Exercise Effects on Maternal Vascular Health and Blood Pressure during Pregnancy and Postpartum: A Systematic Review and Meta-Analysis

Karan Pongpanit; Natalie Dayan; Tania Janaudis-Ferreira; Marc Roig; Jadranka Spahija; Mariane Bertagnolli

doi:10.1093/eurjpc/zwae165

Exercise Effects on Maternal Vascular Health and Blood Pressure during Pregnancy and Postpartum: A Systematic Review and Meta-Analysis

Eur J Prev Cardiol. 2024 May 7:zwae165. doi: 10.1093/eurjpc/zwae165. Online ahead of print.

Authors

Karan Pongpanit^{1

2

3}, Natalie Dayan^{4

5}, Tania Janaudis-Ferreira^{1

4}, Marc Roig¹, Jadranka Spahija^{1

3}, Mariane Bertagnolli^{1

3

5}

Affiliations

¹ School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
² Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand.
³ Hospital Sacre-Coeur Research Center, CIUSSS Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada.
⁴ Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
⁵ Cardiovascular Health Across the Lifespan Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.

PMID: 38711399
DOI: 10.1093/eurjpc/zwae165

Abstract

Aim: This systematic review aimed to assess the effects of exercise training during pregnancy and the postpartum period on maternal vascular health and blood pressure (BP).

Methods: The outcome of interest were pulse wave velocity (PWV), flow-mediated dilation (FMD), and BP from pregnancy until 1-year postpartum. Five databases, including Ovid MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane Library, were systematically searched from inception to August 2023. Studies of randomized controlled trials (RCTs) comparing the effects of prenatal or postpartum exercise to a non-exercise control group were included. The risk of bias and the certainty of evidence were assessed. Random-effects meta-analyses and sensitivity analyses were conducted.

Results: In total, 20 RCTs involving 1,221 women were included. Exercise training, initiated from week 8 during gestation or between 6-14 weeks after delivery, with the program lasting for a minimum of 4 weeks up to 6 months, showed no significant impact on PWV and FMD. However, it resulted in a significant reduction in systolic BP (SBP) (MD: -4.37 mmHg; 95% CI: -7.48 to -1.26; p = 0.006) and diastolic BP (DBP) (MD: -2.94 mmHg; 95% CI: -5.17 to -0.71; p = 0.01) with very low certainty. Subgroup analyses revealed consistent trends across different gestational stages, types of exercise, weekly exercise times, and training periods.

Conclusion: Exercise training during pregnancy and the postpartum period demonstrates a favorable effect on reducing maternal BP. However, further investigations with rigorous methodologies and larger sample sizes are needed to strengthen these conclusions.

Keywords: blood pressure; exercise; postpartum; pregnancy; vascular health.

Plain language summary

This systematic review of the literature demonstrates that exercise training during pregnancy and postpartum can reduce blood pressure in women. Key findings: Exercise training significantly decreased both systolic and diastolic blood pressure values in pregnant and postpartum women.The positive exercise effects on maternal blood pressure were consistently observed regardless of the specific stage of pregnancy, type of exercise, frequency of weekly exercise sessions, or duration of the training programs.