Background
Vaginal delivery for the first birth is of great importance for further obstetric
performance for the individual woman. Given the rising cesarean delivery rates worldwide
over the past decades, a search for modifiable factors that are associated with cesarean
delivery is needed. Exercise may be a modifiable factor that is associated with type
of delivery, but the results of previous studies are not conclusive.
Objective
The purpose of this study was to investigate the association between exercise during
pregnancy and cesarean delivery, both acute and elective, in nulliparous women.
Study Design
We conducted a population-based cohort study that involved 39,187 nulliparous women
with a singleton pregnancy who were enrolled in the Norwegian Mother and Child Cohort
Study between 2000 and 2009. All women answered 2 questionnaires in pregnancy weeks
17 and 30. Acute and elective cesarean delivery data were obtained from the Medical
Birth Registry of Norway. Information on exercise frequency and type was assessed
prospectively by questionnaires in pregnancy weeks 17 and 30. Generalized linear models
estimated risk differences of acute and elective cesarean delivery for different frequencies
and types of exercise during pregnancy weeks 17 and 30. We used restricted cubic splines
to examine dose-response associations of exercise frequency and acute cesarean delivery.
A test for nonlinearity was also conducted.
Results
The total cesarean delivery rate was 15.4% (n=6030), of which 77.8% (n=4689) was acute
cesarean delivery. Exercise during pregnancy was associated with a reduced risk of
cesarean delivery, particularly for acute cesarean delivery. A nonlinear association
was observed for exercise frequency in weeks 17 and 30 and risk of acute cesarean
delivery (test for nonlinearity, P=.003 and P=.027, respectively). The largest risk reduction was observed for acute cesarean delivery
among women who exercised >5 times weekly during weeks 17 (–2.2%) and 30 (–3.6%) compared
with nonexercisers (test for trend, P<.001). Reporting high impact exercises in weeks 17 and 30 was associated with the
greatest reduction in risk of acute cesarean delivery (–3.0% and –3.4%, respectively).
Conclusion
Compared with nonexercisers, regular exercise and high-impact exercises during pregnancy
are associated with reduced risk of having an acute cesarean delivery in first-time
mothers.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Obstetrics & GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Regional variation in the cesarean delivery and assisted vaginal delivery rates.Obstet Gynecol. 2010; 115: 1201-1208
- Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004-2008 WHO Global Survey on Maternal and Perinatal Health.BMC Med. 2010; 8: 71
- Delivery after previous cesarean: long-term maternal outcomes.Semin Perinatol. 2010; 34: 258-266
- Birth after previous cesarean delivery: short-term maternal outcomes.Semin Perinatol. 2010; 34: 249-257
- Cesarean delivery and subsequent pregnancies.Obstet Gynecol. 2008; 111: 1327-1334
- Objectively recorded physical activity and the association with gestational diabetes.Scand J Med Sci Sports. 2014; 24: e389-e397
- Recreational physical activity and the risk of preeclampsia: a prospective cohort of Norwegian women.Am J Epidemiol. 2008; 168: 952-957
- Physical activity and the risk of preeclampsia: a systematic review and meta-analysis.Epidemiology. 2014; 25: 331-343
- Association between regular exercise and excessive newborn birth weight.Obstet Gynecol. 2009; 114: 770-776
- Poor uterine contractility in obese women.BJOG. 2007; 114: 343-348
- Effects of aerobic and strength conditioning on pregnancy outcomes.Am J Obstet Gynecol. 1987; 157: 1199-1203
- Exercise during pregnancy and type of delivery in nulliparae.J Obstet Gynecol Neonatal Nurs. 2000; 29: 258-264
- Type of delivery is not affected by light resistance and toning exercise training during pregnancy: a randomized controlled trial.Am J Obstet Gynecol. 2009; 201: 590.e1-590.e6
- 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
- Exercise during pregnancy and cesarean delivery: North Carolina PRAMS, 2004-2005.Birth. 2009; 36: 200-207
- Exposure analysis methods impact associations between maternal physical activity and cesarean delivery.J Phys Act Health. 2015; 12: 37-47
- Effect of physical activity during pregnancy on mode of delivery.Am J Obstet Gynecol. 2014; 211: 401.e1-401.e11
- Cohort profile: the Norwegian Mother and Child Cohort Study (MoBa).Int J Epidemiol. 2006; 35: 1146-1150
- The Medical Birth Registry of Norway: epidemiological research and surveillance throughout 30 years.Acta Obstet Gynecol Scand. 2000; 79: 435-439
- Self-selection and bias in a large prospective pregnancy cohort in Norway.Paediatr Perinat Epidemiol. 2009; 23: 597-608
- Changes in frequency and indications for cesarean section in Norway 1967-1984.Acta Obstet Gynecol Scand. 1989; 68: 589-593
- Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research.Public Health Rep. 1985; 100: 126-131
- Validation of self-reported recreational exercise in pregnant women in the Norwegian Mother and Child Cohort Study.Scand J Med Sci Sports. 2010; 20: e48-e55
- Reducing bias through directed acyclic graphs.BMC Med Res Methodol. 2008; 8: 70
- A procedure to tabulate and plot results after flexible modeling of a quantitative covariate.Stata J. 2011; 11: 1-29
- Birth complications, overweight, and physical inactivity.Acta Obstet Gynecol Scand. 2009; 88: 550-555
- Antepartum, intrapartum, and neonatal significance of exercise on healthy low-risk pregnant working women.Obstet Gynecol. 2002; 99: 466-472
- The physical work capacity of the expectant mother and its effect on pregnancy, labor and the newborn.Int J Gynaecol Obstet. 1976; 14: 153-159
- Maternal aerobic exercise: newborn effects.Fam Pract Res J. 1991; 11: 387-393
- Pregnancy outcomes among active and sedentary primiparous women.J Obstet Gynecol Neonatal Nurs. 1996; 25: 49-54
- Effects of exercise during pregnancy on mode of delivery: a meta-analysis.Acta Obstet Gynecol Scand. 2015; 94: 1039-1047
- Adherence to ACOG guidelines on exercise during pregnancy: effect on pregnancy outcome.J Obstet Gynecol Neonatal Nurs. 1993; 22: 329-335
- The course of labor after endurance exercise during pregnancy.Am J Obstet Gynecol. 1990; 163: 1799-1805
- Lack of progress in labor as a reason for cesarean.Obstet Gynecol. 2000; 95: 589-595
- Abnormalities of the first and second stages of labor.Obstet Gynecol Clin North Am. 2005; 32 (viii): 201-220
- Risk indicators for dystocia in low-risk nulliparous women: a study on lifestyle and anthropometrical factors.J Obstet Gynaecol. 2010; 30: 25-29
- Effect of antenatal pelvic floor muscle training on labor and birth.Obstet Gynecol. 2009; 113: 1279-1284
- Proposed biological linkages between obesity, stress, and inefficient uterine contractility during labor in humans.Med Hypotheses. 2011; 76: 755-760
- Parturition dysfunction in obesity: time to target the pathobiology.Reprod Biol Endocrinol. 2015; 13: 135
- Review of impacts of physical activity on maternal metabolic health during pregnancy.Curr Diabetes Rep. 2015; 15: 572
- Correlates of regular exercise during pregnancy: the Norwegian Mother and Child Cohort Study.Scand J Med Sci Sports. 2009; 19: 637-645
- Correlates of absolute and excessive weight gain during pregnancy.J Womens Health (Larchmt). 2009; 18: 1559-1566
- Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis.Obes Rev. 2009; 10: 194-203
- Exercise during pregnancy, maternal prepregnancy body mass index, and birth weight.Obstet Gynecol. 2010; 115: 331-337
- Indications for cesarean deliveries in Norway.Am J Obstet Gynecol. 2003; 188: 864-870
- Changed indications for cesarean sections.Acta Obstet Gynecol Scand. 2010; 89: 49-53
Article info
Publication history
Published online: August 21, 2016
Accepted:
August 9,
2016
Received in revised form:
August 2,
2016
Received:
June 23,
2016
Footnotes
Supported by the Norwegian Ministry of Health and the Ministry of Education and Research, NIH/NIEHS (contract no N01-ES-75558), NIH/NINDS (grant no.1 UO1 NS 047537-01 and grant no. 2 UO1 NS 047537-06A1).
None of the funding sources have taken part in the design and conduct of the study; collection, analysis, or interpretation of the data; and preparation, review, or approval of manuscript.
The authors report no conflict of interest.
Cite this article as: Owe KM, Nystad W, Stigum H, et al. Exercise during pregnancy and risk of cesarean delivery in nulliparous women: a large population-based cohort study. Am J Obstet Gynecol 2016;215:791.e1-13.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
