Clinical Practice Guidelines That Address Physical Activity and Exercise During Pregnancy: A Systematic Review

Abstract

Introduction Physical activity is recommended for healthy pregnant women. Clinical practice guidelines vary with regard to initial time, duration, or type of physical activity that is recommended, which is confusing for health care professionals and pregnant women alike. This study aimed to appraise clinical guidelines relevant to physical activity for pregnant women and summarize consensus and discrepant recommendations. Methods The websites of organizations that develop guidelines including those of obstetricians, gynecologists, midwives, and medical sports associations were searched in addition to 9 literature databases for the period from January 2010 through November 2020. Guidelines were included if they were published in a journal or on a website in English or Chinese; were labeled as a recommendation guideline, position paper, practice parameter, or consensus statement; and addressed physical activity for pregnant women. Two authors independently extracted recommendations. Four reviewers independently assessed guideline quality using the AGREE II instrument. Results Thirteen guidelines met the inclusion criteria. The guidelines developed by the World Health Organization and the National Institute for Health and Clinical Excellence were deemed to have the highest methodological quality. The recommendations were consistent with regard to recommended exercise duration, frequency, intensity, and type of physical activity. The main discrepant recommendations included best tools for conducting pre‐exercise screening and assessing intensity of exertion. Guidelines also differ on optimal heart rate during exercise, when in pregnancy to initiate an exercise regimen, and duration or frequency of strengthening exercises. Discussion Of the 13 guidelines, 2 were found to have good methodological quality. The recommendations that were consistent across the differing guidelines can support health care providers in counseling women about physical activity during pregnancy. The recommendations that are discrepant among these guidelines may contribute to confusion and a reluctance to recommend exercise during pregnancy. Research is needed to clarify discrepant recommendations.

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“…The limitation of this study is that the PA level will be evaluated by a questionnaire without objective equipment. Guidelines about PA for pregnant women recommend subjective assessments as the first choice to evaluate exercise status as they are handy and personalized [ 18 ]. We will ask our study participants to keep an exercise diary, including comments on walk steps and their feelings while exercising.…”

“…Women will be excluded from this study if they have an exercise contraindication [ 18 ], such as severe cardiac or respiratory diseases, severe preeclampsia, uncontrolled hypertension, thyroid disease, type 1 diabetes, cervical insufficiency, persistent vaginal bleeding, threatened prematurity, placenta previa, ruptured membranes, poorly controlled anemia, fetal growth restriction, multiple pregnancies (≥ 3), bone or joint problems, severe obesity (body mass index > 35 kg/m 2 ); are participating in other antenatal PA programs; or are currently being treated with metformin or corticosteroids.…”

“…Adherence to the PA intervention will be strongly emphasized and registered in the women’s training diaries and reports from the individuals leading the training groups. Exercise participants who develop obstetric contraindications to exercise [ 18 ] will discontinue the exercise intervention but be included in the intention-to-treat analysis.…”

“…Furthermore, women with regular PA during pregnancy were more likely to give birth vaginally and less likely to have preeclampsia, gestational hypertension, excessive gestational weight gain, postpartum weight retention, or postpartum depression [ 14 – 17 ]. Thirteen clinical practice guidelines consistently recommend that all healthy pregnant women perform 150 min of moderate PA per week [ 18 ]. However, researchers have found that PA in women decreases from pre-pregnancy to pregnancy [ 19 ].…”

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“…The relationship between exercise for mothers without contraindications during pregnancy and maternal, fetal, and newborn wellbeing has been previously illustrated in the international guidelines [ 53 , 54 , 55 ]. All recommendations base an active lifestyle during pregnancy on 30 min of moderate exercise for five days a week [ 53 , 54 , 55 ], although there is a great variety among the physical exercise programs used in previous studies [ 56 ].…”