Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis

Margie H Davenport; Stephanie-May Ruchat; Veronica J Poitras; Alejandra Jaramillo Garcia; Casey E Gray; Nick Barrowman; Rachel J Skow; Victoria L Meah; Laurel Riske; Frances Sobierajski; Marina James; Amariah J Kathol; Megan Nuspl; Andree-Anne Marchand; Taniya S Nagpal; Linda G Slater; Ashley Weeks; Kristi B Adamo; Gregory A Davies; Ruben Barakat; Michelle F Mottola

doi:10.1136/bjsports-2018-099355

Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis

Br J Sports Med. 2018 Nov;52(21):1367-1375. doi: 10.1136/bjsports-2018-099355.

Authors

Margie H Davenport^#¹, Stephanie-May Ruchat^#², Veronica J Poitras³, Alejandra Jaramillo Garcia³, Casey E Gray⁴, Nick Barrowman⁵, Rachel J Skow¹, Victoria L Meah⁶, Laurel Riske¹, Frances Sobierajski¹, Marina James¹, Amariah J Kathol¹, Megan Nuspl⁷, Andree-Anne Marchand⁸, Taniya S Nagpal⁹, Linda G Slater¹⁰, Ashley Weeks¹¹, Kristi B Adamo¹², Gregory A Davies¹³, Ruben Barakat¹⁴, Michelle F Mottola⁹

Affiliations

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 Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.
³ Independent researcher, Ottawa, Ontario, Canada.
⁴ Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
⁵ Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
⁶ Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK.
⁷ Faculty of Medicine and Dentistry, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada.
⁸ Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.
⁹ R Samuel McLaughlin Foundation-Exercise and Pregnancy Laboratory, Department of Anatomy and Cell Biology, Faculty of Health Sciences, School of Kinesiology, Schulich School of Medicine and Dentistry, Children's Health Research Institute, The University of Western Ontario, London, Ontario, Canada.
¹⁰ John W Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada.
¹¹ School of Interdisciplinary Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
¹² Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.
¹³ Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada.
¹⁴ Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Madrid, Spain.

^# Contributed equally.

PMID: 30337463
DOI: 10.1136/bjsports-2018-099355

Abstract

Objective: Gestational diabetes mellitus (GDM), gestational hypertension (GH) and pre-eclampsia (PE) are associated with short and long-term health issues for mother and child; prevention of these complications is critically important. This study aimed to perform a systematic review and meta-analysis of the relationships between prenatal exercise and GDM, GH and PE.

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 [e.g., dietary; "exercise + co-intervention"]), Comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and Outcomes (GDM, GH, PE).

Results: A total of 106 studies (n=273 182) were included. 'Moderate' to 'high'-quality evidence from randomised controlled trials revealed that exercise-only interventions, but not exercise+cointerventions, reduced odds of GDM (n=6934; OR 0.62, 95% CI 0.52 to 0.75), GH (n=5316; OR 0.61, 95% CI 0.43 to 0.85) and PE (n=3322; OR 0.59, 95% CI 0.37 to 0.9) compared with no exercise. To achieve at least a 25% reduction in the odds of developing GDM, PE and GH, pregnant women need to accumulate at least 600 MET-min/week of moderate-intensity exercise (eg, 140 min of brisk walking, water aerobics, stationary cycling or resistance training).

Summary/conclusions: In conclusion, exercise-only interventions were effective at lowering the odds of developing GDM, GH and PE.

Keywords: diabetes; evidence-based review; exercise; meta-analysis; pregnancy.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Diabetes, Gestational / prevention & control*
Exercise*
Female
Humans
Hypertension, Pregnancy-Induced / prevention & control*
Observational Studies as Topic
Pregnancy*
Randomized Controlled Trials as Topic