Influence of prenatal exercise on the relationship between maternal overweight and obesity and select delivery outcomes

Abstract

Women with overweight or obesity (OWOB) have an increased risk of cesarean birth, preterm birth (PTB), and high birth weight infants. Although regular exercise decreases this risk in healthy weight women, these associations have not been explored in OWOB. Women were randomized at 13–16 weeks’ gestation to 150-min of moderate-intensity exercise (n = 131) or non-exercising control (n = 61). Delivery mode, gestational age (GA), and birth weight (BW) were obtained via electronic health records. Pregnant exercisers had no differences in risk of cesarean birth, PTB, or BW compared to control participants. OWOB exercisers had higher rates of cesarean birth (27.1% vs. 11.1%), trends of higher PTB (15.3% vs. 5.6%), but normal weight babies relative to normal weight exercisers. Controlling for race and body mass index (BMI), maternal exercise reduced the relative risk (RR) for cesarean birth from 1.63 to 1.43. Cesarean births predicted by pre-pregnancy BMI and fitness level, whereas BW was predicted by race, gestational weight gain (GWG), pre-pregnancy fitness level, and exercise level. Cesarean birth was predicted by pre-pregnancy BMI and fitness level, while maternal exercise reduced the magnitudes of the relative risks of cesarean birth. Maternal exercise, pre-pregnancy fitness level, and GWG predict neonatal BW.Trial Registration: Influence of Maternal Exercise on Infant Skeletal Muscle and Metabolomics-#NCT03838146, 12/02/2019, https://register.clinicaltrials.gov/prs/app/template/EditRecord.vm?epmode=Edit&listmode=Edit&uid=U0003Z0X&ts=8&sid=S0008FWJ&cx=77ud1i.

Exercise FITT‐V during pregnancy: Association with birth outcomes

“…These findings support that exercise, in general, during pregnancy increases the exchange capability of the placenta, thus enhancing nutrients to the fetus. Overall, our findings suggest that 450 MET⋅min/week prenatal exercise is safe for birth and placental outcomes, while higher prenatal exercise volume has been associated with improved birth outcomes (Claiborne, Jevtovic, & May, 2023; Clapp et al, 2002; Duncombe et al, 2006; Hatch et al, 1998; McDonald et al, 2018, 2022; Takami et al, 2018).…”

The effects of exercise intervention on complications and pregnancy outcomes in pregnant women with overweight or obesity: A systematic review and meta-analysis

“…Finally, after reading the whole content, 22 articles were incorporated. [19–40] Figure 1 presents the literature screening flow chart. Table 1 shows the basic features and assessment of the analyzed articles’ quality.…”

A narrative review of exercise dose during pregnancy

“…Aerobic prenatal exercise improves maternal and infant markers of metabolic (Clark et al, 2019; McDonald et al, 2020; McDonald, Strom, et al, 2021; Strom et al, 2022a, 2022b) and cardiovascular health (May et al, 2010; May et al, 2012; May, Scholtz, Suminski, & Gustafson, 2014). Resistance exercise has been shown as safe (Hall & Kaufmann, 1987; Journal of Science and Medicine in Sport , 2002), and is equally effective for reducing fasting glucose and insulin requirement, especially in women with overweight or obesity (McDonald et al, 2022). Aerobic, Concurrent, and Resistance exercise improves maternal blood pressure compared to no exercise; however, resistance exercise offers more efficacy for maintaining healthy maternal blood pressure during pregnancy (Murphy et al, 2022).…”

“…Prenatal exercise also reduces labor duration (Beckmann & Beckmann, 1990; Botkin & Driscoll, 1991; Salvesen & Mørkved, 2004; Veisy et al, 2021), pain, the acute stress in delivery (Varrassi et al, 1989) and is associated with improved pregnancy outcomes (Clapp & Dickstein, 1984; Gascoigne et al, 2023; Jarrett & Spellacy, 1983; Latka et al, 1999; Lokey et al, 1991; Schlüssel et al, 2008; Wolfe, Brenner, & Mottola, 1994). Prenatal exercisers also tend to undergo fewer delayed or operative deliveries (Bungum et al, 2000; Clapp, 1990; Davenport, Ruchat, et al, 2019; McDonald et al, 2022; Salvesen & Mørkved, 2004; Veisy et al, 2021). Related to maternal health and well‐being, large observational studies and reviews show that women who continue or begin to exercise during pregnancy maintain a healthy weight and normal pregnancy outcomes (Clapp & Dickstein, 1984; Kramer, 2002; Kulpa et al, 1987; Latka et al, 1999; Lynch et al, 2007; Sibley et al, 1981; Sternfeld, 1997).…”

“…However, the ACOG guidelines limit discussion of initial fitness testing and suggest more research is needed to elucidate effects of exercise FITT‐V during pregnancy (American College of Obstetricians and Gynecologists, 2020). Recent works suggest there may be a dose‐dependent effect of prenatal exercise on maternal and offspring health (Allman et al, 2022; Chaves et al, 2022; Davenport et al, 2022; Jevtovic et al, 2023; McDonald et al, 2022; McDonald, May, et al, 2021; Murphy et al, 2022), necessitating further investigation into the five metrics of exercise training, “FITT‐V”: Frequency (number of sessions), Intensity (metabolic equivalents “METs”), Time (duration of sessions), Type (exercise mode), Volume (exercise MET*mins). Although there continues to be a lack of randomized controlled trials addressing exercise dose during pregnancy (Beetham et al, 2019; Bell & Palma, 2000; Stevenson, 1997a), and the lack of standardized protocols limits the power of meta‐analyses (Skow et al, 2019), there are many studies from which we can inform us of the influence of exercise dose on health outcomes for mother and child.…”