 113 studies (n=52 858 women) were included. ‘Moderate’ quality evidence from exercise-only randomised controlled trials (RCTs) indicated a 24% reduction in the odds of instrumental delivery in women who exercised compared with women who did not (20 RCTs, n=3819; OR 0.76, 95% CI 0.63 to 0.92, I 2= 0 %). The remaining outcomes were not associated with exercise. Results from meta-regression did not identify a dose–response relationship between frequency, intensity, duration or volume of exercise and labour and delivery outcomes.

Summary/conclusions Prenatal exercise reduced the odds of instrumental delivery in the general obstetrical population. There was no relationship between prenatal exercise and preterm/prelabour rupture of membranes, caesarean section, induction of labour, length of labour, vaginal tears, fatigue, injury, musculoskeletal trauma, maternal harms and diastasis recti.

  • pregnancy
  • exercise

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Footnotes

  • 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. FS, CY, RS, TSN, LR, MJ, MN, AW and A-AM completed the acquisition of data. MHD, NB and MN performed the data analysis. All authors assisted with the interpretation. MHD, S-MR, FS and CY 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). AAM is funded by a Fonds de Recherche du Québec – Santé Doctoral Research Award (grant number: 34399).

  • Competing interests None declared.

  • Patient consent Not required.

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

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