Abstract
Objective
To investigate the effect of supervised moderate to vigorous exercise on gestational
weight gain, its related risks (gestational diabetes [GD]), macrosomia, and type of
delivery), and the preventive effects on women who exceed the weight gain recommendations.
Patients and Methods
We conducted a single-center, 2-armed, randomized controlled trial between October
1, 2009, and June 30, 2011, in which 678 women were assessed and 345 were randomized
by a central computer system to an intervention group (N=115) or a standard care group
(N=230). The intervention exercise program consisted of 70 to 78 sessions (24 weeks,
3 times per week, 60-65 minutes per session, moderate to vigorous intensity). The
standard care group received usual care. Excessive gestational weight (EGW) gain was
calculated on the basis of the 2009 Institute of Medicine (IOM) recommendations.
Results
Of the 345 women randomized for treatment, 44 were lost to follow-up, leaving 301
women for analysis (intervention, 100; standard care, 201). Fewer women in the intervention
group exceeded IOM recommendations (22 [22.0%] vs 69 [34.3%]; P=.03), including overweight and obese women (15 of 35 [42.9%] vs 40 of 50 [80.0%];
P=.001). Analysis of women exceeding weight recommendations revealed that the 3 main
related risks were directly related to EGW gain in the standard care group (GD, P=.003; macrosomia, P<.001; type of delivery, P<.001) but not in the intervention group (GD, P>.99; macrosomia, 0%; type of delivery, P=.46).
Conclusion
Supervised moderate to vigorous exercise performed throughout gestation was effective
in the prevention of EGW gain even for women with a pregestational body mass index
greater than 25 kg/m2. It also prevented its related risks (GD, macrosomia, and type of delivery) including
for women exceeding the IOM recommendations, so we suggest that being active outweighs
the effect of possible weight gain.
Trial Registration
ClinicalTrials.gov Identifier: NCT01477372
Abbreviations and Acronyms:
BMI (body mass index), IOM (Institute of Medicine), RCT (randomized controlled trial)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Mayo Clinic ProceedingsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Feasibility of a controlled trial aiming to prevent excessive pregnancy-related weight gain in primary health care.BMC Pregnancy Childbirth. 2008; 8: 37
- Pregnancy outcomes with weight gain above or below the 2009 Institute of Medicine guidelines.Obstet Gynecol. 2013; 121: 969-975
- Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis.JAMA. 2017; 317: 2207-2225
- Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women.BMC Med. 2018; 16: 153
- Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) Study: associations with maternal body mass index.BJOG. 2010; 117: 575-584
- Development and validation of exercise target heart rate zones for overweight and obese pregnant women.Appl Physiol Nutr Metab. 2008; 33: 984-989
- Preconceptional and maternal obesity: epidemiology and health consequences.Lancet Diabetes Endocrinol. 2016; 4: 1025-1036
- Effects of suboptimal or excessive gestational weight gain on childhood overweight and abdominal adiposity: results from a retrospective cohort study.Int J Obes (Lond). 2013; 37: 505-512
- Associations of maternal weight gain in pregnancy with offspring cognition in childhood and adolescence: findings from the Avon Longitudinal Study of Parents and Children.Am J Epidemiol. 2013; 177: 402-410
- Institute of Medicine, National Research Council Committee to Reexamine IOM Pregnancy Weight Guidelines Rasmussen K.M. Yaktine A.L. Weight Gain During Pregnancy: Reexamining the Guidelines. National Academies Press, Washington, DC2009
- The impact of maternal gestational weight gain on cardiometabolic risk factors in children.Diabetologia. 2018; 61: 2539-2548
- ACOG committee opinion. Exercise during pregnancy and the postpartum period. Number 267, January 2002. American College of Obstetricians and Gynecologists.Int J Gynaecol Obstet. 2002; 77: 79-81
- Información Y Recomendaciones Para Embarazadas. 2010.(Published November 2010. Accessed November 6, 2018)
- 650: Physical activity and exercise during pregnancy and the postpartum period.Obstet Gynecol. 2015; 126: e135-e142
- Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period.Br J Sports Med. 2003; 37: 6-12
- Pelvic floor muscle training included in a pregnancy exercise program is effective in primary prevention of urinary incontinence: a randomized controlled trial.Neurourol Urodyn. 2014; 33: 67-71
- New guidelines for weight gain during pregnancy: what obstetrician/gynecologists shoud know.Curr Opin Obstet Gynecol. 2009; 21: 521-526
- Guía asistencial de Diabetes Mellitus y Embarazo (3a edición).Av Diabetol. 2006; 22: 73-87
- Supervised exercise-based intervention to prevent excessive gestational weight gain: a randomized controlled trial.Mayo Clin Proc. 2013; 88: 1388-1397
- The role of exercise-induced myokines in regulating metabolism.Arch Pharm Res. 2018; 41: 14-29
- Therapeutic potential of interleukin-15: a myokine involved in muscle wasting and adiposity.Drug Discov Today. 2009; 14: 208-213
- Exercise-induced myokines and their role in chronic diseases.Brain Behav Immun. 2011; 25: 811-816
- Inflammatory lipid mediators in adipocyte function and obesity.Nat Rev Endocrinol. 2010; 6: 71-82
- Physical activity during pregnancy and maternal-child health outcomes: a systematic literature review.Cad Saude Publica. 2008; 24: s531-s544
- Intervention during pregnancy to reduce excessive gestational weight gain—a randomised controlled trial.BJOG. 2015; 122: 537-544
- Diet or exercise, or both, for preventing excessive weight gain in pregnancy.Cochrane Database Syst Rev. 2015; 6: CD007145
- Exercise in pregnancy does not alter gestational weight gain, MCP-1 or leptin in obese women.Aust N Z J Obstet Gynaecol. 2015; 55: 27-33
- Exercise interventions for weight management during pregnancy and up to 1 year postpartum among normal weight, overweight and obese women: a systematic review and meta-analysis.Br J Sports Med. 2015; 49: 1336-1342
- Effects of antenatal exercise in overweight and obese pregnant women on maternal and perinatal outcomes: a randomised controlled trial.BJOG. 2016; 123: 588-597
- Exercise training and weight gain in obese pregnant women: a randomized controlled trial (ETIP Trial).PLoS Med. 2016; 13: e1002079
- Nutrition and exercise prevent excess weight gain in overweight pregnant women.Med Sci Sports Exerc. 2010; 42: 265-272
- Gestational diabetes from A to Z.World J Diabetes. 2017; 8: 489-511
- Prevalence of gestational diabetes and associated maternal and neonatal complications in a fast-developing community: global comparisons.Int J Womens Health. 2011; 3: 367-373
- Potential impact of American Diabetes Association (2000) criteria for diagnosis of gestational diabetes mellitus in Spain.Diabetologia. 2005; 48: 1135-1141
- Exercise is associated with a reduction in gestational diabetes mellitus.Med Sci Sports Exerc. 2015; 47: 1328-1333
- Regular exercise during pregnancy to prevent gestational diabetes: a randomized controlled trial.Obstet Gynecol. 2012; 119: 29-36
- The effect of supervised prenatal exercise on fetal growth: a meta-analysis.Obstet Gynecol. 2015; 125: 1185-1194
- Effects of exercise during pregnancy on mode of delivery: a meta-analysis.Acta Obstet Gynecol Scand. 2015; 94: 1039-1047
- Who and how should prescribe and conduct exercise programs for pregnant women? recommendation based on the European educational standards for pregnancy and postnatal exercise specialists.Dev Period Med. 2018; 22: 107-112
Article info
Footnotes
For editorial comment, see page 1922
Dr Pelaez is now with the Universidad Europea del Atlántico, Santander, Cantabria, Spain. Dr Montejo is now with the Angered Närsjukhus, Angered, Sweden.
Grant Support: This work was supported in part by grants AL09110501 and Q101100196 from the Universidad Politécnica de Madrid.
Potential Competing Interests: The authors report no competing interests.
Identification
Copyright
© 2019 Mayo Foundation for Medical Education and Research
ScienceDirect
Access this article on ScienceDirectLinked Article
- Rethinking Prenatal Exercise Trials: How Can We Improve Translation?Mayo Clinic ProceedingsVol. 94Issue 10
- PreviewRegular exercise is important to maintain health and reduce the risk of chronic disease in the general population. The greatest health benefits occur in sedentary individuals who incorporate small amounts of activity into their daily routine. Additional benefits of exercise for pregnant women include reduced rates of maternal and fetal complications, such as pre-eclampsia, gestational hypertension, gestational diabetes, Caesarean section, excessive gestational weight gain, and macrosomia.1 The trial of supervised moderate to vigorous prenatal exercise by Mireia Pelaez and colleagues,2 published in this issue of Mayo Clinic Proceedings, adds to this body of evidence.
- Full-Text
- Preview
