Impact of structured physical exercise during pregnancy on maternal health and fetal outcomes: A systematic review.

Introduction: Current guidelines recommend that pregnant women engage in physical activity. Exercise during pregnancy has been shown to positively impact both maternal and fetal outcomes. Therefore, we conducted a systematic review to evaluate the impact of structured physical activity during pregnancy on maternal health and fetal outcomes.

Materials and methods: A systematic search was conducted on relevant articles published between 2015 and 2020 using PubMed, Google Scholar, ScienceDirect, Scopus, and the Cochrane Library. Studies on pregnant women, comparative study designs with concurrent controls, structured physical intervention and health outcomes for both maternal and fetal were targeted. Maternal outcomes include gestational weight gain, lumbopelvic pain, gestational diabetes and preeclampsia, while fetal outcomes include prematurity and birth weight. Only original studies with published data were included. This review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- Analysis.

Results: A total of 3441 published articles were retrieved from different databases. After assessing the obtained papers, studies that did not meet the inclusion criteria were excluded. Twenty studies involving 5188 populations that met the inclusion criteria were included in this review. However, due to the heterogeneity of the studies, metaanalysis was not done. Structured physical activity significantly reduced the risk of gestational diabetes (OR: 0.57; 95% CI: 0.40-0.81; p = 0.002), but had no statistically significant effect on lumbopelvic pain (OR 0.98 (95% CI: 0.49 to 1.93) p=0.95), gestational weight gain (OR 0.88 95% CI: (0.44, 1.76) p=0.71), pre-eclampsia (OR 0.78, 95% CI: 0.41, 1.49, p=0.46) causing preterm delivery (OR 0.91, 95% CI (0.69, 1.20), p=0.50) or affecting fetal birth weight (mean difference 0.93, 95% CI (-42.67, 44.53), p=0.97) CONCLUSION: Structured physical activity during pregnancy, three times a week, 30 minutes per day of moderate intensity, is safe and benefits pregnant women and the fetus. Our findings challenge the view that physical exercise during pregnancy is not helpful and can be harmful. To generate further evidence, there is a need for high-quality, standardised trials that assess specific types of structured exercise program with better reporting of adherence and outcomes.