Exercise in pregnancy!
2017; Elsevier BV; Volume: 216; Issue: 4 Linguagem: Inglês
10.1016/j.ajog.2017.01.023
ISSN1097-6868
AutoresVincenzo Berghella, Gabriele Saccone,
Tópico(s)Bariatric Surgery and Outcomes
ResumoRelated article, page 340. Related article, page 340. In this issue of the American Journal of Obstetrics and Gynecology, Wang et al1Wang C. Wei Y. Zhang X. et al.A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women.Am J Obstet Gynecol. 2017; 216: 340-351Abstract Full Text Full Text PDF PubMed Scopus (209) Google Scholar report results from a randomized controlled trial (RCT) on exercise in pregnancy. They found that cycling exercises initiated at <13 weeks gestation that are performed no <30 minutes 3 times per week until 37 weeks gestation significantly reduced the incidence of gestational diabetes mellitus (GDM) and gestational weight gain at 50 RCTs published on exercise in pregnancy. These have been summarized in several metaanalyses.2Di Mascio D. Magro-Malosso E.R. Saccone G. Marhefka G.D. Berghella V. Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials.Am J Obstet Gynecol. 2016; 215: 561-571Abstract Full Text Full Text PDF PubMed Scopus (134) Google Scholar, 3Magro-Malosso E.R. Saccone G. Di Mascio D. Di Tommaso M. Berghella V. Exercise during pregnancy and risk of preterm birth in overweight and obese women: a systematic review and meta-analysis of randomized controlled trials.Acta Obstet Gynecol Scand. 2016 Dec 28; ([Epub ahead of print.])https://doi.org/10.1111/aogs.13087Crossref PubMed Scopus (85) Google Scholar, 4Kramer M.S. McDonald S.W. Aerobic exercise for women during pregnancy.Cochrane Database Syst Rev. 2006; 3: CD000180PubMed Google Scholar, 5Han S. Middleton P. Crowther C.A. Exercise for pregnant women for preventing gestational diabetes mellitus.Cochrane Database Syst Rev. 2012; 7: CD009021PubMed Google Scholar, 6Ceysens G. Rouiller D. Boulvain M. Exercise for diabetic pregnant women.Cochrane Database Syst Rev. 2006; 3: CD004225Google Scholar, 7Meher S. Duley L. Exercise or other physical activity for preventing pre-eclampsia and its complications.Cochrane Database Syst Rev. 2006; 2: CD005942PubMed Google Scholar Often dietary counseling or other dietary interventions, which are beneficial by themselves, have been studied together with exercise,8Muktabhant B. Lawrie T.A. Lumbiganon P. Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy.Cochrane Database Syst Rev. 2015; 6: CD007145Google Scholar, 9Bain E. Crane M. Tieu J. Han S. Crowther C.A. Middleton P. Diet and exercise interventions for preventing gestational diabetes mellitus.Cochrane Database Syst Rev. 2015; 4: CD010443PubMed Google Scholar so it is important, as done by Wang et al,1Wang C. Wei Y. Zhang X. et al.A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women.Am J Obstet Gynecol. 2017; 216: 340-351Abstract Full Text Full Text PDF PubMed Scopus (209) Google Scholar to focus on just exercise data when reviewing the previous literature. Two recent metaanalyses focused on just the effects of exercise on pregnancy outcomes.2Di Mascio D. Magro-Malosso E.R. Saccone G. Marhefka G.D. Berghella V. Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials.Am J Obstet Gynecol. 2016; 215: 561-571Abstract Full Text Full Text PDF PubMed Scopus (134) Google Scholar, 3Magro-Malosso E.R. Saccone G. Di Mascio D. Di Tommaso M. Berghella V. Exercise during pregnancy and risk of preterm birth in overweight and obese women: a systematic review and meta-analysis of randomized controlled trials.Acta Obstet Gynecol Scand. 2016 Dec 28; ([Epub ahead of print.])https://doi.org/10.1111/aogs.13087Crossref PubMed Scopus (85) Google Scholar A metaanalysis of 9 RCTs that included 2059 women with an uncomplicated, singleton pregnancy with normal body mass index showed that women who were assigned randomly to aerobic exercise had similar incidence of PTB, 49% lower incidences of GDM, 79% lower incidence of GHTN disorders, 18% lower incidence of cesarean delivery, and a 9% higher rate of vaginal delivery.2Di Mascio D. Magro-Malosso E.R. Saccone G. Marhefka G.D. Berghella V. Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials.Am J Obstet Gynecol. 2016; 215: 561-571Abstract Full Text Full Text PDF PubMed Scopus (134) Google Scholar A recent metaanalysis that focused, as in Wang et al,1Wang C. Wei Y. Zhang X. et al.A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women.Am J Obstet Gynecol. 2017; 216: 340-351Abstract Full Text Full Text PDF PubMed Scopus (209) Google Scholar on overweight or obese women included 9 RCTs and 1502 women and showed benefits of exercise in terms of a 38% lower rate of PTB and 39% lower rate of GDM (Table 1).3Magro-Malosso E.R. Saccone G. Di Mascio D. Di Tommaso M. Berghella V. Exercise during pregnancy and risk of preterm birth in overweight and obese women: a systematic review and meta-analysis of randomized controlled trials.Acta Obstet Gynecol Scand. 2016 Dec 28; ([Epub ahead of print.])https://doi.org/10.1111/aogs.13087Crossref PubMed Scopus (85) Google ScholarTable 1Benefits of exercise in pregnancyLower incidence of:Higher incidence of:Excessive gestational weight gain1Wang C. Wei Y. Zhang X. et al.A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women.Am J Obstet Gynecol. 2017; 216: 340-351Abstract Full Text Full Text PDF PubMed Scopus (209) Google Scholar, 8Muktabhant B. Lawrie T.A. Lumbiganon P. Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy.Cochrane Database Syst Rev. 2015; 6: CD007145Google ScholarVaginal delivery2Di Mascio D. Magro-Malosso E.R. Saccone G. Marhefka G.D. Berghella V. Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials.Am J Obstet Gynecol. 2016; 215: 561-571Abstract Full Text Full Text PDF PubMed Scopus (134) Google ScholarGestational diabetes mellitus1Wang C. Wei Y. Zhang X. et al.A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women.Am J Obstet Gynecol. 2017; 216: 340-351Abstract Full Text Full Text PDF PubMed Scopus (209) Google Scholar, 2Di Mascio D. Magro-Malosso E.R. Saccone G. Marhefka G.D. Berghella V. Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials.Am J Obstet Gynecol. 2016; 215: 561-571Abstract Full Text Full Text PDF PubMed Scopus (134) Google Scholar, 3Magro-Malosso E.R. Saccone G. Di Mascio D. Di Tommaso M. Berghella V. Exercise during pregnancy and risk of preterm birth in overweight and obese women: a systematic review and meta-analysis of randomized controlled trials.Acta Obstet Gynecol Scand. 2016 Dec 28; ([Epub ahead of print.])https://doi.org/10.1111/aogs.13087Crossref PubMed Scopus (85) Google ScholarGestational hypertensive disorders2Di Mascio D. Magro-Malosso E.R. Saccone G. Marhefka G.D. Berghella V. Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials.Am J Obstet Gynecol. 2016; 215: 561-571Abstract Full Text Full Text PDF PubMed Scopus (134) Google ScholaraDefined as gestational hypertension or preeclampsiaPreterm birth3Magro-Malosso E.R. Saccone G. Di Mascio D. Di Tommaso M. Berghella V. Exercise during pregnancy and risk of preterm birth in overweight and obese women: a systematic review and meta-analysis of randomized controlled trials.Acta Obstet Gynecol Scand. 2016 Dec 28; ([Epub ahead of print.])https://doi.org/10.1111/aogs.13087Crossref PubMed Scopus (85) Google ScholarCesarean delivery2Di Mascio D. Magro-Malosso E.R. Saccone G. Marhefka G.D. Berghella V. Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials.Am J Obstet Gynecol. 2016; 215: 561-571Abstract Full Text Full Text PDF PubMed Scopus (134) Google ScholarBirthweight1Wang C. Wei Y. Zhang X. et al.A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women.Am J Obstet Gynecol. 2017; 216: 340-351Abstract Full Text Full Text PDF PubMed Scopus (209) Google ScholarbLower birthweight.Berghella. Exercise in pregnancy! Am J Obstet Gynecol 2017.a Defined as gestational hypertension or preeclampsiab Lower birthweight. Open table in a new tab Berghella. Exercise in pregnancy! Am J Obstet Gynecol 2017. Our main aim in this editorial is to summarize this now extensive body of level-1 data, based on RCTs and metaanalyses of RCTs, so to provide easy-to-use advice for pregnant women and for us, their providers. First, what are the benefits and harm of exercise in pregnancy? Table 1 lists the many statistically significant benefits of exercise in pregnancy that were reported in RCTs and metaanalyses of RCTs.1Wang C. Wei Y. Zhang X. et al.A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women.Am J Obstet Gynecol. 2017; 216: 340-351Abstract Full Text Full Text PDF PubMed Scopus (209) Google Scholar, 2Di Mascio D. Magro-Malosso E.R. Saccone G. Marhefka G.D. Berghella V. Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials.Am J Obstet Gynecol. 2016; 215: 561-571Abstract Full Text Full Text PDF PubMed Scopus (134) Google Scholar, 3Magro-Malosso E.R. Saccone G. Di Mascio D. Di Tommaso M. Berghella V. Exercise during pregnancy and risk of preterm birth in overweight and obese women: a systematic review and meta-analysis of randomized controlled trials.Acta Obstet Gynecol Scand. 2016 Dec 28; ([Epub ahead of print.])https://doi.org/10.1111/aogs.13087Crossref PubMed Scopus (85) Google Scholar, 8Muktabhant B. Lawrie T.A. Lumbiganon P. Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy.Cochrane Database Syst Rev. 2015; 6: CD007145Google Scholar The list is quite noteworthy. To our knowledge, there is no intervention that we as providers can recommend to pregnant women as impressive in its significant impact on so many maternal and perinatal outcomes. Although nonpregnant data would perhaps predict that exercise decreases the incidence of GDM, the fact that exercise significantly decreases GHTN disorders, PTB, and cesarean delivery is remarkable and destroys the myth that exercise might be harmful in pregnancy, especially in terms of PTB. Moreover, there are good reasons why exercise would be associated with these many benefits. Exercise may decrease the incidence of GDM by attenuating the increase in insulin resistance that is associated with pregnancy.1Wang C. Wei Y. Zhang X. et al.A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women.Am J Obstet Gynecol. 2017; 216: 340-351Abstract Full Text Full Text PDF PubMed Scopus (209) Google Scholar It may decrease the risk of GHTN disorders by reducing oxidative stress and therefore improving endothelial function.10Genest D.S. Falcao S. Gutkowska J. Lavoie J.L. Impact of exercise training on preeclampsia: potential preventive mechanisms.Hypertension. 2012; 60: 1104-1109Crossref PubMed Scopus (66) Google Scholar Exercise may decrease the incidence of cesarean delivery (and importantly increase the incidence of vaginal delivery) by improving maternal physical fitness and lowering birthweight.1Wang C. Wei Y. Zhang X. et al.A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women.Am J Obstet Gynecol. 2017; 216: 340-351Abstract Full Text Full Text PDF PubMed Scopus (209) Google Scholar, 2Di Mascio D. Magro-Malosso E.R. Saccone G. Marhefka G.D. Berghella V. Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials.Am J Obstet Gynecol. 2016; 215: 561-571Abstract Full Text Full Text PDF PubMed Scopus (134) Google Scholar, 3Magro-Malosso E.R. Saccone G. Di Mascio D. Di Tommaso M. Berghella V. Exercise during pregnancy and risk of preterm birth in overweight and obese women: a systematic review and meta-analysis of randomized controlled trials.Acta Obstet Gynecol Scand. 2016 Dec 28; ([Epub ahead of print.])https://doi.org/10.1111/aogs.13087Crossref PubMed Scopus (85) Google Scholar We could not identify any harm reported in level-1 data on exercise in pregnancy.2Di Mascio D. Magro-Malosso E.R. Saccone G. Marhefka G.D. Berghella V. Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials.Am J Obstet Gynecol. 2016; 215: 561-571Abstract Full Text Full Text PDF PubMed Scopus (134) Google Scholar, 3Magro-Malosso E.R. Saccone G. Di Mascio D. Di Tommaso M. Berghella V. Exercise during pregnancy and risk of preterm birth in overweight and obese women: a systematic review and meta-analysis of randomized controlled trials.Acta Obstet Gynecol Scand. 2016 Dec 28; ([Epub ahead of print.])https://doi.org/10.1111/aogs.13087Crossref PubMed Scopus (85) Google Scholar, 4Kramer M.S. McDonald S.W. Aerobic exercise for women during pregnancy.Cochrane Database Syst Rev. 2006; 3: CD000180PubMed Google Scholar, 5Han S. Middleton P. Crowther C.A. Exercise for pregnant women for preventing gestational diabetes mellitus.Cochrane Database Syst Rev. 2012; 7: CD009021PubMed Google Scholar, 6Ceysens G. Rouiller D. Boulvain M. Exercise for diabetic pregnant women.Cochrane Database Syst Rev. 2006; 3: CD004225Google Scholar, 7Meher S. Duley L. Exercise or other physical activity for preventing pre-eclampsia and its complications.Cochrane Database Syst Rev. 2006; 2: CD005942PubMed Google Scholar, 8Muktabhant B. Lawrie T.A. Lumbiganon P. Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy.Cochrane Database Syst Rev. 2015; 6: CD007145Google Scholar, 9Bain E. Crane M. Tieu J. Han S. Crowther C.A. Middleton P. Diet and exercise interventions for preventing gestational diabetes mellitus.Cochrane Database Syst Rev. 2015; 4: CD010443PubMed Google Scholar In fact, the contrary is true. There are lots of data that bed rest or decreased activity are harmful in pregnancy, with increased risks of venous thromboembolism, bone demineralization, and deconditioning.11American College of Obstetricians and GynecologistsPhysical activity and exercise during pregnancy and the postpartum period: Committee Opinion No. 650.Obstet Gynecol. 2015; 126: e135-e142Crossref PubMed Scopus (501) Google Scholar Despite no evidence of benefit and known harms, bed rest continues to have wide use in obstetrics; approximately 15% of women each year are placed in best rest during their pregnancies in the United States.12Goldenberg R.L. Cliver S.P. Bronstein J. Cutter G.R. Andrews W.W. Mennemeyer S.T. Bed rest in pregnancy.Obstet Gynecol. 1994; 84: 131-136PubMed Google Scholar Seventy percent of Maternal Fetal Medicine physicians recommend bed rest for preterm labor (PTL), and 85% of them recommend bed rest in case of preterm premature rupture of membranes (PPROM),13Bigelow C. Stone J. Bed rest in pregnancy.Mt Sinai J Med. 2011; 78: 291-302Crossref PubMed Scopus (30) Google Scholar with no evidence of benefit. In fact, decreased activity is associated with increased risk of PTB in women at high risk for PTB, such as those with a short transvaginal ultrasound cervical length.14Grobman W.A. Gilbert S.A. Iams J.D. et al.Activity restriction among women with a short cervix.Obstet Gynecol. 2013; 121: 1181-1186Crossref PubMed Scopus (50) Google Scholar Second, which women should exercise in pregnancy? The short answer is just about every pregnant woman should exercise in pregnancy. The American College of Obstetricians and Gynecologists (ACOG) lists absolute and relative contraindications to aerobic exercise in pregnancy.11American College of Obstetricians and GynecologistsPhysical activity and exercise during pregnancy and the postpartum period: Committee Opinion No. 650.Obstet Gynecol. 2015; 126: e135-e142Crossref PubMed Scopus (501) Google Scholar To our knowledge, and as even ACOG implies, these are based perhaps on common sense, but none have been substantiated by data. For example, of the ACOG absolute contraindications to exercise in pregnancy, although some (hemodynamically significant heart disease, restrictive heart disease, severe anemia) seem reasonable, the others (cervical insufficiency or cerclage, multiple gestation, vaginal bleeding, placenta previa, PTL, PPROM, preeclampsia, and GHTN) actually may be situations in which some exercise may prove beneficial. We are not aware of level 1, or even good level II, evidence of harm from exercise in these situations. No evidence of fetal harm from exercise has been reported, with a 10–15 beats per minute increase in fetal heart rate (HR) during moderate-to-intense exercise and minimal decrease in birthweight from regular exercise during pregnancy and no increase in intrauterine growth restriction or small for gestational age.1Wang C. Wei Y. Zhang X. et al.A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women.Am J Obstet Gynecol. 2017; 216: 340-351Abstract Full Text Full Text PDF PubMed Scopus (209) Google Scholar, 2Di Mascio D. Magro-Malosso E.R. Saccone G. Marhefka G.D. Berghella V. Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials.Am J Obstet Gynecol. 2016; 215: 561-571Abstract Full Text Full Text PDF PubMed Scopus (134) Google Scholar, 3Magro-Malosso E.R. Saccone G. Di Mascio D. Di Tommaso M. Berghella V. Exercise during pregnancy and risk of preterm birth in overweight and obese women: a systematic review and meta-analysis of randomized controlled trials.Acta Obstet Gynecol Scand. 2016 Dec 28; ([Epub ahead of print.])https://doi.org/10.1111/aogs.13087Crossref PubMed Scopus (85) Google Scholar, 4Kramer M.S. McDonald S.W. Aerobic exercise for women during pregnancy.Cochrane Database Syst Rev. 2006; 3: CD000180PubMed Google Scholar, 5Han S. Middleton P. Crowther C.A. Exercise for pregnant women for preventing gestational diabetes mellitus.Cochrane Database Syst Rev. 2012; 7: CD009021PubMed Google Scholar, 6Ceysens G. Rouiller D. Boulvain M. Exercise for diabetic pregnant women.Cochrane Database Syst Rev. 2006; 3: CD004225Google Scholar, 7Meher S. Duley L. Exercise or other physical activity for preventing pre-eclampsia and its complications.Cochrane Database Syst Rev. 2006; 2: CD005942PubMed Google Scholar, 11American College of Obstetricians and GynecologistsPhysical activity and exercise during pregnancy and the postpartum period: Committee Opinion No. 650.Obstet Gynecol. 2015; 126: e135-e142Crossref PubMed Scopus (501) Google Scholar Third, what types of exercises should pregnant women do? Table 2 shows the types of exercises that have been studied in pregnancy in RCTs and found to be safe and associated with benefits (Table 1). Many other types of exercises are safe and beneficial, such swimming, jogging, running, yoga, pilates.11American College of Obstetricians and GynecologistsPhysical activity and exercise during pregnancy and the postpartum period: Committee Opinion No. 650.Obstet Gynecol. 2015; 126: e135-e142Crossref PubMed Scopus (501) Google Scholar Examples of physical activities that have been listed as possibly unsafe include contact sports (eg, ice hockey, boxing), activities with high risk of falling (eg, skiing, horseback riding, sky diving), and scuba diving.11American College of Obstetricians and GynecologistsPhysical activity and exercise during pregnancy and the postpartum period: Committee Opinion No. 650.Obstet Gynecol. 2015; 126: e135-e142Crossref PubMed Scopus (501) Google Scholar Some sports (eg, crew on an ergometer machine) may be deemed safe early in pregnancy but less feasible in the third trimester (personal communication, my rower son Andrea Berghella today while we were biking next to each other along the Schuylkill river in Philadelphia).Table 2Examples of types of exercises that have been extensively studied in pregnancy and found to be safe and beneficialWalkingStationary cyclingAerobic exercisesDancingResistance (eg, weights, elastic bands) exercisesStretching exercisesHydrotherapy, water aerobicsThis is a partial list because the list of all safe and studied exercises in pregnancy would be too long to publish.Berghella. Exercise in pregnancy! Am J Obstet Gynecol 2017. Open table in a new tab This is a partial list because the list of all safe and studied exercises in pregnancy would be too long to publish. Berghella. Exercise in pregnancy! Am J Obstet Gynecol 2017. Fourth, how much should pregnant women exercise? Most of the RCTs2Di Mascio D. Magro-Malosso E.R. Saccone G. Marhefka G.D. Berghella V. Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials.Am J Obstet Gynecol. 2016; 215: 561-571Abstract Full Text Full Text PDF PubMed Scopus (134) Google Scholar, 3Magro-Malosso E.R. Saccone G. Di Mascio D. Di Tommaso M. Berghella V. Exercise during pregnancy and risk of preterm birth in overweight and obese women: a systematic review and meta-analysis of randomized controlled trials.Acta Obstet Gynecol Scand. 2016 Dec 28; ([Epub ahead of print.])https://doi.org/10.1111/aogs.13087Crossref PubMed Scopus (85) Google Scholar, 4Kramer M.S. McDonald S.W. Aerobic exercise for women during pregnancy.Cochrane Database Syst Rev. 2006; 3: CD000180PubMed Google Scholar, 5Han S. Middleton P. Crowther C.A. Exercise for pregnant women for preventing gestational diabetes mellitus.Cochrane Database Syst Rev. 2012; 7: CD009021PubMed Google Scholar, 6Ceysens G. Rouiller D. Boulvain M. Exercise for diabetic pregnant women.Cochrane Database Syst Rev. 2006; 3: CD004225Google Scholar, 7Meher S. Duley L. Exercise or other physical activity for preventing pre-eclampsia and its complications.Cochrane Database Syst Rev. 2006; 2: CD005942PubMed Google Scholar that showed that exercise in pregnancy is safe and effective in producing benefits recommended starting aerobic exercise in the first trimester, with sessions lasting approximately 30–60 minutes, at least 3–4 times (up to daily) per week, until delivery (Table 3).2Di Mascio D. Magro-Malosso E.R. Saccone G. Marhefka G.D. Berghella V. Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials.Am J Obstet Gynecol. 2016; 215: 561-571Abstract Full Text Full Text PDF PubMed Scopus (134) Google Scholar, 3Magro-Malosso E.R. Saccone G. Di Mascio D. Di Tommaso M. Berghella V. Exercise during pregnancy and risk of preterm birth in overweight and obese women: a systematic review and meta-analysis of randomized controlled trials.Acta Obstet Gynecol Scand. 2016 Dec 28; ([Epub ahead of print.])https://doi.org/10.1111/aogs.13087Crossref PubMed Scopus (85) Google Scholar Many RCTs monitor maternal HR and suggest not exceeding a 60–80% of maximum HR threshold, which approximately means, as used in other RCTs, a maximum maternal HR of approximately 140 beats per minute. The Borg scale is a category scale that has been used to measure the level of perceived exertion to assess the intensity of exercise.15Borg G.A. Psychophysical bases of perceived exertion.Med Sci Sports Exerc. 1982; 14: 377-381Crossref PubMed Scopus (10869) Google Scholar RCTs and metaanalyses of RCTs on exercise in pregnancy have studied mainly "somewhat hard" or moderate-to-intense exercise regimens, which correspond to a Borg score of 13–14 (the scale is 6–20).1Wang C. Wei Y. Zhang X. et al.A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women.Am J Obstet Gynecol. 2017; 216: 340-351Abstract Full Text Full Text PDF PubMed Scopus (209) Google Scholar, 2Di Mascio D. Magro-Malosso E.R. Saccone G. Marhefka G.D. Berghella V. Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials.Am J Obstet Gynecol. 2016; 215: 561-571Abstract Full Text Full Text PDF PubMed Scopus (134) Google Scholar, 3Magro-Malosso E.R. Saccone G. Di Mascio D. Di Tommaso M. Berghella V. Exercise during pregnancy and risk of preterm birth in overweight and obese women: a systematic review and meta-analysis of randomized controlled trials.Acta Obstet Gynecol Scand. 2016 Dec 28; ([Epub ahead of print.])https://doi.org/10.1111/aogs.13087Crossref PubMed Scopus (85) Google Scholar, 4Kramer M.S. McDonald S.W. Aerobic exercise for women during pregnancy.Cochrane Database Syst Rev. 2006; 3: CD000180PubMed Google Scholar, 5Han S. Middleton P. Crowther C.A. Exercise for pregnant women for preventing gestational diabetes mellitus.Cochrane Database Syst Rev. 2012; 7: CD009021PubMed Google Scholar, 6Ceysens G. Rouiller D. Boulvain M. Exercise for diabetic pregnant women.Cochrane Database Syst Rev. 2006; 3: CD004225Google Scholar, 7Meher S. Duley L. Exercise or other physical activity for preventing pre-eclampsia and its complications.Cochrane Database Syst Rev. 2006; 2: CD005942PubMed Google Scholar As recommended by ACOG and others,11American College of Obstetricians and GynecologistsPhysical activity and exercise during pregnancy and the postpartum period: Committee Opinion No. 650.Obstet Gynecol. 2015; 126: e135-e142Crossref PubMed Scopus (501) Google Scholar, 16Department of Health and Human Services2008 physical activity guidelines for Americans. DHHS, Washington, DC2008http://health.gov/paguidelinesGoogle Scholar women should be well hydrated before and during exercise, be able to carry a conversation during exercise (because this means they are likely not overexerting), and avoid lying flat on their backs for long periods.Table 3Characteristics of a safe and effective exercise regimen in pregnancy1Wang C. Wei Y. Zhang X. et al.A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women.Am J Obstet Gynecol. 2017; 216: 340-351Abstract Full Text Full Text PDF PubMed Scopus (209) Google Scholar, 2Di Mascio D. Magro-Malosso E.R. Saccone G. Marhefka G.D. Berghella V. Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials.Am J Obstet Gynecol. 2016; 215: 561-571Abstract Full Text Full Text PDF PubMed Scopus (134) Google Scholar, 3Magro-Malosso E.R. Saccone G. Di Mascio D. Di Tommaso M. Berghella V. Exercise during pregnancy and risk of preterm birth in overweight and obese women: a systematic review and meta-analysis of randomized controlled trials.Acta Obstet Gynecol Scand. 2016 Dec 28; ([Epub ahead of print.])https://doi.org/10.1111/aogs.13087Crossref PubMed Scopus (85) Google Scholar, 4Kramer M.S. McDonald S.W. Aerobic exercise for women during pregnancy.Cochrane Database Syst Rev. 2006; 3: CD000180PubMed Google Scholar, 5Han S. Middleton P. Crowther C.A. Exercise for pregnant women for preventing gestational diabetes mellitus.Cochrane Database Syst Rev. 2012; 7: CD009021PubMed Google Scholar, 6Ceysens G. Rouiller D. Boulvain M. Exercise for diabetic pregnant women.Cochrane Database Syst Rev. 2006; 3: CD004225Google Scholar, 7Meher S. Duley L. Exercise or other physical activity for preventing pre-eclampsia and its complications.Cochrane Database Syst Rev. 2006; 2: CD005942PubMed Google ScholarWhen to startFirst trimester, <12 weeks gestationDuration of a session30-60 minutesTimes per weekAt least 3–4 (up to daily)Intensity of exercise 50 RCTs (including this new one by Wang et al1Wang C. Wei Y. Zhang X. et al.A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women.Am J Obstet Gynecol. 2017; 216: 340-351Abstract Full Text Full Text PDF PubMed Scopus (209) Google Scholar) and several metaanalyses1Wang C. Wei Y. Zhang X. et al.A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women.Am J Obstet Gynecol. 2017; 216: 340-351Abstract Full Text Full Text PDF PubMed Scopus (209) Google Scholar, 2Di Mascio D. Magro-Malosso E.R. Saccone G. Marhefka G.D. Berghella V. Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials.Am J Obstet Gynecol. 2016; 215: 561-571Abstract Full Text Full Text PDF PubMed Scopus (134) Google Scholar, 3Magro-Malosso E.R. Saccone G. Di Mascio D. Di Tommaso M. Berghella V. Exercise during pregnancy and risk of preterm birth in overweight and obese women: a systematic review and meta-analysis of randomized controlled trials.Acta Obstet Gynecol Scand. 2016 Dec 28; ([Epub ahead of print.])https://doi.org/10.1111/aogs.13087Crossref PubMed Scopus (85) Google Scholar, 4Kramer M.S. McDonald S.W. Aerobic exercise for women during pregnancy.Cochrane Database Syst Rev. 2006; 3: CD000180PubMed Google Scholar, 5Han S. Middleton P. Crowther C.A. Exercise for pregnant women for preventing gestational diabetes mellitus.Cochrane Database Syst Rev. 2012; 7: CD009021PubMed Google Scholar, 6Ceysens G. Rouiller D. Boulvain M. Exercise for diabetic pregnant women.Cochrane Database Syst Rev. 2006; 3: CD004225Google Scholar, 7Meher S. Duley L. Exercise or other physical activity for preventing pre-eclampsia and its complications.Cochrane Database Syst Rev. 2006; 2: CD005942PubMed Google Scholar, 8Muktabhant B. Lawrie T.A. Lumbiganon P. Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy.Cochrane Database Syst Rev. 2015; 6: CD007145Google Scholar, 9Bain E. Crane M. Tieu J. Han S. Crowther C.A. Middleton P. Diet and exercise interventions for preventing gestational diabetes mellitus.Cochrane Database Syst Rev. 2015; 4: CD010443PubMed Google Scholar show that almost all pregnant women should exercise. Aerobic exercise (Table 2) is associated with important benefits, including less gestational weight gain; lower incidences of GDM, GHTN, GHTN disorders, PTB, and cesarean delivery; lower birthweight, and higher incidence of vaginal delivery (Table 1). To seize these benefits, aerobic exercise should be started in the first trimester and continued 3-4 times per week for 30- to 60-minute sessions each until delivery (Table 3). To stay inactive is to die. A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant womenAmerican Journal of Obstetrics & GynecologyVol. 216Issue 4PreviewObesity and being overweight are becoming epidemic, and indeed, the proportion of such women of reproductive age has increased in recent times. Being overweight or obese prior to pregnancy is a risk factor for gestational diabetes mellitus, and increases the risk of adverse pregnancy outcome for both mothers and their offspring. Furthermore, the combination of gestational diabetes mellitus with obesity/overweight status may increase the risk of adverse pregnancy outcome attributable to either factor alone. Full-Text PDF
Referência(s)