The impact of physical activity during pregnancy on labor and delivery


      Physical activity in pregnancy is associated with decreased risks of adverse pregnancy outcomes such as gestational diabetes and preeclampsia. However, the relationship between the amount and type of physical activity during pregnancy and subsequent labor outcomes remains unclear.


      This study aimed to test the hypothesis that higher levels of physical activity across different lifestyle domains in pregnancy are associated with a shorter duration of labor.

      Study Design

      This study is a secondary analysis of a prospective cohort study in which patients with singleton pregnancies without a major fetal anomaly were administered the Kaiser Physical Activity Survey in each trimester. The Kaiser Physical Activity Survey was designed specifically to quantify various types of physical activities in women and includes 4 summative indices—housework/caregiving, active living habits, sports, and occupation. The study included women at full-term gestations admitted for induction of labor or spontaneous labor. The primary outcome of this analysis was duration of the second stage of labor. Secondary outcomes were duration of the active stage, prolonged first and second stage, mode of delivery, rates of second-stage cesarean delivery, operative vaginal delivery, severe perineal lacerations, and postpartum hemorrhage. These outcomes were compared between patients with and without high physical activity levels, defined as overall Kaiser Physical Activity Survey score ≥75th percentile in the third trimester. Multivariable logistic regression was used to adjust for obesity and epidural use. In addition, a subgroup analysis of nulliparous patients was performed.


      A total of 811 patients with complete Kaiser Physical Activity Survey data in the third trimester were included in this analysis. The median Kaiser Physical Activity Survey score was 9.5 (8.2–10.8). Of the 811 patients, 203 (25%) had higher levels of physical activity in pregnancy. There was no difference in the duration of the second stage of labor between patients with and without higher physical activity levels (1.29±2.94 vs 0.97±2.08 hours; P=.15). The duration of active labor was significantly shorter in patients with higher levels of physical activity (5.77±4.97 vs 7.43±6.29 hours; P=.01). Patients with higher physical activity levels were significantly less likely to have a prolonged first stage (9.8% vs 19.4%; P<.01; adjusted relative risk, 0.55; 95% confidence interval, 0.34–0.83). However, rates of prolonged second-stage cesarean delivery, operative vaginal deliveries, and perineal lacerations were similar between the 2 groups.


      Patients who are more physically active during pregnancy have a shorter duration of active labor.

      Key words

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        • Aune D.
        • Sen A.
        • Henriksen T.T.
        • Saugstad O.D.
        • Tonstad S.
        Physical activity and the risk of gestational diabetes mellitus: a systematic review and dose-response meta-analysis of epidemiological studies.
        Eur J Epidemiol. 2016; 31: 967-997
        • Dempsey J.C.
        • Butler C.L.
        • Sorensen T.K.
        • et al.
        A case-control study of maternal recreational physical activity and risk of gestational diabetes mellitus.
        Diabetes Res Clin Pract. 2004; 66: 203-215
        • 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
        • Marcoux S.
        • Brisson J.
        • Fabia J.
        The effect of leisure time physical activity on the risk of pre-eclampsia and gestational hypertension.
        J Epidemiol Community Health. 1989; 43: 147-152
        • Currie L.M.
        • Woolcott C.G.
        • Fell D.B.
        • Armson B.A.
        • Dodds L.
        The association between physical activity and maternal and neonatal outcomes: a prospective cohort.
        Matern Child Health J. 2014; 18: 1823-1830
        • The American College of Obstetricians and Gynecologists
        Physical activity and exercise during pregnancy and the postpartum period.
        (Available at:) (Accessed November 16, 2020)
        • World Health Organization
        Physical activity.
        (Available at:) (Accessed November 16, 2020)
        • Perales M.
        • Calabria I.
        • Lopez C.
        • Franco E.
        • Coteron J.
        • Barakat R.
        Regular exercise throughout pregnancy is associated with a shorter first stage of labor.
        Am J Health Promot. 2016; 30: 149-154
        • Ghodsi Z.
        • Asltoghiri M.
        • Hajiloomohajerani M.
        Exercise and pregnancy: duration of labor stages and perinea tear rates.
        Procedia Soc Behav Sci. 2012; 31: 441-445
        • Salvesen K.Å.
        • Stafne S.N.
        • Eggebø T.M.
        • Mørkved S.
        Does regular exercise in pregnancy influence duration of labor? A secondary analysis of a randomized controlled trial.
        Acta Obstet Gynecol Scand. 2014; 93: 73-79
        • Masoud A.T.
        • AbdelGawad M.M.
        • Elshamy N.H.
        • et al.
        The effect of antenatal exercise on delivery outcomes: a systematic review and meta-analysis of randomized controlled trials.
        J Gynecol Obstet Hum Reprod. 2020; 49: 101736
        • Schmidt M.D.
        • Freedson P.S.
        • Pekow P.
        • Roberts D.
        • Sternfeld B.
        • Chasan-Taber L.
        Validation of the Kaiser Physical Activity Survey in pregnant women.
        Med Sci Sports Exerc. 2006; 38: 42-50
        • Schuster S.
        • Šklempe Kokić I.
        • Sindik J.
        Measuring physical activity in pregnancy using questionnaires: a meta-analysis.
        Acta Clin Croat. 2016; 55: 440-452
        • Harrison M.S.
        • Ali S.
        • Pasha O.
        • et al.
        A prospective population-based study of maternal, fetal, and neonatal outcomes in the setting of prolonged labor, obstructed labor and failure to progress in low- and middle-income countries.
        Reprod Health. 2015; 12: S9
        • The American College of Obstetricians and Gynecologists
        Safe prevention of the primary cesarean delivery.
        (Available at:)
        • Zhang J.
        • Yu K.F.
        What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes.
        JAMA. 1998; 280: 1690-1691
        • Barakat R.
        • Franco E.
        • Perales M.
        • López C.
        • Mottola M.F.
        Exercise during pregnancy is associated with a shorter duration of labor. A randomized clinical trial.
        Eur J Obstet Gynecol Reprod Biol. 2018; 224: 33-40
        • Beckmann C.R.
        • Beckmann C.A.
        Effect of a structured antepartum exercise program on pregnancy and labor outcome in primiparas.
        J Reprod Med. 1990; 35: 704-709
        • Ashton-Miller J.A.
        • DeLancey J.O.L.
        On the biomechanics of vaginal birth and common sequelae.
        Annu Rev Biomed Eng. 2009; 11: 163-176
        • Li X.
        • Kruger J.A.
        • Nash M.P.
        • Nielsen P.M.F.
        Effects of nonlinear muscle elasticity on pelvic floor mechanics during vaginal childbirth.
        J Biomech Eng. 2010; 132: 111010
        • Gachon B.
        • Fritel X.
        • Pierre F.
        • Nordez A.
        In vivo assessment of the elastic properties of women’s pelvic floor during pregnancy using shear wave elastography: design and protocol of the ELASTOPELV study.
        BMC Musculoskelet Disord. 2020; 21: 305
        • Horsley K.
        Fitness in childbearing years.
        in: Sapsford R. Bullock-Saxton J. Markwell S. Women’s Press’ Health. A textbook for physiotherapists. WB Saunders Company Ltd, London (United Kingdom of Great Britain and Northern Ireland)1998: 168-191
        • Raadgers M.
        • Ramkers M.J.
        • van Lunsen R.H.W.
        Treatment of sexual and pelvic floor dysfunction.
        in: Carriere B. Feldt C.M. The pelvic floor. Thieme Verlag, New York (NY)2006
        • Artal R.
        • O'Toole M.
        Guidelines for the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period.
        Br J Sports Med. 2003; 37: 6-12
        • Bø K.
        • Fleten C.
        • Nystad W.
        Effect of antenatal pelvic floor muscle training on labor and birth.
        Obstet Gynecol. 2009; 113: 1279-1284
        • Spinnewijn W.E.
        • Lotgering F.K.
        • Struijk P.C.
        • Wallenburg H.C.S.
        Fetal heart rate and uterine contractility during maternal exercise at term.
        Am J Obstet Gynecol. 1996; 174: 43-48
        • Artal R.
        Hormonal responses to exercise in pregnancy.
        in: Artal R. Wiswell R.A. Exercise in pregnancy. Williams & Wilkins, Baltimore (MD)1986: 727-730
        • Zhang J.
        • Bricker L.
        • Wray S.
        • Quenby S.
        Poor uterine contractility in obese women.
        BJOG. 2007; 114: 343-348
        • Smith R.D.
        • Babiychuk E.B.
        • Noble K.
        • Draeger A.
        • Wray S.
        Increased cholesterol decreases uterine activity: functional effects of cholesterol alteration in pregnant rat myometrium.
        Am J Physiol Cell Physiol. 2005; 288: C982-C988
        • Suhr F.
        • Gehlert S.
        • Grau M.
        • Bloch W.
        Skeletal muscle function during exercise-Fine-tuning of diverse subsystems by nitric oxide.
        Int J Mol Sci. 2013; 14: 7109-7139
        • Wray S.
        • Kupittayanant S.
        • Shmygol A.
        • Smith R.D.
        • Burdyga T.
        The physiological basis of uterine contractility: a short review.
        Exp Physiol. 2001; 86: 239-246
        • Yüksel O.
        • Ateş M.
        • Kızıldağ S.
        • et al.
        Regular aerobic voluntary exercise increased oxytocin in female mice: the cause of decreased anxiety and increased empathy-like behaviors.
        Balkan Med J. 2019; 36: 257-262
        • Irianti S.
        • Ginandjar A.B.
        • Krisnadi S.R.
        • Effendi J.S.
        • Nataprawira D.
        • Gandamihardja S.
        Aerobic exercise and its effect on oxytocin level and labor progression.
        IOP Conf Ser.: Mater Sci Eng. 2017; 180
        • Ferreira C.L.M.
        • Guerra C.M.L.
        • Silva A.I.T.J.
        • do Rosário H.R.V.
        • Pereira M.B.F.L.O.
        Exercise in pregnancy: the impact of an intervention program in the duration of labor and mode of delivery.
        Rev Bras Ginecol Obstet. 2019; 41: 68-75