监督性产前运动对胎儿生长的影响：一项荟萃分析。

The effect of supervised prenatal exercise on fetal growth: a meta-analysis.

作者信息

Wiebe Henry W, Boulé Normand G, Chari Radha, Davenport Margie H

机构信息

Program for Pregnancy and Postpartum Health and Physical Activity and Diabetes Laboratory, Faculty of Physical Education and Recreation, the Women and Children's Health Research Institute, the Alberta Diabetes Institute, and the Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada.

出版信息

Obstet Gynecol. 2015 May;125(5):1185-1194. doi: 10.1097/AOG.0000000000000801.

DOI:10.1097/AOG.0000000000000801

PMID:25932847

Abstract

OBJECTIVE

To estimate the influence of structured prenatal exercise on newborn birth weight, macrosomia, and growth restriction.

DATA SOURCES

A structured search of MEDLINE, EMBASE, CINAHL, Sport Discus, Ovid's All EBM Reviews, and ClinicalTrials.gov databases up to January 13, 2015. The search combined keywords and MeSH-like terms including, but not limited, to "physical activity," "exercise," "pregnancy," "gestation," "neonatal," and "randomized controlled trial."

METHODS OF STUDY SELECTION

Articles reporting randomized controlled trials comparing standard care with standard care plus supervised prenatal exercise for which birth size was available were included. Supervision was defined as at least one exercise session performed with study personnel every 2 weeks throughout the program. Interventions consisting solely of pelvic floor exercises, stretching, or relaxation were excluded. Our search yielded 1,036 publications of which 79 were assessed for eligibility. Twenty-eight studies reporting on 5,322 pregnancies were subsequently included in the analysis.

TABULATION, INTEGRATION, AND RESULTS: Our meta-analysis demonstrated that prenatal exercise reduced the odds of having a large newborn (birth weight greater than 4,000 g or greater than the 90th percentile for gestational age and sex) by 31% (odds ratio [OR] 0.69, 95% confidence interval [CI] 0.55-0.86; I 25%) without altering the risk of having a small newborn (birth weight less than 2,500 g or less than the 10th percentile for gestational age and sex) (OR 1.02, 95% CI 0.72-1.46; I 0%) or gestational age at delivery (weighted mean difference -0.00 weeks, 95% CI -0.09 to 0.09; I 0%). Newborns of mothers assigned to exercise were lighter than those of nonexercising controls (weighted mean difference -31 g, 95% CI -57 to -4; I 0%). Maternal gestational weight gain (weighted mean difference -1.1 kg, 95% CI -1.5 to -0.6; I 53%) and odds of cesarean delivery (OR 0.80, 95% CI 0.69-0.94; I 0%) were also reduced.

CONCLUSION

These data demonstrate that structured prenatal exercise reduces the risk of having a large newborn without a change in the risk of having a small newborn.

摘要

目的

评估结构化产前运动对新生儿出生体重、巨大儿及生长受限的影响。

数据来源

截至2015年1月13日，对MEDLINE、EMBASE、CINAHL、Sport Discus、Ovid's All EBM Reviews及ClinicalTrials.gov数据库进行结构化检索。检索结合了关键词及类似医学主题词，包括但不限于“体力活动”“运动”“妊娠”“孕期”“新生儿”及“随机对照试验”。

研究选择方法

纳入报告随机对照试验的文章，这些试验比较了标准护理与标准护理加有监督的产前运动，且有出生时大小的数据。监督定义为在整个项目中每2周至少与研究人员进行一次运动课程。仅由盆底肌锻炼、伸展或放松组成的干预措施被排除。我们的检索得到1036篇出版物，其中79篇被评估是否符合纳入标准。随后，28项报告5322例妊娠情况的研究被纳入分析。

列表、整合与结果：我们的荟萃分析表明，产前运动使出生体重较大的新生儿（出生体重超过4000g或超过相应孕周和性别的第90百分位数）的几率降低了31%（优势比[OR]0.69，95%置信区间[CI]0.55 - 0.86；I² 25%），同时不改变出生体重较小的新生儿（出生体重低于2500g或低于相应孕周和性别的第10百分位数）的风险（OR 1.02，95% CI 0.72 - 1.46；I² 0%）或分娩时的孕周（加权平均差 -0.00周, 95% CI -0.09至0.09；I² 0%）。分配到运动组的母亲所生新生儿比未运动对照组的新生儿体重更轻（加权平均差 -31g，95% CI -57至 -4；I² 0%）。孕妇孕期体重增加（加权平均差 -1.1kg，95% CI -1.5至 -0.6；I² 53%）及剖宫产几率（OR 0.80，95% CI 0.69 - 0.94；I² 0%）也有所降低。