Effect of Maternal Physical Activity on
Pregnancy and Birthing Outcomes
Outcome Active women (n =
27)
Inactive women (n =
...
EXS 304- March 28, 2013
Effect of Maternal Physical Activity on
Pregnancy and Birthing Outcomes
Kimberly Nicole Rooker
Introduction
✤ Background: Many pregnant women wish to engage in exercise during pregnancy, but are
concerned about possib...
Search Methods
✤ The Kresge Library Database was the main search engine used by going to library.oakland.edu
and searching...
Methods of Study at Hand-
Melzer K, Schuts Y, Soehnchen N, et al.
✤ The study that was examined in detail evaluated the en...
Results
✤ Active women spent more time on moderate physical activity than the inactive
women (69.1 ± 26.6 vs 16.6 ± 9.2 mi...
Results continued;
✤ As shown in Table 2, between active and inactive women differences
in birthweight, Apgar scores, meco...
Summary Results
✤ As shown in Figure 1.1, four out of eight studies determined lower
mean birth weights among active pregn...
Conclusion
✤ For women with normal pregnancies, thirty minutes or more of
moderate physical activity per day is accompanie...
Conclusion
✤ Overall, still not much is known about exercising during pregnancy for
various reasons including data collect...
Conclusion cont.;
✤ Universally agreed upon warning signs that one should stop exercising
[1, 2]:
✤ Vaginal bleeding/ flui...
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Effect of Maternal Physical Activity on Pregnancy and Birthing Outcomes

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A meta-analysis of assessed maternal and fetal responses to exercise in regards to pregnancy and birthing outcomes; possible risks and benefits of exercise during pregnancy; and current recommendations for exercise during pregnancy.

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Effect of Maternal Physical Activity on Pregnancy and Birthing Outcomes

  1. 1. Effect of Maternal Physical Activity on Pregnancy and Birthing Outcomes Outcome Active women (n = 27) Inactive women (n = 17) P value Birthweight, g 3448 ± 310 3518 ± 418 0.53 First stage of labor, mina 301 (40–770) 304 (75–555) .87b Second stage of labor, minc 88 (9–178) 146 (3–212) .05b Duration of pushing efforts, minc 50 (4–115) 83 (1–133) .14b Apgar score (<7 at 5 min) 1 1 0.74 Meconium 12 6 0.77 Episiotomy/perineal lacerationa 19 7 0.19 Anesthesia (spinal/epidural) 20 15 0.45 Postpartum hemorrhage (≥500 mL) 6 7 0.32 Operative delivery (vacuum/forceps/cesar ean) 9 11 0.06 Characteristic Active womena (n = 27) Inactive womenb (n = 17) P value General Age, y 31.5 ± 5.4 30.5 ± 5.8 0.55 Primiparous women, n (%) 19 (70.4) 10 (58.8) 0.52 Height, cm 167.8 ± 6.4 163.2 ± 5.2 0.01 Prepregnancy weight, kg 64.3 ± 13.1 60.8 ± 9.9 0.35 Prepregnancy BMI, kg/m2 22.8 ± 4.2 22.8 ± 3.5 0.98 Weight, kg 79.3 ± 13.4 75.1 ± 11.4 0.88 Body weight gain, kg 15.9 ± 3.8 15.1 ± 4.3 0.51 Metabolic PAL 1.6 ± 0.1 1.4 ± 0.1 0.001 TEE, kJ/d 12,557 ± 2374 10,508 ± 1751 0.004 AEE, kJ/d 3478 ± 1129 1735 ± 456 0.001 V̇O2max, (mL/min/kg) 34.9 ± 5.6 30.3 ± 6.2 0.01 V̇O2max, (mL/min) 2742 ± 475 2256 ± 484 0.002 Sleeping heart rate, bpm 66.7 ± 7.8 74.6 ± 6.4 0.001 Movement, counts/min 23.5 ± 9.5 13.4 ± 5.6 0.012 TABLE 1. Characteristics of subjects AEE, activity energy expenditure; BMI, body mass index; PAL, physical activity level; TEE, total energy expenditure; V̇O2max, maximal oxygen uptake. Melzer. Effects of recommended levels of physical activity on pregnancy outcomes. Am J ObstetGynecol 2010. a≥30 minutes of moderate physical activity, defined as any activity with an energy expenditure between 3-6 metabolic equivalents (METS), or multiples of resting metabolic rate; b<30 minutes of moderate physical activity (METs = 3-6). TABLE 2. Delivery outcomes Melzer. Effects of recommended levels of physical activity on pregnancy outcomes. Am J Obstet Gynecol 2010. a Active women (n = 25) and inactive women (n = 15) who started first stage of labor; b Means (range) estimated from survival curves (Kaplan-Meier), P value computed from log rank test; c Active women (n = 24) and inactive women (n = 14) who started second stage of labor.
  2. 2. EXS 304- March 28, 2013 Effect of Maternal Physical Activity on Pregnancy and Birthing Outcomes Kimberly Nicole Rooker
  3. 3. Introduction ✤ Background: Many pregnant women wish to engage in exercise during pregnancy, but are concerned about possible adverse effects on the outcome of pregnancy. Contrary to traditionally recommending reducing exercise during pregnancy, doctors are now recommending light to moderate physical activity throughout pregnancy. Research has provided new information about how pregnant women and their fetuses respond graded exercise [15]. Studies have shown possible maternal benefits of exercising during pregnancy to be improved cardiovascular function [16, 21], improved muscular strength [21], fewer cesarean deliveries [7, 21], limited pregnancy weight gain [13], decreased pregnancy symptoms including nausea, musculoskeletal discomfort, edema, gestational diabetes and hypertension [23]. Fetal benefits include decreased fat mass, improved stress tolerance, and advanced neurobehavioral maturation [6]. Currently, The American College of Obstetricians and Gynecologists generally recommends at least thirty minutes of exercise on most days, but preferably all days for healthy women with uncomplicated pregnancies [2]. However these guidelines are not universally accepted, and many women and doctors are hesitant to start and recommend an exercise routine due to the insufficient evidence about benefits and risks. ✤ Objectives: To summarize assessed maternal and fetal responses to exercise in regards to pregnancy and birthing outcomes; possible risks and benefits of exercise during pregnancy; and current recommendations for exercise during pregnancy.
  4. 4. Search Methods ✤ The Kresge Library Database was the main search engine used by going to library.oakland.edu and searching the below keywords. Returned search results of interest cited multiple other studies, which were then specifically searched for through the library’s database by entering the title of the study, authors, and year published. ✤ Keywords: Pregnancy, exercise, prenatal care, perinatal care, postpartum care, fetal response to exercise, effect of exercise on gestation age ✤ Selection criteria: Controlled trials and peer-reviewed articles. Types of interventions included increasing, decreasing, and/or not changing current exercise habits. Aside from inactive groups, exercise durations ranged from twenty to sixty minutes per session, at various frequencies, and intensities spanning from low to heavy. ✤ Criteria for exclusion from the summary were studies that examined participants with the following: irregular medical follow-ups throughout the entire pregnancy, heart disease or treatment that may alter cardiovascular conditioning, preeclampsia, diabetes, risk for premature delivery, high probability of cesarean section, fetal malformation, or any other serious medical condition preventing them from exercising safely.
  5. 5. Methods of Study at Hand- Melzer K, Schuts Y, Soehnchen N, et al. ✤ The study that was examined in detail evaluated the energy expenditure, aerobic fitness, and sleeping heart rate of 44 total pregnant women. Medical records were examined for pregnancy outcome [16]. ✤ Women were split into an active group (n = 27) and an inactive group (n = 17) after total and activity-related energy expenditure and cardiovascular fitness measurements were obtained. The active group did 30 or more minutes of moderate physical activity per day and the inactive group did less than 30 minutes of moderate physical exercise per day [16]. ✤ Based on ACOG recommendations, moderate physical activity was defines as any activity between 3-6 METs [16].
  6. 6. Results ✤ Active women spent more time on moderate physical activity than the inactive women (69.1 ± 26.6 vs 16.6 ± 9.2 minutes, respectively; P = 0.001), but no statistically significant difference in time spent on vigorous activity (>6 METs) (1.52 ± 3.5 and 0.24 ± 0.6 minutes/day, respectively; P = 0.14) [16]. ✤ As shown in Table 1, the groups had general similar characteristics, except for height, with the active group being taller (168 cm) than the inactive group (163 cm) (P = 0.01) [16]. ✤ The activity-related energy expenditure of the active women was twice of that of the inactive women (3478 kJ/day vs 1735 kJ/day, respectively; P = 0.001) [16]. ✤ Compared to inactive women, the higher physical activity level of active women was associated with significantly higher relative and absolute VO2max, and significantly lower sleeping heart rate (Table 1) [16].
  7. 7. Results continued; ✤ As shown in Table 2, between active and inactive women differences in birthweight, Apgar scores, meconium-stained amniotic fluid, use of spinal/epidural anesthesia, episiotomy or perineal laceration, and postpartum hemorrhage were not significant [16]. ✤ Duration of the first stage of labor was similar between the two groups. Duration of the second stage of labor was shorter in the active compared to the inactive (88 vs 146 minutes, respectively; P = 0.051) [16]. ✤ Association between physical activity and operative delivery, adjusted for parity, maternal weight gain, and newborn birthweight was significant (crude OR, 3.67; adjusted OR, 7.65; 95% CI, 1.27-45.84; P = 0.026) [16].
  8. 8. Summary Results ✤ As shown in Figure 1.1, four out of eight studies determined lower mean birth weights among active pregnant women, and the other four studies exhibited higher mean birth weights among active pregnant women; however none of these results were statistically significant. ✤ Figure 2.1 depicts the same same eight studies, but is adjusted to account for the different confidence intervals. ✤ The study examined in this summary shows no adverse effects to the fetus from light to moderate intensity exercise, which is consistent with conclusions published in similar studies [3, 4, 7, 9, 11, 21, 23]. Furthermore, this study and several of the studies conclude maternal exercise benefits the mother and/or the baby [3, 7, 21, 23].
  9. 9. Conclusion ✤ For women with normal pregnancies, thirty minutes or more of moderate physical activity per day is accompanied by better cardiovascular fitness, with no negative effects on fetal condition or outcome of labor and delivery. Furthermore, the study indicates that the recommended level of physical activity may play a role in decreasing both the duration of the second stage of labor and the incidence of operative delivery [16]. ✤ Further studies with larger sample sizes are essential to confirm any associations between physical activity and pregnancy outcomes [16].
  10. 10. Conclusion ✤ Overall, still not much is known about exercising during pregnancy for various reasons including data collection difficulties and participant compliance and consistency [4]. ✤ This is why the best prescription for exercise during pregnancy is still believed to be one that is individually dosed. Although there are many potential benefits, maternal health and fitness level should be assessed before beginning a regimen. ✤ Currently, The American College of Obstetricians and Gynecologists generally recommends at least 30 minutes of exercise on most days, but preferably all days for healthy women with uncomplicated pregnancies [2]. If the normal, healthy mother is already in a regular exercise regimen that is more than 30 minutes, then she may continue with that regimen [1].
  11. 11. Conclusion cont.; ✤ Universally agreed upon warning signs that one should stop exercising [1, 2]: ✤ Vaginal bleeding/ fluid leakage ✤ Dizziness ✤ Chest pain ✤ Headache ✤ Uterine contractions ✤ Decreased fetal movement

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