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Is supine exercise associated with adverse maternal and fetal outcomes? A systematic review
  1. Michelle F Mottola1,2,
  2. Taniya S Nagpal1,
  3. Roberta Bgeginski3,
  4. Margie H Davenport4,
  5. Veronica J Poitras5,
  6. Casey E Gray6,
  7. Gregory A Davies7,
  8. Kristi B Adamo8,
  9. Linda G Slater9,
  10. Nick Barrowman6,
  11. Ruben Barakat10,
  12. Stephanie-May Ruchat11
  1. 1 R Samuel McLaughlin Foundation- Exercise and Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada
  2. 2 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 Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
  4. 4 Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, Women and Children’s Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
  5. 5 Independent Researcher, Ottawa, Ontario, Canada
  6. 6 Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
  7. 7 Department of Obstetrics and Gynecology, Queen’s University, Kingston, Ontario, Canada
  8. 8 School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
  9. 9 John W Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
  10. 10 Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Madrid, Spain
  11. 11 Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, Canada
  1. Correspondence to Dr Michelle F Mottola, R. Samuel McLaughlin Foundation-Exercise & Pregnancy Laboratory, The University of London Ontario, London, ON N6A 3K7, UK; mmottola{at}


Objective Theoretical concerns regarding the supine position at rest due to the gravid uterus obstructing aorta and vena caval flow may impinge uterine blood flow (UBF) to the fetus and maternal venous return.

Design Systematic review.

Data sources Online databases up to 11 December 2017.

Study criteria Eligible population (pregnant without contraindication to exercise), intervention (frequency, intensity, duration, volume or type of supine exercise), comparator (no exercise or exercise in left lateral rest position, upright posture or other supine exercise), outcomes (potentially adverse effects on maternal blood pressure, cardiac output, heart rate, oxygen saturation, fetal movements, UBF, fetal heart rate (FHR) patterns; adverse events such as bradycardia, low birth weight, intrauterine growth restriction, perinatal mortality and other adverse events as documented by study authors), and study design (except case studies and reviews) published in English, Spanish, French or Portuguese.

Results Seven studies (n=1759) were included. ‘Very low’ to ‘low’ quality evidence from three randomised controlled trials indicated no association between supervised exercise interventions that included supine exercise and low birth weight compared with no exercise. There was ‘very low’ to ‘low’ quality evidence from four observational studies that showed no adverse events in the mother; however, there were abnormal FHR patterns (as defined by study authors) in 20 of 65 (31%) fetuses during an acute bout of supine exercise. UBF decreased (13%) when women moved from left lateral rest to acute dynamic supine exercise.

Conclusion There was insufficient evidence to ascertain whether maternal exercise in the supine position is safe or should be avoided during pregnancy.

  • supine exercise
  • fetal health
  • fetus
  • maternal health
  • pregnancy complications
  • pregnancy outcomes

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  • Contributors Substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data were provided by MFM, MHD, TSN and RB. All authors drafted the work or revised it critically for important intellectual content. All authors gave final approval of the version submitted. The authors are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This project was funded by a Canadian Institutes 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.

  • Competing interests None declared.

  • Patient consent Not required.

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

  • Data sharing statement Any available unpublished data are available from the corresponding and primary author via encrypted email.