Exercise in Pregnancy and Children’s Cardiometabolic Risk Factors: a Systematic Review and Meta-Analysis

Abstract

BackgroundMaternal metabolic health during the prenatal period is an established determinant of cardiometabolic disease risk. Many studies have focused on poor offspring outcomes after exposure to poor maternal health, while few have systematically appraised the evidence surrounding the role of maternal exercise in decreasing this risk.The aim of this study is to characterize and quantify the specific impact of prenatal exercise on children’s cardiometabolic health markers, at birth and in childhood.MethodsA systematic review of Scopus, MEDLINE, EMBASE, CENTRAL, CINAHL, and SPORTDiscus up to December 2017 was conducted.Randomized controlled trials (RCTs) and prospective cohort studies of prenatal aerobic exercise and/or resistance training reporting eligible offspring outcomes were included.Four reviewers independently identified eligible citations and extracted study-level data. The primary outcome was birth weight; secondary outcomes, specified a priori, included large-for-gestational age status, fat and lean mass, dyslipidemia, dysglycemia, and blood pressure. We included 73 of the 9804 citations initially identified. Data from RCTs was pooled using random effects models. Statistical heterogeneity was quantified using the I2 test. Analyses were done between June and December 2017 and the search was updated in December 2017.ResultsFifteen observational studies (n = 290,951 children) and 39 RCTs (n = 6875 children) were included. Observational studies were highly heterogeneous and had discrepant conclusions, but globally showed no clinically relevant effect of exercise on offspring outcomes. Meta-analyzed RCTs indicated that prenatal exercise did not significantly impact birth weight (mean difference [MD] − 22.1 g, 95% confidence interval [CI] − 51.5 to 7.3 g, n = 6766) or large-for-gestational age status (risk ratio 0.85, 95% CI 0.51 to 1.44, n = 937) compared to no exercise. Sub-group analyses showed that prenatal exercise reduced birth weight according to timing (starting after 20 weeks of gestation, MD − 84.3 g, 95% CI − 142.2, − 26.4 g, n = 1124), type of exercise (aerobic only, MD − 58.7 g, 95% CI − 109.7, − 7.8 g; n = 2058), pre-pregnancy activity status (previously inactive, MD − 34.8 g, 95% CI − 69.0, − 0.5 g; n = 2829), and exercise intensity (light to moderate intensity only, MD − 45.5 g, 95% CI − 82.4, − 8.6 g; n = 2651). Fat mass percentage at birth was not altered by prenatal exercise (0.19%, 95% CI − 0.27, 0.65%; n = 130); however, only two studies reported this outcome. Other outcomes were too scarcely reported to be meta-analyzed.ConclusionsPrenatal exercise does not causally impact birth weight, fat mass, or large-for-gestational-age status in a clinically relevant way. Longer follow up of offspring exposed to prenatal exercise is needed along with measures of relevant metabolic variables (e.g., fat and lean mass).Protocol RegistrationProtocol registration number: CRD42015029163.Electronic supplementary materialThe online version of this article (10.1186/s40798-018-0148-x) contains supplementar...

The Effectiveness of Smoking Cessation, Alcohol Reduction, Diet and Physical Activity Interventions in Improving Maternal and Infant Health Outcomes: A Systematic Review of Meta-Analyses

“…Fifty-six were excluded as they did not report meta-analysis of health-related outcomes, leaving 65 which met the inclusion criteria and were included in this review ( Table S5 ). There were 63 [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , ...…”

“…Out of the 63 included reviews that reported interventions with different diet- and/or physical-activity-related components, 19 reported effectiveness data for diet-only interventions [ 30 , 35 , 39 , 40 , 42 , 44 , 45 , 51 , 52 , 55 , 62 , 63 , 65 , 67 , 69 , 82 , 85 , 89 , 90 ], 37 reported data for physical-activity-only interventions [ 33 , 36 , 38 , 39 , 42 , 46 , 47 , 48 , 49 , 51 , 52 , 53 , 54 , 55 , 59 , 62 , 66 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 78 , 80 , 81 , 82 , 83 , 84 ,…”

“…The effectiveness of interventions on increasing or decreasing birth weight was reported by 30 systematic reviews [ 28 , 29 , 36 , 39 , 40 , 41 , 43 , 44 , 45 , 50 , 51 , 52 , 53 , 54 , 56 , 57 , 58 , 59 , 60 , 63 , 65 , 66 , 67 , 68 , 75 , 76 , 78 , 87 , 91 , 92 ] and 45 meta-analyses ( n = 6 smoking, n = 14 diet and/or physical activity, n = 9 diet only, n = 16 physical activity only, Table S13a ). All meta-analyses of smoking cessation interventions had a direction of effect towards interventions to increase birthweight, and the majority (four out of six) showed a statistically significant increase (ranging from MD 0.28 g (95% CI 0.05, 0.50) [ 92 ] to 134.58 g (95% CI 76.32, 192.83) [ 91 ]) ( Figure 10 ).…”

“…However, there was no consistent direction of effect, and limited significant findings among meta-analyses of the different categories of diet and physical activity interventions. Six meta-analyses showed a significantly reduced birthweight (ranging from WMD −31 g (95% CI −57 to −4) [ 87 ] to MD −0.84 g (95% CI −1.16, −0.52) [ 40 ], one significantly increased (SMD 0.19 (95% CI 0.06, 0.31) [ 67 ]), and 32 meta-analyses were not statistically significant (ranging from MD −151.08 g (95% CI −528.90, 226.73) [ 76 ] to MD 28.24 g (95% CI −78.26, 134.74) [ 29 ]. Thirteen meta-analyses were restricted to specific BMI groups, and none were significant for any intervention type.…”

Effect of Adherence to Mediterranean Diet during Pregnancy on Children’s Health: A Systematic Review

“…Obesity and metabolic syndrome (MetS) are two of the most common chronic diseases among children. Recent evidence suggests these conditions have their roots in utero as maternal obesity, dyslipidaemia, and hyperglycaemia are associated with child cardiometabolic health and developing insulin resistance and obesity later in life [85,86]. Although studies considered in this review indicate that higher adherence to the MD during pregnancy is a potential protective factor against abdominal obesity [73,74] and positively influences lipoprotein and homocysteine concentration [76], and insulin resistance in new-borns [70], the use of different endpoints to evaluate outcomes reduces the level of evidence.…”