Magro-Malosso Elena Rita, Saccone Gabriele, Di Mascio Daniele, Di Tommaso Mariarosaria, Berghella Vincenzo
Division of Pediatrics, Obstetrics and Gynecology, Department of Health Science, Careggi Hospital, University of Florence, Florence, Italy.
Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
Acta Obstet Gynecol Scand. 2017 Mar;96(3):263-273. doi: 10.1111/aogs.13087.
The incidence of overweight and obesity in pregnancy has risen significantly in the last decades. Overweight and obesity have been shown to increase the risk for some adverse obstetric outcomes. Lifestyle interventions, such as diet, physical activity and behavior changes, may reduce these risks by promoting weight loss and/or preventing excessive weight gain. The possible impact of exercise on the risk of preterm birth (PTB) in overweight or obese women is controversial. Therefore, the aim of our study was to evaluate the effect of exercise on the risk of PTB in overweight or obese pregnant women.
MEDLINE, EMBASE, Web of Sciences, Scopus, ClinicalTrial.gov, OVID and Cochrane Library were searched from their inception to November 2016. This meta-analysis included only randomized controlled trials (RCTs) of pregnant women assigned or not assigned before 25 weeks to an aerobic exercise regimen. Types of participants included overweight or obese (mean body mass index ≥25 kg/m ) women with singleton pregnancies without any contraindication to physical activity. The summary measures were reported as relative risk (RR) or as mean difference (MD) with 95% confidence intervals (CI). The primary outcome was the incidence of PTB <37 weeks.
Nine trials including 1502 overweight or obese singleton gestations were analyzed. Overweight and obese women who were randomized in early pregnancy to aerobic exercise for about 30-60 min three to seven times per week had a lower percentage of PTB <37 weeks (RR 0.62, 95% CI 0.41-0.95) compared with controls. The incidence of gestational age at delivery (MD 0.09 week, 95% CI -0.18 to 0.24) and cesarean delivery (RR 0.93, 95% CI 0.77-1.10) were similar in both groups. Women in the exercise group had a lower incidence of gestational diabetes mellitus (RR 0.61, 95% CI 0.41-0.90) compared with controls. No differences in birthweight (MD 16.91 g, 95% CI -89.33 to 123.19), low birthweight (RR 0.58, 95% CI 0.25-1.34), macrosomia (RR 0.92, 95% CI 0.72-1.18) and stillbirth (RR 2.13, 95% CI 0.22-20.4) between the exercise group and controls were found.
Overweight and obese women with singleton pregnancy can be counseled that, compared with being more sedentary, aerobic exercise for about 30-60 min three to seven times per week during pregnancy is associated with a reduction in the incidence of PTB. Aerobic exercise in overweight and obese pregnant women is also associated with a significant prevention of gestational diabetes mellitus, and should therefore be encouraged.
在过去几十年中，孕期超重和肥胖的发生率显著上升。超重和肥胖已被证明会增加一些不良产科结局的风险。生活方式干预，如饮食、体育活动和行为改变，可能通过促进体重减轻和/或防止体重过度增加来降低这些风险。运动对超重或肥胖女性早产风险的可能影响存在争议。因此，我们研究的目的是评估运动对超重或肥胖孕妇早产风险的影响。
检索了MEDLINE、EMBASE、科学网、Scopus、ClinicalTrial.gov、OVID和Cochrane图书馆，检索时间从各数据库建库至2016年11月。这项荟萃分析仅纳入了在妊娠25周前被分配或未被分配到有氧运动方案的孕妇的随机对照试验（RCT）。参与者类型包括超重或肥胖（平均体重指数≥25kg/m²）、单胎妊娠且无任何体育活动禁忌证的女性。汇总测量结果以相对风险（RR）或平均差（MD）及95%置信区间（CI）表示。主要结局是孕周<37周的早产发生率。
分析了9项试验，包括1502例超重或肥胖的单胎妊娠。与对照组相比，在妊娠早期被随机分配至每周进行三至七次约30 - 60分钟有氧运动的超重和肥胖女性，孕周<37周的早产百分比更低（RR 0.62，95% CI 0.41 - 0.95）。两组的分娩孕周（MD 0.09周，95% CI -0.18至0.24）和剖宫产率（RR 0.93，95% CI 0.77 - 1.10）相似。与对照组相比，运动组女性的妊娠期糖尿病发生率更低（RR 0.61，95% CI 0.41 - 0.90）。运动组与对照组在出生体重（MD 16.91g，95% CI -89.33至123.19）、低出生体重（RR 0.58，95% CI 0.25 - 1.34）、巨大儿（RR 0.92，95% CI 0.72 - 1.18）和死产（RR 2.13，95% CI 0.22 - 20.4）方面未发现差异。
对于超重和肥胖的单胎妊娠女性，可以建议她们，与久坐不动相比，孕期每周进行三至七次约30 - 60分钟的有氧运动与早产发生率降低相关。超重和肥胖孕妇进行有氧运动还与显著预防妊娠期糖尿病相关，因此应予以鼓励。
