Benefits of Physical Activity during Pregnancy and Postpartum: An Umbrella Review

Purpose This study aimed to summarize the evidence from the 2018 Physical Activity Guidelines Advisory Committee Scientific Report, including new evidence from an updated search of the effects of physical activity on maternal health during pregnancy and postpartum. Methods An initial search was undertaken to identify systematic reviews and meta-analyses published between 2006 and 2016. An updated search then identified additional systematic reviews and meta-analyses published between January 2017 and February 2018. The searches were conducted in PubMed®, CINAHL, and Cochrane Library and supplemented through hand searches of reference lists of included articles and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results The original and updated searches yielded a total of 76 systematic reviews and meta-analyses. Strong evidence demonstrated that moderate-intensity physical activity reduced the risk of excessive gestational weight gain, gestational diabetes, and symptoms of postpartum depression. Limited evidence suggested an inverse relationship between physical activity and risk of preeclampsia, gestational hypertension, and antenatal anxiety and depressive symptomology. Insufficient evidence was available to determine the effect of physical activity on postpartum weight loss, postpartum anxiety, and affect during both pregnancy and postpartum. For all health outcomes, there was insufficient evidence to determine whether the relationships varied by age, race/ethnicity, socioeconomic status, or prepregnancy weight status. Conclusions The gestational period is an opportunity to promote positive health behaviors that can have both short- and long-term benefits for the mother. Given the low prevalence of physical activity in young women in general, and the high prevalence of obesity and cardiometabolic diseases among the U.S. population, the public health importance of increasing physical activity in women of childbearing age before, during, and after pregnancy is substantial.

[1]  A. García-Hermoso,et al.  Effects of exercise‐based interventions on postpartum depression: A meta‐analysis of randomized controlled trials , 2017, Birth.

[2]  Nicholas P. Deputy,et al.  Gestational Weight Gain - United States, 2012 and 2013. , 2015, MMWR. Morbidity and mortality weekly report.

[3]  E. Lau,et al.  Does dose matter in reducing gestational weight gain in exercise interventions? A systematic review of literature. , 2016, Journal of science and medicine in sport.

[4]  A. Beyerlein,et al.  Physical activity and gestational weight gain: a metaanalysis of intervention trials , 2011 .

[5]  K. Owe,et al.  Leisure Time Physical Activity and the Risk of Pre-eclampsia: A Systematic Review , 2014, Maternal and Child Health Journal.

[6]  Ying Yu,et al.  Effect of exercise during pregnancy to prevent gestational diabetes mellitus: a systematic review and meta-analysis , 2018, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[7]  J. Zheng,et al.  Influence of exercise intervention on gestational diabetes mellitus: a systematic review and meta-analysis , 2017, Journal of Endocrinological Investigation.

[8]  B. Horta,et al.  Changes in Leisure-Time Physical Activity From the Prepregnancy to the Postpartum Period: 2004 Pelotas (Brazil) Birth Cohort Study. , 2016, Journal of physical activity & health.

[9]  Prevalence Estimates of Gestational Diabetes Mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007–2010 , 2014, Preventing chronic disease.

[10]  A. Herring,et al.  Physical activity patterns during pregnancy through postpartum , 2009, BMC women's health.

[11]  K. Evenson,et al.  Prevalence of U.S. Pregnant Women Meeting 2015 ACOG Physical Activity Guidelines , 2016, American journal of preventive medicine.

[12]  A. Beyerlein,et al.  Physical activity and gestational weight gain: a meta‐analysis of intervention trials , 2011, BJOG : an international journal of obstetrics and gynaecology.

[13]  W. Brown,et al.  Guidelines for Physical Activity During Pregnancy , 2014, American journal of lifestyle medicine.

[14]  W. H. Pearse American College of Obstetricians and Gynecologists , 2020, Definitions.

[15]  P. Middleton,et al.  Exercise for pregnant women for preventing gestational diabetes mellitus. , 2012, The Cochrane database of systematic reviews.

[16]  Janet E. Fulton,et al.  Adult Participation in Aerobic and Muscle-Strengthening Physical Activities — United States, 2011 , 2013, MMWR. Morbidity and mortality weekly report.

[17]  Xia Li,et al.  Physical activity during pregnancy and the risk of gestational diabetes mellitus: a systematic review and meta-analysis of randomised controlled trials , 2013, British Journal of Sports Medicine.

[18]  K. Pearson,et al.  Impact of Maternal Exercise during Pregnancy on Offspring Chronic Disease Susceptibility , 2015, Exercise and sport sciences reviews.

[19]  B W Mol,et al.  Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence , 2012, BMJ : British Medical Journal.

[20]  Bethany Tennant,et al.  Umbrella and Systematic Review Methodology to Support the 2018 Physical Activity Guidelines Advisory Committee. , 2018, Journal of physical activity & health.

[21]  K. Kasawara,et al.  Exercise and physical activity in the prevention of pre‐eclampsia: systematic review , 2012, Acta obstetricia et gynecologica Scandinavica.

[22]  Craig M. Hales,et al.  Trends in Obesity and Severe Obesity Prevalence in US Youth and Adults by Sex and Age, 2007-2008 to 2015-2016 , 2018, JAMA.

[23]  G. Saccone,et al.  Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials. , 2016, American journal of obstetrics and gynecology.

[24]  J. Stoker,et al.  The Department of Health and Human Services. , 1999, Home healthcare nurse.

[25]  W. Brown,et al.  Summary of International Guidelines for Physical Activity After Pregnancy , 2014, Obstetrical & gynecological survey.

[26]  J. Ioannidis,et al.  The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration , 2009, Annals of Internal Medicine [serial online].

[27]  Mark Payne,et al.  Health and Human Services , 2020, Congress and the Nation 2013-2016, Volume XIV: Politics and Policy in the 113th and 114th Congresses.

[28]  F. Hu,et al.  Physical Activity Before and During Pregnancy and Risk of Gestational Diabetes Mellitus , 2010, Diabetes Care.

[29]  A. García-Hermoso,et al.  Effectiveness of physical activity interventions on preventing gestational diabetes mellitus and excessive maternal weight gain: a meta‐analysis , 2015, BJOG : an international journal of obstetrics and gynaecology.

[30]  M. Davenport,et al.  The Effect of Supervised Prenatal Exercise on Fetal Growth: A Meta-analysis , 2015, Obstetrics and gynecology.

[31]  W. Nicholson,et al.  Systematic review of the effect of individual and combined nutrition and exercise interventions on weight, adiposity and metabolic outcomes after delivery: evidence for developing behavioral guidelines for post-partum weight control , 2014, BMC Pregnancy and Childbirth.

[32]  Richard D Riley,et al.  Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials , 2017, BMJ.

[33]  T. Farrell,et al.  Prevention of gestational diabetes in pregnant women with risk factors for gestational diabetes: a systematic review and meta-analysis of randomised trials , 2015, Obstetric medicine.

[34]  K. Evenson,et al.  Leisure-Time Physical Activity in Pregnancy and Maternal-Child Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Cohort Studies , 2017, Sports Medicine.

[35]  Committee Opinion No. 650: Physical Activity and Exercise During Pregnancy and the Postpartum Period , 2015, Obstetrics and gynecology.

[36]  G. Saccone,et al.  Exercise during pregnancy and risk of gestational hypertensive disorders: a systematic review and meta‐analysis , 2017, Acta obstetricia et gynecologica Scandinavica.

[37]  S. Tonstad,et al.  Physical Activity and the Risk of Preeclampsia: A Systematic Review and Meta-Analysis , 2014, Epidemiology.

[38]  J. Repke,et al.  Effect of Diet and Physical Activity–based Interventions in Pregnancy on Gestational Weight Gain and Pregnancy Outcomes: Meta-Analysis of Individual Participant Data from Randomized Trials , 2018, Obstetric Anesthesia Digest.

[39]  M. Teychenne,et al.  Physical activity, sedentary behavior, and postnatal depressive symptoms: a review. , 2013, American journal of preventive medicine.

[40]  M. Davenport,et al.  Effects of Exercise on Mild-to-Moderate Depressive Symptoms in the Postpartum Period: A Meta-analysis. , 2017, Obstetrics and gynecology.

[41]  D. Saunders,et al.  Sedentary behaviours during pregnancy: a systematic review , 2017, International Journal of Behavioral Nutrition and Physical Activity.

[42]  Ann L. Yaktine,et al.  Weight Gain During Pregnancy , 2009 .

[43]  W. van Mechelen,et al.  Interventions for preventing gestational diabetes mellitus: a systematic review and meta-analysis. , 2011, Journal of women's health.

[44]  B. Whitcomb,et al.  Physical Activity Interventions in Pregnancy and Risk of Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis , 2015, Obstetrics and gynecology.

[45]  Z. Sui,et al.  Antenatal exercise to improve outcomes in overweight or obese women: A systematic review , 2012, Acta obstetricia et gynecologica Scandinavica.

[46]  R. Ma,et al.  Lifestyle intervention can reduce the risk of gestational diabetes: a meta‐analysis of randomized controlled trials , 2016, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[47]  K. Jolly,et al.  Does aerobic exercise reduce postpartum depressive symptoms? a systematic review and meta-analysis. , 2017, The British journal of general practice : the journal of the Royal College of General Practitioners.

[48]  Cheryl L. Woods-Giscombe,et al.  Efficacy, Feasibility, and Acceptability of Perinatal Yoga on Women’s Mental Health and Well-Being , 2016, Journal of holistic nursing : official journal of the American Holistic Nurses' Association.

[49]  K. Hesketh,et al.  Systematic review of lifestyle interventions to limit postpartum weight retention: implications for future opportunities to prevent maternal overweight and obesity following childbirth , 2013, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[50]  Y. Linné,et al.  Diet or exercise, or both, for weight reduction in women after childbirth. , 2013, The Cochrane database of systematic reviews.

[51]  Blair T. Johnson,et al.  Methodological quality of meta-analyses on the blood pressure response to exercise: a review , 2014, Journal of hypertension.

[52]  K. Palmer,et al.  Risk of prematurity, low birthweight and pre-eclampsia in relation to working hours and physical activities: a systematic review , 2006, Occupational and Environmental Medicine.

[53]  P. Lumbiganon,et al.  Diet or exercise, or both, for preventing excessive weight gain in pregnancy. , 2015, The Cochrane database of systematic reviews.

[54]  M. Trivedi,et al.  Antenatal depression: a rationale for studying exercise , 2011, Depression and anxiety.

[55]  M. Melbye,et al.  Risk, treatment duration, and recurrence risk of postpartum affective disorder in women with no prior psychiatric history: A population-based cohort study , 2017, PLoS medicine.

[56]  K. Adamo,et al.  The effect of physical exercise strategies on weight loss in postpartum women: a systematic review and meta-analysis , 2014, International Journal of Obesity.

[57]  D. Lawlor,et al.  Pregnancy characteristics and women's future cardiovascular health: an underused opportunity to improve women's health? , 2014, Epidemiologic reviews.

[58]  S. Tonstad,et al.  Physical activity and the risk of gestational diabetes mellitus: a systematic review and dose–response meta-analysis of epidemiological studies , 2016, European Journal of Epidemiology.

[59]  K. Elliott-Sale,et al.  Systematic review of randomised controlled trials on exercise interventions for weight management during pregnancy and up to one year postpartum among normal weight, overweight and obese women. , 2014, Pregnancy hypertension.