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Exercise during pregnancy protects against hypertension and macrosomia: randomized clinical trial

  • Ruben Barakat
    Affiliations
    Physical Activity and Sports in Specific Populations (AFIPE) Research Group, Faculty of Physical Activity and Sports Sciences-Facultad de Ciencias de la Actividad Física y el Deporte, Technical University of Madrid, Madrid, Spain
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  • Mireia Pelaez
    Affiliations
    Physical Activity and Sports in Specific Populations (AFIPE) Research Group, Faculty of Physical Activity and Sports Sciences-Facultad de Ciencias de la Actividad Física y el Deporte, Technical University of Madrid, Madrid, Spain
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  • Yaiza Cordero
    Affiliations
    Catholic University of Murcia, Murcia, Spain
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  • Maria Perales
    Affiliations
    Physical Activity and Sports in Specific Populations (AFIPE) Research Group, Faculty of Physical Activity and Sports Sciences-Facultad de Ciencias de la Actividad Física y el Deporte, Technical University of Madrid, Madrid, Spain
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  • Carmina Lopez
    Affiliations
    Physical Activity and Sports in Specific Populations (AFIPE) Research Group, Faculty of Physical Activity and Sports Sciences-Facultad de Ciencias de la Actividad Física y el Deporte, Technical University of Madrid, Madrid, Spain
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  • Javier Coteron
    Affiliations
    Physical Activity and Sports in Specific Populations (AFIPE) Research Group, Faculty of Physical Activity and Sports Sciences-Facultad de Ciencias de la Actividad Física y el Deporte, Technical University of Madrid, Madrid, Spain
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  • Michelle F. Mottola
    Correspondence
    Corresponding author: Michelle F. Mottola, PhD, FACSM.
    Affiliations
    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, University of Western Ontario, London, Ontario, Canada
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Published:December 16, 2015DOI:https://doi.org/10.1016/j.ajog.2015.11.039

      Background

      The prevalence of all pregnancies with some form of hypertension can be up to 10%, with the rates of diagnosis varying according to the country and population studied and the criteria used to establish the diagnosis. Prepregnancy obesity and excessive gestational weight gain (GWG) of all body mass index (BMI) categories have been associated with maternal hypertensive disorders and linked to macrosomia (>4000 g) and low birthweight (<2500 g). No large randomized controlled trial with high adherence to an exercise program has examined pregnancy-induced hypertension and these associated issues. We investigated whether women adherent (≥80% attendance) to an exercise program initiated early showed a reduction in pregnancy-induced hypertension and excessive GWG in all prepregnancy BMI categories, and determined if maternal exercise protected against macrosomia and low birthweight.

      Objective

      We sought to examine the impact of a program of supervised exercise throughout pregnancy on the incidence of pregnancy-induced hypertension.

      Study Design

      A randomized controlled trial was used. Women were randomized into an exercise group (N = 382) or a control group (N = 383) receiving standard care. The exercise group trained 3 d/wk (50-55 min/session) from gestational weeks 9-11 until weeks 38-39. The 85 training sessions involved aerobic exercise, muscular strength, and flexibility.

      Results

      High attendance to the exercise program regardless of BMI showed that pregnant women who did not exercise are 3 times more likely to develop hypertension (odds ratio [OR], 2.96; 95% confidence interval [CI], 1.29–6.81, P = .01) and are 1.5 times more likely to gain excessive weight if they do not exercise (OR, 1.47; 95% CI, 1.06–2.03, P = .02). Pregnant women who do not exercise are also 2.5 times more likely to give birth to a macrosomic infant (OR, 2.53; 95% CI, 1.03–6.20, P = .04).

      Conclusion

      Maternal exercise may be a preventative tool for hypertension and excessive GWG, and may control offspring size at birth while reducing comorbidities related to chronic disease risk.

      Key words

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      References

        • Mustafa R.
        • Ahmed S.
        • Gupta A.
        • Venuto R.C.
        A comprehensive review of hypertension in pregnancy.
        J Pregnancy. 2012; 2012: 105918
        • American College Obstetricians Gynecologists
        Hypertension in pregnancy.
        Obstet Gynecol. 2013; 122: 1122-1131
        • Cortés Pérez S.
        • Pérez Milán F.
        • Gobernado Tejedor J.A.
        • Mora Cepeda P.
        Epidemiología de los estados hipertensivos del embarazo.
        Clin Invest Ginecol Obstet. 2009; 36: 132-139
        • Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC)
        ESC guidelines on the management of cardiovascular diseases during pregnancy.
        Eur Heart J. 2011; 32: 3147-3197
        • Abbas A.E.
        • Lester S.J.
        • Connolly H.
        Pregnancy and the cardiovascular system.
        Int J Cardiol. 2005; 98: 179-189
        • Brown C.M.
        • Garovic V.D.
        Mechanisms and management of hypertension in pregnant women.
        Curr Hypertens Rep. 2011; 13: 338-346
        • Roberts J.M.
        • Lain K.Y.
        Recent insights into the pathogenesis of pre-eclampsia.
        Placenta. 2002; 23: 359-372
        • Chandrasekaran S.
        • Levine L.
        • Durnwald C.
        • Elovitz M.A.
        • Srinivas S.K.
        Excessive weight gain and hypertensive disorders of pregnancy in the obese patient.
        J Matern Fetal Neonatal Med. 2015; 28: 964-968
        • O’Brien T.E.
        • Ray J.
        • Chan W.S.
        Maternal body mass index and the risk of preeclampsia: a systematic overview.
        Epidemiology. 2003; 14: 368-374
        • He Y.
        • Wen S.
        • Tan H.
        • et al.
        Study on the influence of pregnancy-induced hypertension on neonatal birth weight and its interaction with other factors.
        Zhonghua Liu Xing Bing Xue Za Zhi. 2014; 35: 397-400
        • Alves E.
        • Azevedo A.
        • Rodrigues T.
        • Santos A.C.
        • Barros H.
        Impact of risk factors on hypertensive disorders in pregnancy, in primiparae and multiparae.
        Ann Hum Biol. 2013; 40: 377-384
        • Martin C.L.
        • Huber L.
        Physical activity and hypertensive complications during pregnancy: findings from 2004 to 2006 North Carolina Pregnancy Risk Assessment Monitoring System.
        Birth. 2010; 37: 202-210
        • Sorensen T.K.
        • Williams M.A.
        • Lee I.M.
        • Dashow E.E.
        • Thompson M.L.
        • Luthy D.A.
        Recreational physical activity during pregnancy and risk of preeclampsia.
        Hypertension. 2003; 41: 1273-1280
        • Saftlas A.F.
        • Logsden-Sackett N.
        • Wang W.
        • Woolson R.
        • Bracken M.B.
        Work, leisure-time physical activity, and risk of preeclampsia and gestational hypertension.
        Am J Epidemiol. 2004; 160: 758-765
        • Rudra C.B.
        • Sorensen T.K.
        • Luthy D.A.
        • Williams M.A.
        A prospective analysis of recreational physical activity and preeclampsia risk.
        Med Sci Sports Exerc. 2008; 40: 1581-1588
        • Genest D.S.
        • Falcao S.
        • Gutkowska J.
        • Lavoie J.L.
        Impact of exercise training on preeclampsia: potential preventive mechanisms.
        Hypertension. 2012; 60: 1104-1109
        • Kasawara K.T.
        • Nascimento S.
        • Costa M.L.
        • Surita F.
        • Silva L.
        Exercise and physical activity in the prevention of pre-eclampsia: systematic review.
        Acta Obstet Gynecol Scand. 2012; 91: 1147-1157
        • Meher S.
        • Duley L.
        Exercise or other physical activity for preventing preeclampsia and its complications (review).
        Cochrane Database Syst Rev. 2006 Apr 19; (Review. PMID: 16625645): CD005942
        • American College Obstetricians Gynecologists
        Exercise during pregnancy and the postpartum period. ACOG Committee opinion no. 267, January 2002 (reaffirmed 2009).
        Obstet Gynecol. 2002; 99: 171-173
        • O'Neill M.E.
        • Cooper K.A.
        • Mills C.M.
        • Boyce E.S.
        • Hunyor S.N.
        Accuracy of Borg's ratings of perceived exertion in the prediction of heart rates during pregnancy.
        Br J Sports Med. 1992; 26: 121-124
        • Institute of Medicine
        Weight gain during pregnancy: reexamining the guidelines.
        National Academies Press, Washington (DC)2009 (324)
        • Stetzer B.P.
        • Thomas A.
        • Amini S.B.
        • Catalano P.M.
        Neonatal anthropometric measurements to predict birth weight by ultrasound.
        J Perinatol. 2002; 22: 397-402
        • Moher D.
        • Dulberg C.S.
        • Wells G.A.
        Statistical power, sample size, and their reporting in randomized controlled trials.
        JAMA. 1994; 272: 122-124
        • Schulz K.F.
        • Grimes D.A.
        Sample size calculations in randomized trials: mandatory and mystical.
        Lancet. 2005; 365: 1348-1353
        • Yeo S.
        Prenatal stretching exercise and autonomic responses: preliminary data and a model for reducing preeclampsia.
        J Nurs Scholarsh. 2010; 42: 113-121
        • Ruchat S.M.
        • Davenport M.H.
        • Giroux I.
        • et al.
        Walking program of low or vigorous intensity during pregnancy confers an aerobic benefit.
        Int J Sports Med. 2012; 33: 661-666
        • Falcao S.
        • Bisotto S.
        • Michel C.
        • et al.
        Exercise training can attenuate preeclampsia-like features in an animal model.
        J Hypertension. 2010; 28: 2446-2453
        • Ruchat S.M.
        • Davenport M.H.
        • Giroux I.
        • et al.
        Nutrition and exercise reduce excessive weight gain in normal weight pregnant women.
        Med Sci Sports Exerc. 2012; 44: 1419-1426
        • Ruiz J.R.
        • Perales M.
        • Pelaez M.
        • Lopez C.
        • Lucia A.
        • Barakat R.
        Supervised exercise-based intervention to prevent excessive gestational weight gain: a randomized controlled trial.
        Mayo Clin Proc. 2013; 88: 1388-1397
        • Mottola M.F.
        • Giroux I.
        • Gratton R.
        • et al.
        Nutrition and exercise prevents excess weight gain in pregnant overweight women.
        Med Sci Sports Exerc. 2010; 42: 265-272
        • Barakat R.
        • Pelaez M.
        • Lopez C.
        • Montejo R.
        • Coteron J.
        Exercise during pregnancy reduces the rate of cesarean and instrumental deliveries: results of a randomized controlled trial.
        J Matern Fetal Neonatal Med. 2012; 25: 2372-2376
        • Polman R.
        • Kaiseler M.
        • Borkoles E.
        Effect of a single bout of exercise on the mood of pregnant women.
        J Sports Med Phys Fitness. 2007; 47: 103-111
        • Poudevigne M.S.
        • O'Connor P.J.
        Physical activity and mood during pregnancy.
        Med Sci Sports Exerc. 2005; 37: 1374-1380
        • Ferraro Z.M.
        • Gaudet L.
        • Adamo K.B.
        The potential impact of physical activity during pregnancy on maternal and neonatal outcomes.
        Obstet Gynecol Surv. 2012; 67: 99-110
        • Barakat R.
        • Pelaez M.
        • Montejo R.
        • Luaces M.
        • Zakynthinaki M.
        Exercise during pregnancy improves maternal health perception: a randomized controlled trial.
        Am J Obstet Gynecol. 2011; 204: 402.e1-402.e7
        • May L.E.
        • Suminski R.R.
        • Langaker M.D.
        • Yeh H.W.
        • Gustafson K.M.
        Regular maternal exercise dose and fetal heart outcome.
        Med Sci Sports Exerc. 2012; 44: 1252-1258
        • Oken E.
        • Kleinman K.P.
        • Belfort M.B.
        • Hammitt J.K.
        • Gillman M.W.
        Associations of gestational weight gain with short- and longer-term maternal and child health outcomes.
        Am J Epidemiol. 2009; 170: 173-180
        • Seiga-Riz A.M.
        • Evenson K.R.
        • Dole N.
        Pregnancy-related weight gain–a link to obesity?.
        Nutr Rev. 2004; 62: S105-S111
        • Schack-Neilsen L.
        • Michaelsen K.F.
        • Gamborg M.
        • Mortensen E.L.
        • Sørensen T.I.
        Gestational weight gain in relation to offspring body mass index and obesity from infancy through adulthood.
        Int J Obes (Lond). 2010; 34: 67-74
        • Ruchat S.M.
        • Mottola M.F.
        Preventing long-term risk of obesity for two generations: prenatal physical activity is part of the puzzle.
        J Pregnancy. 2012; 2012: 470247
        • Benyshek D.C.
        The developmental origins of obesity and related health disorders–prenatal and perinatal factors.
        Coll Antropol. 2007; 31: 11-17
        • Lee B.E.
        • Ha M.
        • Park H.
        • et al.
        Psychosocial work stress during pregnancy and birthweight.
        Paediatr Perinat Epidemiol. 2011; 25: 246-254